nnancy627

What a 'brilliant' plan! Overstaffing every shift can prevent quite a few problems, some of which you might never even think of: One, you won't be understaffed, ever. Two, since you are never understaffed, you'll never have to rely on desperate calls to agencies(always taboo in LTC due to the cost), OR paying anyone overtime. Three, if you have a sudden influx of new admits, you won't have to beg staff to come early, stay late, etc. to process them. FOUR: It guarantees that the DON, ADON, SSD, etc. will 'never' have to come in to work. Number five? Your facility can do away with any 'staffing coordinator' position, because staffing will be overstaffed, initially, but any supervisor can then send people home after the needs of the shift have been determined- saving not only another salary= but also keeping your ability to manage your PPD ratios on a fluid basis! Finally: What a great way to absolutely prevent those 'late stayer' nurses from racking up overtime, since the oncoming shift will be overstaffed with nurses that are not only on straight time, but since they are sent home at random, they will never have enough hours on the clock to come NEAR o being on overtime status. Amazing, even I have never heard of such a new foul way to abuse employeess. But it's only going to get worse, that's a fact. Still, I have to say to whoever thought this up? KUDOS. Yet another way to screw the wowking people....Too bad that this idea has been publicly posted in the most popular nursing blog site in America- just wait and see how this nasty idea takes hold like a wild fire... If there are any DONs in the house, care to comment on my insight???

All things come to an end- not just good things. Just wanted to get your mind in that thought train... "This too shall pass", Mom always said.

One more note, on 'skilled nurses notes': Used to be that the rehab professionals worked FOR the SNF, like nurses do. When the PPS came about, rehab people became employees of rehab companies that provide services to SNFs- because without those services, SNFs would not be able to admit 'skilled patients'. (Again- skilled patients in nursing homes are there for rehab, not nursing, in most cases, sorry!). This creates a sort of barrier- the SNF doesn't like to pay the rehab companies the big $ they require, and also- the therapists are sort of treated as outsiders in the SNF, because they don't 'work FOR the SNF'. There's a certain weird relationship now. But if you talk to any PT, OT, or ST (or rehab aide) , you'll find them all very intelligent, caring, and willing to help in any way they can with any patient- but their hands are also tied by 'billable hours' constraints, and 'productivity' mandates.

What case manager$ look for in fact, is whether nursing documentation jives with rehab notes, not so much the oher way around. It is not a matter of repetition (and case managers aren't EXPECTING repetition- they get paid to get peole OUT!)- it's a matter of agreement. If a nurse charts, for example, that a recent hip fx. 'got self OOB, walked down the hall to the TV room with no device, watched TV, then walked back to her room, with no device, and then put herself to bed', and yet PT claims that patient is a 'mod/max assist of one to transfer' and requires an assitive device? Be sure to leave some time open tomorrow for a discharge- because that patient is going home with home health. REAL quick. Again: Skilled 'nursing notes' in a SNF? Whatever. -Been there, Done THAT.

I've seen 'many' instances of denied claims for skilled care, based soley upon having 'skilled charting' guidelines posted in the chart, as a sort fraudulent charting platform that was based solely on the reimbursement focus, rather than on the condition or needs of the patient. In fact- one of the first things a medical record person usually does upon discharge is to REMOVE those 'guidelines' from the chart. Some companies do not allow them, some do, some require them, in fact. The net result, however- is a lot of more wasted time, that reduces LTC staff to paperwork mules, and having no time to perform compassionate, competent care for their charges.

Hold onto your nurse cap, I'm about to blow your mind!: 'Skilled charting' doesn't really exist. The need for 'daily' documentation does exist for patients covered by Medicare, or certain HMOs, etc. that covers their 'reason for admission' (diagnosis), and physicial need for 'rehabilitation', which is very expensive. You may be suprised to hear that MOST 'skilled nursing patients' would never be in a SNF, if it were not for the rehab department? If not for almost daily rehab, those people would be sent home with home health care, and NO rehab. It's much cheaper to provide rehab in a SNF. Also, no actual 'nurses notes' are even required. If a COPD patient comes into the SNF with pneumonia, and resulting weakness, inability to take care of his ADL? Flowsheets, MARs, TARS, ADL documents, and rehab progress notes (which is what case managers REALLY pore over) are what the pay source will be looking for, to substantiate or to disclaim the need for the placement (AKA payment) in the SNF. What nurses notes do, more often than not , is to contradict the efforts of the rehab department to paint a clear, concise need of rehab required for the patient to return to the prior, lower level of care. Sorry to burst your bubble- but the majority of 'skilled nurses notes' in a SNF are wasted effort, and busywork. Why do them, than? Many managers feel that if they require daily notes, there will at least be 'something' for the case managers to read- even if the notes are contradictory to the reason for the 'skilled admission'.

Fifty patients is laughable, if not sad- but almost an overthought, compared to the fact they are PRIVATE rooms. The amount of physical space (distance) you have to traverse in a shift is logistically impossible. Much less passing the meds, and etc. It simply cannot be done.

You're already taking another huge risk- in CA, you 'have' to inform the BON of your name, current physical address, mailing address (if different), and phone number- you can't 'use your parents' address. If you are found out, you will have lost your chance at a license. What are you thinking? You do not have to live in the state of CA to apply for a license, or to apply for a renewal. You DO have to provide them your real address, however. You've spent three months collecting accurate documents for the CA BON, and yet...you are playing with fire?

Lucrative? If your billing outweighs your expenses, sure. Agencies are a dime a dozen- all they have to verify, often, is a 3-6 month ability to pay bills, to get a license. Most scratch by, many don't pay their staff and go defunk, and lots of other situations. It's not really what it appears to be. But with the popullation aging by the millions every day- opportunities will abound.

What's being 'nosey' (is that even a word?) about having pause to question a coworkers credentials? If you have a chance to look at your own state BON website, you'll find that every year, hundreds of imposters (aides, nurses, doctors, etc.) have been found out to be posing as licensed. I like that the OP thought of the idea of such a basic check of credentials, and what a can of worms it may open.

Welcome to the American nursing home world. It's a big gooey pot of 'lose/lose' situations, daily. Same menu every day, just different spices. (Hot 'n' nasty being the preferred).

Lots of people would fall off their chairs if they knew just how 'serious' such a 'slight' thing is, to not update your name, or address, as examples with MVD, the BON, etc. In some states you have only maybe 30 days to do either, then your DL becomes invalid- hence, you'll be driving without a valid driver license, which is a misdemeanor (a crime) in most states. Your BON spells out such penalties very clearly. I also know a few people that have moved across state lines and don't immediately get a new dl and registration- if caught here, after only 30 days of relocating, it's over $800 in fines plus the criminal charge.

No chance that the are just 'not listed'. Even if they changed their names, like got married- those changes have to be reported to the BON, or whoever tracks CNAs. You mention more than one even, is not located in the registry online, so that's going to be fun...

I'm baffled how an MDS Coordinator can not be familiar with current meds, much less not be familair with the common forms used for incidents, etc?

You're a bit too involved in your job. Take a step back, and look at the whole picture.