Serious scope of practice concern

Nurses General Nursing

Published

Hi all, I may need to post in the MDS coordinator section but will put this out there as the general nursing forum is looked at the most I believe. Here goes. Less than 4 wks ago I was glad to be hired into an LTAC as an MDS coordinator with a part timer coming in 2 days a week for support. I am an LPN. I very much wanted the experience and certainly was a big increase in hourly pay. Recently, the regional director, DON, and ADON have also incorporated me into additional areas of responsibility that I am not comfortable with and feel may be outside my scope of practice. Aside from having to take call a full week every 2 wks, they are having me conduct care plan meetings with family members/doing all the PT OT ST therapy reports/clinical standards reports and as of 2 days ago after the Licensed Social Worker quit have been told I now have to do her job also. Sign the MDS section for her, do her social work assessment needs, do referals out to specialist doctors, return to community housing etc. They have incorporated 3 other depts on to me and I do not want to do RN, rehab and social worker responsibilities on top of all the MDS as I feel it makes me an imposter. I know I can do MDS as an LPN but I shouldn't be made to do initial skin assessments etc.

Can my state board determine if this is wrong or illegal for me if I contact them. I am ready to give my notice as I know I can't humanly take on all these duties and do MDS at the same time. They won't even let me get the MDS done by the due dates or allow me to spend any time in my little office on the computer. Anyone know what recourse I may have or if LPN's can be doing social work without a degree!!

Depending on the state in which you are located you may be able to perform SW functions if your facility is under a regional SW Director who has a Masters in SW. I would be more concerned about signing off on assessments. I know in Florida you must be an RN to sign assessments. Many LPNs do awesome assessments but if the practice act says RNs must sign..end of story. Maybe if your DON/ADON are RNs and cosign with you that may satisfy the requirements. That is a lot of maybes and ifs, so checking your practice act is a must.

Involve the Board anonymously. If you name your own name or the name of the employer, you will have big, big headaches - like being black balled from further employment in your area or anywhere else this employer operates.

You need to decide what tasks you are willing to do and which you are not willing to do. You need to either make up some excuse to quit or have a frank talk with them and say that you weren't aware that you'd be wearing so many hats, express your fears and worries (but know the legally correct answers before this meeting, as they will say anything to keep you), tell them you can't work OT q day, just tell them all that is upsetting you and see what their response is.

Actually, I think we already know their answer. They want to pay a pittance to as few people as possible and just work them into the ground, let them quit or fire them, then repeat the process with the next person.

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Specializes in Medical Surgical Orthopedic.

Wow, and when the building needs to be repainted they'll probably expect you to do that too.

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In my state, you can't call yourself a "social worker" unless you are licensed as one (just as not just anyone can refer to themselves as a "nurse" unless properly licensed). And you can't get a license to be a social worker unless you have a degree in social work. So yes, that would be illegal in Michigan.

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In Ohio you can work as a SSD(social service designee) without being licensed or having a degree in social work. I believe the facility has to be under 120 beds to use an SSD and not have a LSW.

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Specializes in Med surg, LTC, Administration.

I am a LPN and MDS coordinator. I am able legally to do what you wrote. But, I will not or even attempt to do so. You are being used and abused. Sections GHIJLMNOP are sufficient. The rest can be assigned to other departments. I also would not be on call. There just is not enough time. I do run the care plan meetings, but, social service and activities are responsible for their own care plans. I even feel, more of my sections could be done by nursing, but am comfortable for now. Please have a talk with your ED as soon as possible. They will never get someone to do all you are doing. No one with experience would take on all that responsibility. It is humanly impossible to do. They will have to concede or you will have to leave. Keep us posted. Peace!

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Specializes in med surg ltc psych.

Thank you all for your compassion and clarity. Bad feeling when you know what they are doing and trying to to do, and the new employee is left pushed against a wall with no recourse, stability or security in what would have been a dandy job for me. I'm 52 now and don't want to go back to rolling a med cart. I wonder how much time/experience I shoud have to apply for any other MDS positions that come along. I would think a good facility would want upwards to a year or more and I was hoping I could get that time there. But they most likely will plan on giving me my "discharge papers" soon or be none surprised if I submit notice to resign. Amazing that the day the regional director was not in the facility last Friday I was able to do 7 MDS with two annuals, one admit, two re-admit and quarterlies. That's what I should be able to do on a daily basis and this numbskull director has me away from the computer an entire day with MDS that are due left sitting on a calendar with due dates and thinks reviewing charts all day (which DON and ADON had been doing all along) is far more important and ordering lunch in for delivery while those MDS are days late. Unbelieveable.

