SitcomNurse

This is an excellent article for the future of Nursing, not only how we teach it, but where we can tell our students this field can take them. I have been educating since 2012 with many different course styles - (self modulated video, small class setting, in person seminars, 1:1 education, bedside education) and my own education as a Hybrid student to Masters degree. This pandemic has certainly put many people in front of the computer to learn. I hope that in the progression of Nursing, there is ample time for self learning. Within that, I still feel that the new students, the ones just learning about Nursing and how to care for someone Holistically - need a human in front of them sharing the human experiences that only Nurses are privy to. After that.... the sky is the limit.

The State Operations Manual(SOM) is 600+ pages long, and much of it does not apply directly to Nurses. Try researchign something like .. QIS manual or Guidelines to Surveyors for XX subject. Essentially, follow the policies of the facility you are in. The policies are guided by the SOM, I (prettymuch) guarantee it, or the facility is not in compliance. Read your policies, because at the top is a listing that says CFR or F-Tag, if the policy interests you, then research the CFR# or F-Tag number. One is federal, one is state. Good Luck, keep your head Policy minded, keep yourself in league with the policies, and you should be OK.

I am grateful to : The Commuter : for giving some kudos to LTC. It is a sad state though that provides no support, no linear system to ensure the proper care and education for the LTC population. In my orientation practices, there is structure, specific pairing and skills checklists. You are entering a SKILLED NURSING FACILITY. You will use those skills, or you will not make it out of orientation. When I started this position, I was left a laundry list of things by my redecessor of what had to be covered. Although she had an ad-hoc approach, she covered EVERYTHING that could be taught. Our approach was different, but our goal was the same, Educate the new employees to ensure their competence. Then test. remediate, then test, Sepearte Workforce Training from Education. Provide opportunities for both. Thats how it gets done where I am. Feel free to come to NY, and join me in a place where Education matters. A. Lot.

I wish you the best of luck. Its the best challenging position I have held, and that includes starting a Nursing Rehab program at my facility. I love it. I hope you will too.

Well, I have been doing it only for a year, and I can tell you in for my MSN, the focus initially was on theroy, and then my ability to remember how to be a nurse on the floor(clinical skills) then it got into teaching the adult learner and the psychology of how people learn. I love it. I spend my day with a little research, reviewing best practices for nurses, teaching those best practices, helping to update policy and procedure in a cohesive and clinically pertinent manner. I get to have coffee with people who are struggling, while we review on a 1:1 basis what the stumbling blocks are. I get to adjust my work schedule, i get to see all the shifts and assist with CODE calls. I get to have 6 colleges come through my facility all different learning levels....CNA, LPN, RN, NP, Dental, Leadership, Internship..... and they pay me for it. And I get to put my own spin on it to make it fun. When is the last time you saw a classroom full of people laughing while you taught them about ALS? Thats how I spend my day.

As an educator in a LTC facility, I lack the glamour of the ED, Mother/Baby and even the MD office for that matter. Im in LTC.. But I often have to draw a hard line for whats real and whats not. I have my own orientees and students from 4 surrounding colleges come for clinicals and I interact with them all. I ask them what TV shows they watched growing up. What nickelodeon TV or MTV or whatver genre they are seeming to come from. I remind them that the show needed to go on, and things were resolved in 30 minutes or 60 minutes, and life went on. They cant and dont feel the anguish of the mistake, because the show moves you on to another subject/topic or love scene. In real life a huge difference difference is - Nurses remember everything, and if you were to do an act that is not compliant with good health care delivery, a Nurse will remember. That Greys Anatomy is all "goo goo" is great. But after a tour around the facility, I ask them if they can visualize it actually happening in these halls, in this room, in that stairway. They cant. I use the enviornment they are experiencing and ask of they can see the same thing happening from TV to real life, and also discuss Immediate Jeopardy definitions and other legal aspects that are magically ignored when TV happens. I give them real life senarios from right around us, as I read Legal Nursing articles consistently, and report on them to the facility I serve and the students that come. Good luck,

SO RIGHT!! I neede the "actual delivery of food/beverage from receptacle to mouth (or other means)" part of the answer. THAT Is the difference. Im trying to explain it to people.. but the manual states, Staff must set up the tray, cut the meat, open containers and HAND HIM THE UTENCILS.. the bold part is the Limited ( I tried to explain) the rest is SET UP.. Staff Performance, not resident performance...... so they were trying to include the cut up the food as LIMITED.. Ah, thank you thank you thank you.

OK, just one question: For Dining... how do you describe Supervised Vs. Limited. I know the definitions, I want the semantics.... Supervised/set up: opened tray items, cut up food, observed during meals, documented intake. OR: Limited/One: opened tray items, cut up food, observed during meals, documented intake.

