Training and Career Changes

Y

ou know the type. “I hate doing Minimum Data Sets (MDSs)!” she scowls. This might be someone you usually avoided asking questions of about care because she had little regard for what we do. This also might be someone who was in control, and if she didn’t want to do something, she didn’t do it. And now she’s employed under you.
       Just last week I interviewed two nurses who had a history of health problems. One nurse, an experienced licensed practical nurse (LPN), knew her value as an MDS nurse. She had been pain-free for years and exuded confidence. She spoke of her back injury from helping a patient move up in bed. And then the inevitable happened. She hurt her back. She was trained as an MDS nurse and has never looked back.
       The other nurse, a registered nurse (RN), recently had health problems and applied as an assistant MDS coordinator. She also hurt her back moving a patient while she was in a home health position. She had never been an MDS coordinator and was willing to learn if I was willing to train her.
       Both applicants were willing to push a medical cart if the facility needed help. Both also were willing to help out on the 3–11 or 11–7 shifts if necessary. Their stories have similarities, and both had good attitudes about the job of an MDS coordinator. One nurse eventually got the job.
       The Occupational Safety and Health Administration (OSHA) determined that 67,000 back injuries occur among healthcare professionals every year. This amount could cost up to $1.7 billion in worker’s compensation claims for therapy and/or surgery.
       In nursing, we’ve established many alternative nursing positions that don’t requires lifting. Supervisory positions and jobs in quality assurance, case management, and doctors’ offices are abundant, as are MDS coordinator positions. Because the field of nursing is so diversified, nurses needn’t leave the field.
       Job descriptions will always state the number of pounds required to lift. When interviewing, make it clear what your limitations are. A chart may weigh up to five pounds and might be a burden to carry. I carry some charts to my office or my desk. However, I have a chart rack in which to place many charts, and I try to use it whenever I take more than two charts to my office.
       The person with a health condition must have a good attitude about doing the MDS or else productivity might suffer. Hopefully, one does not feel that he/she is “just doing a job,” because the role is multifaceted and enables the MDS coordinator to be involved in his/her resident’s lives and develop a care plan to fit each resident’s needs. The value of the MDS coordinator must be emphasized so that the nurse feels that he/she is contributing to the care of each resident. Additionally, the MDS coordinator who completes the MDS for Prospective Payment System (PPS) contributes to the financial reimbursement for the facility.
       It would behoove the nurse to know as much as he/she can about this topic in order to bring in the most dollars for the care. Imagine the amount of information to be learned by the new MDS nurse. Everyone depends on this nurse to keep the assessments completed, hold care plan conferences, and determine a timely schedule for the MDS. The facility depends on and expects a good MDS nurse to comply with all the regulations set forth by the government. This field is very complicated, and one must know all the ins and outs of completing of the Resident Assessment Instrument (RAI) process.
       The MDS nurse must overcome the feeling of loss of function and self-esteem that comes from the ability to care directly for residents. Nurses usually come into the nursing field with the glorious notion that they can provide the best care by being at the bedside. Now they have to spend most of their time in an office, and it might be a blow to them. It might not suit their personality to have to concentrate for the length of time it takes to complete the RAI.
       Other nurses and nursing assistants might resent the fact that MDS coordinators spend their time sitting down at a desk, reading a chart and other documents, typing and doing data entry, and not doing physical labor. Staff might feel angry or disbelief when they ask for assistance and the person states he/she is unable to assist due to a health condition.

Q & A

       Q: I have a question I’m hoping you can answer. I’m an LPN and have been doing the MDS for the past six years. I have taken many classes and updates. My question is, if I were to become certified, would I still need an RN to sign the MDS? (licensed practical nurse, via e-mail)
       A: Yes. The regulations state that an RN must attest to the completion of the form and sign as the RN MDS coordinator. Many nurses who are LPNs are certified in the RAI process and know more than an RN. I know it doesn’t seem fair, and many nurses feel the extra step isn’t needed, but so far there is no action to change the process.
       Q: I’m the new food services manager with the responsibilities of the MDS/Resident Assessment Protocols (RAPs) for Section K (Nutrition). If there’s a trigger, what are some basic solutions to address the RAPs? Help! (food services manager, via e-mail).
       A: Congratulations on your new position! Sounds like you know how to fill out the MDS. So, your question is about the RAP. In my company, I have to address five items. I organize it like this: Trigger—repeat the problem. Usually “mechanically altered diet” or “therapeutic diet” or “leaves 25% or more food uneaten at most meals.” I just state what’s triggered with the wording from Section K. For contributing factors, I state exactly what the diet order reads (eg, “soft” or “CHO-control” diet). I then state the diagnoses related to diet order, such as chronic obstructive pulmonary disease (COPD), pneumonia, or recent surgery. I don’t always use complete sentences when typing. I also add other diagnoses, such as anemia, hypertension, osteoporosis, cerebrovascular disease, Alzheimer’s disease, or anything else that might influence the diet order or other interventions, by writing “also has” or “other dx include.” In the same paragraph, I’ve learned from the dietitian to state the height, weight, and ideal body weight (IBW) range. I put in any details that might be of note—just about anything that would go on a nutritional assessment. And, if the resident eats less than 75% or more at most meals, I might put interventions that all nursing staff does routinely, such as, “Staff sets up meals for resident at mealtimes” or “Staff encourages meal intake” or “Staff to monitor meal intake and weight” or “Staff monitors labs.” For the next line, risks, write items such as “abnormal labs” or “weight loss” or “choking.” I was advised by the previous dietitian I worked with not to write “malnutrition” (or “dehydration” on the dehydration RAP). I’m told surveyors, as a rule, don’t like to see this. Or, I might write “poor wound healing” or “continued poor intake of meals” or even “abnormal finger sticks.” For referrals, you’ll usually write “none” or “dietary to follow.” Everyone (regardless of regular diet, specialty diet, no weight loss, etc.) gets a nutritional care plan. The dietitian I work with just marks the appropriate interventions on a pre-printed care plan. Everywhere I’ve worked, Section K is filled out within the first few days of admission. Then, if an order comes through that changes the MDS, it can be changed before signing. I usually give a heads up to the person doing Section K if something needs to be changed. In my company, we always have to wait until nursing or anyone else completes their sections before doing the RAPs. Is it like that with your system?