The ballad of the MDS coordinator
Like I hope for many of you, I appreciate the hours before 6 a.m. as ones in which I am asleep.
Apparently there is a subset of MDS coordinators using these pre-dawn hours to sneak into their skilled nursing facility so that they can work in peace and quiet. That's one of the first of many tantalizing tidbits I picked up during the first day of the NADONA LTC (National Association of Directors of Nursing Administration LTC) conference, specifically through a session on MDS 3.0 Accuracy Survey Process given by Leah Klusch, RN, BSN, executive director of the Alliance Training Center.
While the presentation focused on preparing documentation and audits, she spent time diving into the way MDS managers are treated — and it doesn't look great.
She said many times she's walked into a facility and asked the administrator the name of the MDS coordinator —and he couldn't quite remember. “Take me to her/him,” Klusch will say, and he/she will say, “Let me get someone.”
“That MDS manager is writing your paycheck,” she reminded sternly. The MDS 3.0 gives the outside world a picture of the SNF, and it is unacceptable for administrators to be removed from the day-to-day lives of the people making this happen.
“Don't tell me you don't know where they are, or that they have one phone line, or you can't afford to buy them a new computer,” she said. “Or that they share an office with the activity coordinator.” They are coming in at 4 a.m. so they can have a quiet office, or working weekends, or 14-hour days, she said. Also, I'm not sure I entirely understand why so many MDS offices have a refrigerator, but apparently this is a thing Klusch sees, and my sense is she would like to drag it out of the office with her bare hands and put it in the administrator's office. Consider this your warning.
Too many MDS nurses and RN assessment coordinators are being bled through a tiny thousand paper cuts or indignities such as what's above.
There's a lack of understanding of how important it is to have proper levels of staff in this area, because tired and burned out MDS coordinators make mistakes. Klusch said one facility instituted a policy that no one could code after 3 p.m. She also reminded that an RN assessment coordinator is required, and it cannot be an LPN/RVN in most states.
Another piece of advice was around passwords: MDS nurses need to have a secure password sharing system or leave instructions as to where these passwords are kept. Klusch told a story about a system where the two MDS coordinators were hit by a truck, and no one else had the passwords to any software system or CASPER. The building lost almost $300,000 while the staff waited — and prayed for — the nurses to recover.
The total message was overwhelming for some nurses, and it caught some off-guard compared to NADONA sessions that are designed to be more about morale or team-building. It's good to balance that out with nitty-gritty parts of the job. While Klusch compared reviewing the accuracy and survey process as cleaning out one's closet, an attendee near me murmured that she thought it sounded more similar to a colonoscopy.
In both cases, though, the metaphor is clear: The junk has to be cleared out.
Elizabeth Newman is Senior Editor at McKnight's. Follow her @TigerELN.