The Power of Laughter

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elp! I’m being swallowed by a vortex of paperwork!” Hey, is that you? Are there some weeks for which you generate so many Minimum Data Sets (MDSs) that all you do is print, print, and print some more? Can you easily imagine that sinking feeling that one gets when trying to keep on schedule or falling just a little bit behind? This can be the story of our lives at work. Sometimes all you can do is laugh about it. This article is all about how to see the lighter side of the MDS world. And there is no one out there who knows that world like the MDS coordinator.
       Many people in the medical and nursing field have seen “M*A*S*H” and its irreverence for war and authority on television. Fortunately, we do not work in a war zone, but the nursing home industry is full of stories that one cannot help but laugh at. It is great when you can see the humor in life and work. It is one way of coping. We can make jokes to keep us sane.
       There is no substitute for a wonderful belly laugh, or even a chuckle, when the deadlines keep approaching, the residents keep coming in, and the Director of Nursing (DON) and Administrator begin thinking that you have nothing to do and assigning you new tasks. That is what our jobs can be like—more and more work. The key is to have a sense of humor.
       It is possible that paying attention to jokes and humorous situations can keep us mentally alert and improve our memories. According to recent research published in the online magazine Cerebral Cortex, “people use (humor) to relieve stress and to facilitate social bonding, as well as for pure enjoyment in the absence of any apparent adaptive value.” Humor activates the cerebral cortex, also known for intelligence and higher functioning. So, exercising your funny bone may make you smarter with a better memory. Executives in the advertising field certainly recognize this when their funny commercials are remembered for years on end.
       Persons in many other professions can stand around the water cooler and tell jokes. But in our field, who has time? In our jobs, we assess the resident, talk to the staff, and gather and input information. Much of the nurse’s work is done solely by himself/herself on the computer. Sometimes, there is no one to tell you jokes or listen to yours. It can be lonely. But if possible, surround yourself with funny people whom you like and respect to help you through your day. You might be surprised about how much it helps.

Questions and Answers

       Question: I am the Director of Rehabilitation (DOR) and newly appointed to my job. I was told that the activities of daily living (ADL) Resident Assessment Protocols (RAPs) were not completed by the prior DOR and that I was not responsible for them. Is this common? (director of rehabilitation, via e-mail)
       Answer: The nurse usually completes the MDS’s Section G. However, there are some facilities that do have the rehabilitation staff complete the section if the resident is receiving therapy. In my facility, I do use information from the rehabilitation staff, but I also include the nursing department’s assessments over 24 hours; for me, it works better if I as the nurse complete the section to get a more rounded assessment.
       The RAPs are an explanation of why we code certain sections the way we do, and those are always done by the nurse instead of rehabilitation. I’ve never heard of the rehabilitation department being responsible for RAPs.
       I presume the MDS coordinator is the one who determines who does which section (although this is sometimes governed by the corporation). Where I work, our new DOR was used to filling out the information in Section G, but it is our corporation’s policy for the MDS coordinator to complete Section G. When I worked at a smaller facility, I was also used to completing it myself. I’ve found that getting more information from the nursing staff might increase Resource Utilization Groups (RUG) levels and reimbursement.
       Question: When Day 14 rolls around and an admission assessment is due to be completed, I’m sometimes off of work that day. Can I date it for the day before or day after? (licensed practical nurse, Florida)
       Answer: No. It’s best to have the MDS and RAPs from the team completed early so that you can sign it the exact day that you are working. You may not backdate or sign late. Sometimes you have to have your team adjust its schedule so that you can complete the MDS at an earlier date. Another solution is to have a back-up staff member who is working the day of the completion date to assist you.
       Question: My DON argues with me on how I code an assessment. I’ve been doing MDSs for years. Why is she making me feel like I don’t know what I’m doing? (registered nurse, Texas)
       Answer: MDS coordinators are typically the ones who keep up on the new information and coding definitions. The team learns new definitions or coding and challenges the MDS coordinator. Be professional and have the MDS manual handy as you prepare your argument on why you are coding something the way you are. It may be necessary at times, however, to call your state Resident Assessment Instrument (RAI) coordinator for clarification. In that case, document your conversation in case you are challenged by a surveyor.
       Question: I’m going to have too many annual MDSs due around Christmas, and it’s so busy then. Can I move them up? (registered nurse, Washington)
       Answer: The RAI manual states that an annual MDS “may be scheduled early if a facility wants to stagger due dates for assessments.” I do this frequently when there are holidays or when I go on vacation so I don’t have late assessments when I come back. It might mean I have to work extra hard in the month prior to the holidays or vacation, but I’d rather be on time than have the extra work catching up. I also take a look when all the annual assessments are due and try to stagger them so that there are several throughout the year.
       Question: Who looks at care plans, anyway? (registered nurse, Michigan)
       Answer: That’s probably the most common question I’ve heard throughout my nursing career. In many facilities, the admitting nurse initiates the care plan, and then the MDS coordinator completes the care plan after the MDS and RAPs are complete. Periodically throughout the year and each time an audit is done, the charge nurse should make sure the care plans are accurate and updated. It is up to the nurses to know what’s on their residents’ care plans.
       We all look at care plans differently, I believe. While we care for a resident on a daily basis, others want to see a theoretical basis for what’s going on with the resident. Care plans are important so that the staff and regulatory agency personnel all know that there is a holistic approach to a resident. Having a team approach is the goal. Documenting behaviors that may be seen as a problem is another important aspect of a resident’s care plan. The care plan is invaluable to others who see that the staff is actually caring for that individual. The staff can then attend to the resident’s needs with realistic goals. The motto, “If it isn’t documented, it wasn’t done,” also applies to care plans. Individual problems and strengths should be covered on the care plan. There is always much discussion of which specifics should go on the care plan, but there’s no magic answer. Just make sure that as many specifics as possible are there so that the care plan is individualized.

       If you have a question you would like to see addressed and/or an idea for a future “MDS” article, e-mail it to ryand@hmpcommunications.com.