In my facility we hold a weekly meeting. In attendance are: Medcare coordinator / MDS coordinator, PT/OT/ST and Nursing Rehab. And any students we have that are involved in these departments, so they can see an interdiscpilnary approach to care provisions. We discuss projected outcomes, participation levels and any issues affecting the resident. In that regard: Do we need saturday therpapy for any reason? i.e: resident with outside appointment on any given day that interferes with therapy? Is the appointment in the AM or afternoon that Therapy can work around? Is it an ortho appt. affording WB status that would increase therapy participation? Is the program we are providing affording the best recovery and the residnts ability to tolerate it.. Should we go to 3:2 split? Rehab Low? Increase therapy? Do we need a home visit and when for potential discharges? The medicare coord/MDS coord are there for dates affecting the resident, to be aware of discharges and provide MDS's appropriately. (COT's are discussed, as well as rug scores and) Also, we have Med B's and maintenence therapy to discuss. All the same issues are discussed, as well as Nursing Rehab transitions. We also have a much more informal, therapy/nurse on unit meeting lasting 3-5 minutes a week on each unit - to discuss any ADL declines for any residdnt, so we may obtain assessments as needed before the therapy/case mix/obra meetings. This all happens in a 400+ bed facility. Hope this helps.

Im sorry this happened to you. Where I am, we report to the nurses we see, when see somenone/anyone is back from a day off or a week off. Also, our computer system takes out all info upon 'discharge' for any reason, and .. from this point I can only say, if communication is nto forth coming in this regard, you can alsways ask when getting report.. Are there any dishcarges for any reason? It may be that 48* later, in that LTC facility it is 'old news'. Some residents we talk about for years, some we dont. The nurses on duty in the previous 48* should have removed the medications too, and returned them to pharmacy. Again, Im sorry you found out this way.

Do you mean to say that she cannot put the ARD as 10/12/12 for a look back of that period, and signature today? OR she should have the ARD as 10/12/12 and signature 10/18/12? By putting the signatures 10/18/12, the document will lock normally, and making any later date for signature (as in today) it wont lock normally. I said.. there has to be a late submission then, but I dont work the system so I dont know if something like that even exists in sumissions.

OK, Im helping a friend who dosent even know AllNurses, but will be a convert when I am done.. Im sure! She forgot to put in an MDS that should have been done in October. Should she: Send out the e-mail request with the ARD as it should have been, and signature 7 days from that? She thinks it is legal, becuase the info is collected is from that timeframe. I say its not, because you are esentially back dating. I think you cant do a pain or cognitive interview at this point and call it that point.... OR Do the MDS with the ARD, but a signature date of now/today, and a late submission? She told a few people that the first option I mentioined is not illegal. I cant see how it isnt. Im having a problem with the whole thing. She is waiting on my responsee, and we are both scouring the manual.. help!!

The manual is online at CMS.org There are videos available on you tube. The only time I code total is when I have complete non participation in the task by the resident. Remember, that is the qualification. In this instance the person that held on is not participating in the task, there is no benefit to the staff for the fact that he can hold the bars.

WOW, I would like to work there.. just worry about some mental status changes r/t UTI, toss some meds and be done with it!! I ran respiratory, PICC, IV, Trach, Dementia, GTF.. and sometimes all on one person! THAT LTC is kickin if you dont even have to draw a Coumadin! Hospice? The patient was easy, Roxinol, comfort measures, soft music, quiet atmosphere. The relatives? HYSTERICAL in the hallway at 3 am, bawling and tearful.. and still needing comfort and a hug and the respect for ther relative, and their greiving process... CHALLENGING!! I loved every minute of it. (except for the pee on my sneakers) and if you love Nursing, you will find the atmosphere you want to work in too. LTC s are very different now, but if you have a relaxed atmosphere, then God Bless!! Im sure you will still find your challenges. The shift plays a role, no doubt, as does the attitude with which you approach it. Now Im doing LTC Short Term rehab! Yep, I work in LTC providing Nursing Rehab concurrent with PT/OT for a smooth discharge. New challenge in LTC... making it Short Term. Good Luck!!

I use the MDS language to chart behaviors, that way the social workers and MDS personnel who are completing the forms for reimbursement can easily recognize the behaviors, and GET PAID FOR IT. Read the MDS, sections C,D,E... if youa re exhibiting any of that, then ... you are missing money by not documenting it. Bring that to the table and see how it gets gobbled up, especially with all the cutbacks. The other half of that is... are you doing any justince for the resident by undermedicating depression?

