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I started with being a NAC before going back to school for my RN. I have worked my way up through the ladder and have done almost everything at my building. I graduated with my RN in 2010 and was a nurse on the day shift for a while then Infection Control for 2.5yrs and now MDS.

NurseMellie's Latest Activity

  1. NurseMellie

    Becoming increasingly frustrated at work.

    I totally get the frustration piece. As RCM I have lots to juggle on my plate. I have been accused to being threatening to my staff when I have informed them of something they need to be doing or face the consequences. Most of the longer term staff understand where I am coming from and we remember when we had nurses who literally held a write up over your head throughout the shift. I am very blunt and point blank. I tell them what I expect and inform them of the consequences if it does not happen. Some do not like the fact that I no longer handle every little thing. Delegation is a hard thing for me to do and I have learned to do it for the most part. There were times that one nurse would come to me multiple time throughout the day with things she wanted me to do. I finally said you can do that. Every since she has found me to be hostile and threatening to her. I find my staff does not give a s***. I think something is in the air since so many of us in our profession are feeling this way.
  2. NurseMellie

    Accepted job as MDS nurse but skeptical!

    It is difficult to learn the MDS especially when the training is hit and miss. I often had those same types of days in the beginning of my training. I would be pulled to do an admit or work the floor so it was a bit difficult to put some of the things you needed to remember all into play. If you are on your 2nd day of orientation to the MDS, what did you do on the first? Is this a new facility for you? I think you need to know the facility you are at inside and out before you can effectively care for your residents.
  3. NurseMellie

    Non surgical dressing

    You are covering a surgical site so is a surgical site, coding under nonsurgical would be inappropriate. You have to think of why you are doing the dressing.
  4. NurseMellie

    Getting started as MDS nurse

    Yes, it the 14day pays for days 15-30 of the day. There are graphs in the MDS manual that show what assessments pay for which days of the stay.
  5. NurseMellie

    ADL documentation

    Correctly documenting the ADLs is always an on going problem. Myself and my fellow MDS nurses have inserviced our staff on the different levels of care and how important it is to get it all right. We explain that we want them to receive the credit for the amount of care they give to each resident. Changes in the amount of care required are often first indicators that something is going on with that resident. We tell them that they are responsible for documenting the amount of care given through their shifts and if they choose not to, it will be a write up because it goes against policy of the building. We also explain that we as nurses when we make mistakes do not have the luxury of saying "Opps, my bad." and blowing off the consequences.
  6. NurseMellie

    indefinite suspension because of med error

    With a blood sugar of 75 some other intervention should most likely have been done. In most facilties that I am aware of a blood sugar less than 80 requires some kind of intervention and a follow up blood sugar check. Metformin is a long acting medication, yes it should be taken with food but does not affect blood sugar like insulins do. It is possible for episodes of hypoglycemia to occur which is what I would call this episode and proper interventions should have been attempted. Suspension is a bit harsh at this point especially if there are no protocols for what to do in the situation of a blood sugar of 75.
  7. NurseMellie

    New to mds

    I have a blank calendar that I start with, I then pencil in the OBRAs which are the quarterly and annual assessments. So you have 92 days from the previous quarterly assessment to do another assessment and the follow up annual needs to be completed no later than 366 days after the last annual assessment. I usually set those ARDS for a Monday or Tues depending on the work week. The day of the ARD the only thing you can really do is the interviews. You can start gathering some of your data but you will need to recheck some areas like the restorative programs if you are waiting on those minutes. I try not to schedule any more than 3-4 on any given day if at all possible. There is more leeway with the Obras than the PPS when scheduling. So once that calendar is set, it gets typed and handed out to the rest of the team members. From there I check my PPS assessments and my initial assessments. Those also get penciled in on the calendar for me to follow. We discuss in our rehab meetings when it would be most beneficial for the PPS to be set. Our jobs is to maximize the payment we receive and give appropriate care. It takes probably a good six months before the light bulb goes off in your brain that you've got a handle on it and a full year to become comfortable. Keep working at it and ask questions :)
  8. NurseMellie

    New to mds

    Open the RAI manual and go to chapter 2 page 41. There is a list of what you need to remember. You have until day 8 to set your 5day ARD. You should be doing a 5 day atleast. If the resident stays less than 14 days you don't have to do an admission assessment that would be required by OBRA. But of course I work in LTC/rehab not swing beds.
  9. NurseMellie

    New to mds

    I have a couple of different sources that I use. One is Point Click Care for our main charting system and then the Contracted Therapy's system. Between the two I set the dates. In your manual there should be a table that states when you can have your ard. There are grace periods etc. Those will also play a role in how you set your ards. In most systems you cannot set the ARD before the grace window opens for example. You have an ard coming up but your grace days haven't begun yet. You cannot set a 30day with an ard on day 23. Completing and sending in the MDS's early there is no penalty. In most cases signing them as complete there is no penalty. The penalty comes in opening the mds late or not at all. Once the mds's are open though you can tweak the dates.
  10. NurseMellie

    Thank you

    It is definitely appreciated, I hope you said something to the staff or management bout the care you saw. Trust me it will brighten their day hearing it!
  11. NurseMellie

    what else can I do? (burned out)

    I think we all experience similar frustrations and feelings at some point in our careers. Sometimes what can help is just changing carts or units or shifts can help. When I've felt the same way you described, I usually asked for a change of scenery. There was one time I left to do somewhere else and was not happy at all. The drama was worse, so I ended up going back to my old company and have been there since. Where I work, we have been feeling the pinch of extreme shortages in nurses and NACs, so its been very frustrating. Not to mention the ones that call off atleast one day in every rotation. You might also try picking up a new hobby to relieve stress, something that you really enjoy. Hope things settle and you find your groove again!
  12. NurseMellie

    January 2015 Caption Contest: Win $100!

    I'll be with you in a moment
  13. NurseMellie

    Sending meds with family

    If they are going for just a day or so, we use small envelopes that we write the meds on and what time. If they are going to be gone longer, we may send the card from the pharmacy depending on how many doses are needed. You can also use the pill boxes mentioned by another poster. You want to make sure you send a MAR that's easy for the family to read.
  14. NurseMellie

    New RN sup still orienting but full of questions

    We have an admission check list we use. I look at the home medications that are sometimes listed, not always accurate though. I also look at the meds from the hospital. We have standard admission orders that we have received the OK from the MD to put into play for the majority of our residents. Most of the time our MD just wants to know if the resident arrived and will be in that day or the next to see them. If there are any major issues I'll bring those up at the time I speak with the MD.
  15. NurseMellie

    New Gad questions

    I wouldn't recommend taking the position at this point in your career. As other posters have mentioned theres a huge responsibility level placed on your shoulders. Typically the MDS nurse makes more than some of the floor nurses, it depends on experience, etc; just like any other job. Sometimes the increase in pay is not worth the stress of the job. (I am still a fairly new MDS coordinator with 5yrs of Nursing experience, 8yrs as a NAC).
  16. NurseMellie

    The topper of all toppers!!!!!

    I work with lots of psych behaviors and this is a fairly common occurrence in my facility, we get a couple throughout the year. I have had only 2-3 cases where we sent them to the hospital to be detained. Most of the time, you give the aggressor a PRN, if she doesn't have one, you ask for one. Sending her to the ER is not the correct answer in this case, in my opinion. Dip her for a UTI, give her a PRN. Good job in keeping them separated.