DavidKarl

What a psychotic way to staff a place- begging for med errors, and the like. Unless most of the staff is agency? If that's the case, they are trying to spread their in house staff around, to DECREASE liablity, so their own staff sees the patients at least some of the time?

Don't forget the LTC folks that are sent out to be admitted (for 3 days, naturally) for an easily treatable UTI, or etc., in order to requalify for MED-A.

An easy way to affect a transfer to a different SNF, once admitted? Just raise. HELL. The first place will pull out all of the stops to help you out.

No time to urinate? Hmm. A SNF nurse that never heard of Depends? This alarms me.

Lot's of RNs look down their noses at LPNs, but usually they are new grad RNs that are intimidated by the practical skills LPNs might posses. This stuff happens in any occupation. Other than that-here's a related cute one, that's happened to me 100's of times: "Hi, I'm David- I'm going to be your nurse for this shift". Silence. Then?:"Oh, so you're a MALE nurse?". "Yes- and I'm REAL glad you noticed!"

I was fired once when I failed to quit- the DON made a new boyfriend, who was also an LPN (and wanted my job), and made all type of excuse that I was incompetent. I took my glowing evaluations, etc. to unemployment, to get an official determination that I was fired without cause- but that determination and $1.50 will get you a cup of coffee. Clear your mind, and move on. It's the new lay of the land: disposable employees. Even if you love your current job? It never hurts to read the want ads every Sunday. I'm just sayin'.

The real issue is that word: assessment. In some states an LPN cannot legally 'assess' a patient, but 'evaluates', or etc. It's weird but true. Wicki describes an assessment as a 'plan of care'- lots of states don't allow that scope in LPN practice, and some even require a BSN, rather than an ADN, to be qualified to 'care plan' a patient. When I was in FL, an RN had to co-sign certain forms and notes completed by LPNs. Print your nurse practice act and keep it in your locker at work. It's basically the rules, in your BON's language, that allow you to keep your license. Be especially careful about IVs, if you have an IV cert in your state as an LPN. The language, although cumbersome, is very specific in the practice act.

Another thought- who ordered the IV med, and who started the IV, and who started the IV med via the IV? Two, possibly 3 healthcare workers involved (aside from the LPN) were treating a patient with an IV, without possibly obtaining consent, but obviously without bothering to tell the patient what was going on, and why the IV was needed. And, also- why didn't the patient ASK the ordering provider, or the nurse while the IV was going in, or what the medication was when it was hanged, since she appears to be alert, etc., and taking notes? Lots of potential liability in this scenario- especially if the RN made a med error that wasn't caught by the LPN, eh? I've seen an awful lot of nonchalance, and lawsuits about IVs.

I suspect that the atomosphere in that place is that the RN makes it clear that she is there to supervise, and not do any hands-on care. I suspect that's what the LPN meant to imply, but it was inaccurately told to the EMTs. I also agree that some EMTs have a holier than thou attitude- last place I worked, I'd just lay the transfer paperwork on the desk for them to pick up, because they were above me (just an LPN) to bother even asking why the call was made, or my obervations. As I say this- most folks have no idea that EMTs are paid a little above minumum wage? So, even they are first responders and can possibly save your life- they are not paid a liveable wage. Knowing the nurses that call them make several times what they do, I keep that in mind.

There are 40, maybe 70 million uninsured in America. Another 100 million can't afford to USE their insurance, due to the high deductibles. The uninsured use ERs, and don't pay. Under Obamacare, 20 or maybe 50 million people will now be able to obtain insurance. How can adding millions of newly insured patients, indicate a monetary loss for hospitals? It can't, and doesn't. Hospitals are using it as a technique to save money (rather, see the end of this sentence), scare employees, and etc...but at the same time they are all spending billions on new construction (to be prepared for the huge influz of, paying patients)? For those of unaware of Obamacare, Wickipedia has an in-depth detail of the consequences, and benefits- the best I've seen, to try to make sense of the chaos that will happen in 2014. But there are going to be a LOT of winners, and losers..it all depends on your income, and whether your employer will retain you as full time and be required to provide you a plan. The biggest losers will be individual plan owners with significant incomes- your premiums will 'explode', and also employees that are cut below full time, and forced into the individual plan system. The biggest winner? HOSPITALS, since almost everyone will now have insurance to pay THEM.

My second clarification- I was talking licensed staff only. Obviously, CNAs are taken for granted, abused, unappreciated, paid slave wages, and many have personal strife to deal with. I have always advocated them, and usually taken their sides in arguments, nurse vs aide bickering, and have never allowed a nurse to treat any CNA badly, if I was aware of it. I tried that gig way back in the 1980's, when everyone was tied down, and it took an hour to change those cloth diapers, and all the patients were drugged and immobilized. At least now there are disposables, few restraints, patients are more mobile and helpful, and etc. But, it's still 'the most difficult job in a SNF', if not in the WORLD. I've always thought up ways to ease their job, help them be organized to prevent repeating steps, stay calm, and the like. They love it when I'm working their assignment, they think I'm from another planet because I answer lights, toilet folks, feed them, help them change folks, insist that they take their breaks, and the like.

Is this 'palliative' care more aptly what would be 'hospice' care, if the patients qualified for Medicare or another program that paid for hospice, but don't, so therefore are on Medicaid, or etc? If yes, I can imagine the nightmare caseload you have, since every state is broke. Wonder what'll happen next year with Obamacare, in your line of work?

(Oops, correction to the above: choking RISK).