If I only counted on the RL category to get anywhere, I'd have 5 people under my belt in 2 years. That wont do! Do you have a RUGs IV breakdown for your facility? How to acheive a RUGS of course is in the MDS, but each state has different reimbursement categories. I concentrate on getting the '2'. PD2, PC2, there is a financial difference in PD2 and PD1, the difference is Nursing Rehab. Certainly formal therapy carries more weight for reimbursement, but the standard is, to have any resident on program get 15 minutes of combined ambulation(or any other single therapy) in 24*. So, between days eves and nights, I get my 15 minutes. Then the second therapy.. dressing and grooming.. days & eves gotta pull together. When we are headed for look back in an MDS. I send a reminder to notify me if there are any problems, and to re-inforce with the CNA's to spend the extra time encouraging the ADL task, to be sure we are getting the capture. MOST of the time it works, sometimes, it dosent. I have people on program because it is better for them to be there, and I KNOW I will get no capture. But they do not out number the persons who I capture in the '2'. Simply, I have a list, and monitor RUGS scores monthly (for those on program who have an MDS due) and write down how much more we obtained because of NR. and how much we failed to capture too, that is equally important for Admin to see, if we lose the program, we have no hope of X dollars, and will lose XX dollars. If you need any other help, look me up, send an inbox if you like, I would be glad to help in any way I can.

Without you, who know that there is more to be done, we are here left with people who dont care to do it. I hope you get the peace you need.

If you have been in geriatrics, then you should be fine. Its what we do everyday, working in this population, and being prepared for every contingency that applies to geriatrics. there were a few questions on culture change and enviornmental factors affecting the overall wellbeing of a person, but it looks like you have a pretty comprehensive study program already! Good luck!

Yeah, each discipline is on board and has been doing it for years, nursing keeps changing its 'notes'. Used to be a 3 shift assessment, based on PRI. Thats out. Then it was an InterDisciplinary Team(IDT) note, with everyone putting in a piece, but the other departments were now triplicating work. their assessment, their note, then the IDT note. So, Nsg is changing again. Was looking for anyone out there who had a list/format of what is required on a quarterly note. Turns out, nothing is required, other than to say the quarterly MDs was done, to direct the team/audits to the MDS for the most recent assessment. But prudence dictates... a mention of things in a way that does not duplicate, but more explains the reasoning behind the answers in the MDS. So, thats what I left them all with in the end. Thanks for being here for me anyway, having no form/udat/etc. answer just solidified the answer I already knew. Write a note, and be smart about it.

I guess what I am asking for is a corresponding progress note that is a ROS in accord with the MDS quarterly. Not a quarterly assessment.

Ok, I am not directly speaking about a quarterly MDS. What I am talking about is an 'assessment'. Our dietary completes the MDS quarterly does an assessment. Our SWS does an assessment, then completes the quarterly MDS. PT/OT write a quarterly progress note with their quarterly MDS, so the chart has a note in it no longer than q3 mo from all disciplines. They all have forms, either a UDAT or writeable PDF that they use. I do not have one. I am asked to create one. Does anyone out there have a form: udat, copy machine, PDF, whatever.. that they can forward to me? I would be so really appreciative! Barring that, does anyone have any ideas of how to go about creating a form? I checked the MDS manual to see what is required of a quarterly, but of course, everything in a 1/4 ly MDS is required, so that was a big tail chase. I checked online, looked for PDF, looked for ltc quarterly form, looked for associated with mds nursing assessment.. and a while bunch of other terms. Ended up in New Jersey's list of forms for civil service workers. HELP!

"jan 14 by jaimie.rn jan 14 by jaimie.rn a member since oct '11 - from 'indiana'. posts: 72 likes: 90 awards: if i didn't have to, i wouldn't! i ask for time changes on these things but day shift keeps changing them back, and since the nurses on day shift are all the ones who have been there 20 years and are buddy buddy with the adon, my complaints fall on deaf ears. " come work with us, where we respet the population we serve, and have patients rights to not be awakened for meds, and even q4h is while awake. our don comes in on the night shift to see htings for herself!

In our facility the MDS coordinator initiates the assessment, she is the one who is certified in MDS's. The med records person is not. Who better to work with the team in coordinating the therapy schedules and be sure to get the best capture? Think the Med Records person knows that? MDS certified RN is also the one who helps to determine when the next is due, when there is an appropriate sig change, when there is a question of should I or shouldnt I, the MDS coordinator is who I turn to, and I TEACH the MDS. There are constant changes in submission requirements and information requirements. I kieep up on it because I teach it, she keeps up on it because she is the one who issues the MDS schedule.

Spread the cure, not the cold! Please stay home if you are sick. A smile is the only thing we want to spread here! Please stay home if you are sick. We are only asking you to clean up after one person, yourself. (in the kitchens)

We redline as part of the CQI. The night nurse checks the charts and signs in red, which indicates she reviewed the order for all the things that can go wrong: 5 R's (which seem like 80 R's now) transcription errors occur, and charts get missed. Every nurse around here knows that if the day nurse didnt get to it, it wasnt left on purpose. It may actually be an omission. The chart could have been off the unit at another department, and the order written without notification of the nurse on duty. It happens. The night nurse is an integral part of the whole functioning of the unit, and without them telling the days... you wrote insulin on Schmidt instead of Shmidt... we would be dropping like flies. I feel for you Missouri, in NY we dont tolerate that 'dumping' stuff.