Should I stay or should I go?


have been an RN for almost three years with about one year experience in MDS. For the past year and a half though I have been working in cardiology (hospital and clinic). I left my MDS job when my husbands work relocated us. I've been looking for another since moving and I finally have an offer. It's a $3/hr pay raise and a reasonable commute just outside of the city we live in. The catch is, I would be the only MDS nurse and they want me to be on call for a week at a time every five weeks. The facility has 75 beds and the census currently floats around 45-50, but they are wanting to fill the beds I'm sure. In my last position we were around 100 beds and had two full time MDS nurses. I think I can handle the case load on my own even though I will need to learn quite a bit. I will also be responsible for PAEs/PASSR, care plan meeting schedule and invites, quarterly assessments (falls, bradens, smoking, etc.) Does anyone else think this sounds like too much or is it just me? I really want to take the job and I feel I am capable - minus the call. I feel like I need to be 100% focused on MDS anyways but also since I will be learning new things as well. They told me there would be call up front and they would train me on the floor- I've never worked the floor in ltc and I really want to get out of floor nursing for right now. I was polite and maybe too agreeable in the interview to the on call and I ended up basically getting offered the job on the spot. So now I am super stressed because I want the job but I don't feel comfortable being on call as an MDS nurse. I also don't have supervisor experience which they know... Anyways... Sorry this is so long. I am just so ready to get back into an MDS job. I am not happy where I'm at but I don't want to jump into something else where I'll be just as unhappy. I knew the clinic was a bad fit my first day on the job and I have basically been sticking it out until I find the right fit. In the clinic I do have every weekend and holidays off but work 8-5, MDS would be 7-3:30 plus the on call rotation. I need to make a decision within the next day or two and I'm feeling so torn.


1,381 Posts

What does MDS stand for?

SaltySarcasticSally, LPN, RN

2 Articles; 440 Posts

I think it's common for non floor administrative staff to take call. When I was interviewing, there was a manager position that had on call which was more often than every 5 weeks. Bring on call in acute care means just getting called in which I don't mind. Being on call for LTC means being 24/7 available for phone calls, staffing situations, etc. I knew I wouldn't like that. I don't like to be called at home when I'm off the clock unless its my scheduled call day known in advance.

If you have this feeling, I would listen to it. Say your not interested in being on call due the work load and see what they say.

HeySis, BSN, RN

435 Posts

Specializes in PACU. Has 25 years experience.

MDS = Multiple Data Set. Its a very long assessment form that get completed on prescribed days and is used for reimbursement and for the surveyors to look for weakness (cause they already know how many people are on 10+ meds and are incontinent or have decubitus ulcers, weight loss and so forth). It is used in Long Term Care (LTC) facilities and Medicare Rehab facilities.

I would ask for more particulars about call... I hated doing call as a manager, it was all staffing issues... and if they are going to spend time training you to the floor I'd be concerned that when someone calls in.. you are going to have to cover, and do you regular work load, which sounds like a lot.

When I worked in LTC the head nurses did the quarterly assessments (braden and fall scales) and completed the nursing section of the MDS. The MDS coordinator made sure that the documentation backed up what was placed on the MDS after each discipline did their sections, wrote care plans, scheduled meetings.

I think as far as number of patients and work load it depends on how many of those beds are rehab/medicare, since those patients will require a lot more MDS's to be completed (If I remember correctly it's day 7, 14, 21 and so on) instead of the just quarterly and with significant change the long term care residents need.


16 Posts

Thank you guys! They told me to expect a call with an official offer tomorrow (Monday). It's a very small facility, in a very small town. I really like the staff that interviewed me, but I did feel the responsibilities being piled on during the interview. I'm confident I can do a good job, but being on call for a whole week at a time could really hinder that. And yes, I would he expected to cover the floor if a nurse or tech calls out and I cannot fill the spot. I'm just afraid if I say I don't want to do call they'll move on to the next candidate...

My husband thinks it's worth a try but I'm really on the fence. I just don't see why you would want to have your MDS nursing call and being pulled away from their main job while trying to grow census as well - therefore adding to the MDS workload. The good thing is the ADON used to be the MDS coordinator so I would have a resource person in the building if I had questions about stuff.


16 Posts

Oh will also be responsible for NOMNCs, which would be new to me as well. Is anyone else responsible for this and PASRR/PAEs as an MDS nurse? In my past experience the business office manager and DON did this so I do not know much about doing it myself.

Ruas61, BSN, RN

1,368 Posts

Specializes in MDS/ UR. Has 41 years experience.
What does MDS stand for?

Minimum Data Set (MDS)


7,735 Posts

Specializes in retired LTC.

The fact that they've told you flat out up front and EMPHATICALLY early on sends a warning out to me.

And that they see the need to provide a floor orientation to an 'inexperienced' floor LTC nurse is more icing on that cake that tells me you'll be pushing a med cart more often that I think you want to.

When you start wearing the 2 hats, your MDS job will most likely start to fall behind. Convenient that they have a backup' MDS/ADON nurse in the bullpen.

You need to fully aware of what you might stepping into. I'd be curious as to how often the on-call person has had to shift-over? Would you feel comfortable to ask?

Good luck.

PS - What are NOMNCs?


16 Posts

Thanks for your reply - Notice of Medicare Non-Coverage (NOMNC) is what I was referring to. I think I am just going to be as transparent as possible when they call with the official offer and hope they will be understanding. I plan on asking if they will consider doing the position without on call. If not, I suppose I will just keep waiting for the "right" one.

kbrn2002, ADN, RN

3,729 Posts

Specializes in Geriatrics, Dialysis. Has 21 years experience.

If they were transparent in the interview about being on call for floor nursing and said you would be trained on the floor to cover that on call, expect to be on the floor the majority of those on call days. If that's not something you are prepared to do, politely decline the offer.

LTC is notoriously short staffed to begin with, add in unexpected call offs and it's a rare day there isn't a hole in the nursing schedule. If the employers expectation of your on call week is that you cover those nursing holes I'd be very surprised if there's not a hole in the schedule at least half those days. Before accepting the job find out if you would be the first option to fill shifts as the on call, or if you are the option of last resort if nobody else can take the shift and that includes mandating overtime from the previous shift.

Would you be expected to cover any hole as the designated on call? I can see the potential of you being called in for a day shift one day, a NOC shift another day, a PM a different day. Who would you be obligated to answer to? Is it only the DON that can call you in to work during that on call week, or can any nurse just trying to get out of a shift contact you to come in?

I don't want to sound too negative about the job offer, but it does worry me that if they were honest about the on call expectation from jump that means it won't be a rare occurrence. In fact it'll most be likely be much worse than they admit to during the interview process. That's when they will try to sugarcoat things to convince you it'll be a great place to work, especially if they are having a hard time filling the position.


7,735 Posts

Specializes in retired LTC.

to kbrn - glad you're thinking like me. Kudos to you for pointing out more possible 'waving red flags'.

to OP - ty for the NOMNC def.

Jedrnurse, BSN, RN

2,776 Posts

Specializes in school nurse. Has 31 years experience.

LTC will use you and abuse you. Your primary job will suffer and you'll end up being more relief staff/supervisor than anything. The higher salary will not be higher when you factor in unpaid overtime...