If you don't care plan that the patient has dentures, those reading the care plan (as if...anyone does, other than surveyors?) wouldn't know that he had dentures, for example, and if he could not speak, he may be taken to meals without his dentures, which would be a choking . We've all happened upon dentures, also, that had been sitting untouched/unwashed in a cup for a few days, or months. Not pretty.

There is no 'care plan meeting' requirement. The requirement is that the patient/and or family must be able to 'be involved in the care plan process'. No meeting, again, is required. Why does everyone go through this ordeal, that, even most family members despise? I don't have the answer.

Fifty beds? EIGHT skilled? Oh, my. I worked at one place, 180 beds, alone, with SIXTY skilled patients. Never missed a beat. Never missed an asssessment. Never received a survey deficiency. I'm now older, and tired, but still frisky...looking for YOUR job! Aside from that, you have it MADE. I suspect you work for a small corporation or a non-profit? If so, and you really feel overwhelmed- ask them to pay you to attend an MDS conference, or etc.- it sounds like they are not too focused on income, and would more than likely welcome your request for further education? BUT: If you'd like to bail, please email me so I can send in my resume. [email protected]

From your medical records software: Every week print a patient census- and compare that to your own census. Every week print an MDS schedule of completed assessments. Every week print an MDS schedule of assessments due, by pay source (MEDA or LTC or ETC). Every week print a list of transmitted assessments. Every week print a list of transmitted assessments, by type (MEDA, or LTC or ETC). And? Every DAY, if you can, access your state site and do the same as above. Spend a few minutes, or an hour, comparing all this stuff, you'll be in good shape. It's a fluid process, that needs to be updated every day. Every week sync all of the above into a hand written calendar to plan what assessments are due on which day of the upcoming week. Don't forget tracking, admit, DC forms, and the rest. It does take some hands on doing though. You really can't base your plan on computer reports, alone- there are too many other people accessing and inputting into the HIT program, to rely on computer reports alone. Checks/balances.

The OP is not correct. If you have a mental health diagnosis, or are or ever have taken any psychoactive medication, that can be traced- you are entering a grey zone, from hell, in regards to obtaining and or keeping a nursing license. Your state may label you as 'unstable'. They may require psych evals, drug testing, former work evaluations, and on, and on. My advice is to not post any personally identifiable information online, thoroughly research and evaluate the contents of the CA nurse practice act, and then to contact MANY lawyers that deal with nurse practice, for FREE conultations. Then, you will have much more information than you do, now. You are in a precarious situation, so be careful of what you post in here, or if you can be revealed. Things are far worse for nurses, to keep their licenses, than most of the postings in here would indicate.

The 'most ungodly' part of your job as ADON is the governmental requirement of 'infection control', but let's not forget to mention the human aspect- the constant issues with CNAs, who are underpaid, treatly badly, oftentimes abused, constantly leaving and coming, and come from abusive situations: The main difference, is that your stress from ADON will change from human, to paper form, as MDS Coordinator. There are far fewer variables with paper, than with humans. But there are also regulatory concerns, and financial pressures on you. Also- your personal nursing license is far less at risk as MDS Coordinator, than if you were to miss a simple complaint issue given to you as ADON. Also- from my experience? Even an LPN MDS Coordinator made more $ than an RN, ADON. I've worked in 3 states. (But a DON will take a 50% cut to do MDS, yes). But take an MDS job that clarifies no floor shifts, else you'll be sorry!

You need no cerification to be an MDS Coordinator, unless your employer requires it. It is not a licensed occupation. It's another expensive educational burden. Best bet it to get hands on training for someone you know that does MDS- you may find it's too crazy for you, or you may love it, then feel justified at taking online classes, or 'becoming certified'.

Did you leave your DON job? Any chance, if not, that you can be tutored fom your MDS person? Hands down, in your face training is way better than a 'class'. It's just too bizarre of an idea, MDS, if it isn't practical training. And certification is not required anywhere anyway.

I'll modify my answer, because I sense that you're one of the 'other' type of DON. The enlightened type. The real type? "The MDS Coordinator is the second most thankless jobs in the typical SNF". DEAL?

Well said. But in all of the last SNFs I worked at, every therapy company was outsourced, and they had to account, financially (be able to bill), for every minute of their time. So, give them a lot of cookies, and PRAISE! I love therapists. Even more so than nurses, however- they are being squeezed to their very last drop, and treated like the enemy, even as their educational requirements for licenseure escalate.

March 20, 2013 (I have trouble determining the posting dates for most of this site, some list the year, most do not); Long term MDS Coordinator (2.0), out of the field for a few years. I'm teaching myself 3.0, as I did 2.0, like a million years ago- have some questions: -Anybody have a list of sections indicating who (which discipline) completes which section?(It can be either directly onto the computer, or by a sample form you give each department, then you enter it into the computer)? -Anyone have comments that relate to the perseverence of the your SNF administration to get the various departments to complete their work (and the assessements to back it up)? -The new 'RAP thing they call the 'other name' has me baffled- any leads into how proceed from targeted items on an MDS, to follow that up on a care plan, etc? Even with 2.0, the RAPS were like diving down the rabbit hole= nonsensical, but they did end up with a comprehensive care plan. Thanks. Email me, anyone. [email protected]

It's too cheap not to have it. It may or may not benefit you in a crisis (like most types of insurance, that have small print to exclude every claim)- but in this case, it's so cheap, just do it. (But be sure it pays for a lawyer if you are charged with a compliant, or are arrested for anything). It's not like 'health' insurance, for $800 a month with a $25,000 deductible!