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Specializes in MDS/Office.
Thank you all for your compassion and clarity. Bad feeling when you know what they are doing and trying to to do, and the new employee is left pushed against a wall with no recourse, stability or security in what would have been a dandy job for me. I'm 52 now and don't want to go back to rolling a med cart. I wonder how much time/experience I shoud have to apply for any other MDS positions that come along. I would think a good facility would want upwards to a year or more and I was hoping I could get that time there. But they most likely will plan on giving me my "discharge papers" soon or be none surprised if I submit notice to resign. Amazing that the day the regional director was not in the facility last Friday I was able to do 7 MDS with two annuals, one admit, two re-admit and quarterlies. That's what I should be able to do on a daily basis and this numbskull director has me away from the computer an entire day with MDS that are due left sitting on a calendar with due dates and thinks reviewing charts all day (which DON and ADON had been doing all along) is far more important and ordering lunch in for delivery while those MDS are days late. Unbelieveable.

Start sending out your Resume to other Companies today.

If the facility you are in now is Corporate owned (most are) find out the MDS Job Description.

It's possible that they may not be following policy.

Like I posted before, Companies are begging for MDS Coordinators...

I've been told recently that some Companies are even willing to train...

I do know of a couple specific Corporations that do NOT allow the MDS Dept to take Call/get pulled to floor.

Good Luck... :)

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Specializes in Med surg, LTC, Administration.
Thank you all for your compassion and clarity. Bad feeling when you know what they are doing and trying to to do, and the new employee is left pushed against a wall with no recourse, stability or security in what would have been a dandy job for me. I'm 52 now and don't want to go back to rolling a med cart. I wonder how much time/experience I shoud have to apply for any other MDS positions that come along. I would think a good facility would want upwards to a year or more and I was hoping I could get that time there. But they most likely will plan on giving me my "discharge papers" soon or be none surprised if I submit notice to resign. Amazing that the day the regional director was not in the facility last Friday I was able to do 7 MDS with two annuals, one admit, two re-admit and quarterlies. That's what I should be able to do on a daily basis and this numbskull director has me away from the computer an entire day with MDS that are due left sitting on a calendar with due dates and thinks reviewing charts all day (which DON and ADON had been doing all along) is far more important and ordering lunch in for delivery while those MDS are days late. Unbelieveable.

I think you are hire ready now. You know the basics, probably more if you can do 7 MDS with 2 annuals in one day. In fact, you will soar someplace else, where all your energy is on MDS and only MDS. Get a headhunter. I bet they have quite a few clients looking for someone. MDS is in demand everywhere right now. Since you cut your teeth in a chaotic place, it is all up hill from here. Peace!

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Specializes in med surg ltc psych.

Thank you Chin Up for the boost of confidence. By the way, I did see posted in my Sunday paper the facility has posted the position of LSW. I think the response will be far fewer than the nurses and CNA's that call or come in for applications but I was quite relieved to see that they have at least made the effort to bring someone on board to fill the social work dept. In looking myself at what's out there in my city for MDS positions, they all state that one yr is necessary for hire. That's what I thought was the average requirement. Even if I can hold out there for 6 months I think I'd be more in line for hire. I don't think many facilities feel confident in someone who's only had just a few months experience. Onward struggle and hope for a repreave.

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Specializes in Med surg, LTC, Administration.
Thank you Chin Up for the boost of confidence. By the way, I did see posted in my Sunday paper the facility has posted the position of LSW. I think the response will be far fewer than the nurses and CNA's that call or come in for applications but I was quite relieved to see that they have at least made the effort to bring someone on board to fill the social work dept. In looking myself at what's out there in my city for MDS positions, they all state that one yr is necessary for hire. That's what I thought was the average requirement. Even if I can hold out there for 6 months I think I'd be more in line for hire. I don't think many facilities feel confident in someone who's only had just a few months experience. Onward struggle and hope for a repreave.

Good! I hope they find a LSW. But even if they don't, try to get your experience, you are correct, the closer to a year the better. Maybe, just maybe things will ease up. Just keep sucking up the knowledge, get in as much as you can. When you do finally transfer, just think, no more med cart! I know how you feel, I never want to touch it again. Did my time and no more. Most places don't pull you for a cart. For that alone, I love it. But the work, the hours, the money, everything about it is good to me. Peace!

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Specializes in med surg ltc psych.

Yeah, that one night I had to cover for a call in and work the floor I racked up 18.5 hrs in one day. Don't want to touch the cart either! the sticky Lactulose, the bang bang of crushing meds. the peg tube that only clogs on you, the new abx to start and not available, the "that's not the right color of the one I get for sleep, and don't I get a Lortab too?" Why is there no Xopenex on this cart! Oh no.. Mr Jones Humalin is empty in the box, and the ultimate: "Mr J just fell!" Sweet memories yes? I really hope I am allowed to hang in for a good span of time. Now lets delete the visual of "the cart" so we can sleep at night.

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