Re: RNAC per facility numbers

[Corey Ali]

Psychosocial usually calls for a knowledge of the patient's life background, as well as how they get along with their peers and family.  Usually, the social worker is stretched to the brealing point with admission assessments, arranging examinations for eyes & ears, co-ordinating outside services, tracking all the psych consults, handling family problems, doing discharge planning, co-ordinating with home care services for discharges, tracking down clothing, doing Mini-Mentals every 6 months (or quarterly in some cases), that they don't have the time to sit with each patient long enough to get that information.  Activities kind of gets it every day thru their activity work with the patients as a group.  They actually see how the patients interact with one another, and who relies on whom for support, etc. etc.    Also, delirium is almost always a physical response to a situation, quite often medical.  Infection, pain, new meds, medication interaction, lack of sleep, change of food, loss of routine can all cause delirium  Social workers don't have the training to evaluate the medical illness, the medication interactions, the labs, etc., to determine if delirium is a possibility.  Or, they spend an inordinate amount of time learning it in a knd of on the job torture test.  I'm not saying social workers are incompetent to do so, but rather that in order for them to do so requires a truly unfair amount of on the job learning and guessing in order to do them properly.    Where I work they have just hired a new social worker.  She was a psychiatric social worker for kids in her last position and has 20 years experience.  But she has never handled the specifics of medication, and has to look up on her list the classifications of the meds, and their use in which situations.  She knows depression, and dementia, and behavior problems, but hasn't a clue as to what meds, illness, social losses, etc. can interact to cause a delirious process because the nurses and doctors have always done that evaluation.  But the corporation expects all social workers to do the Delirium RAPs.  She spends at least an hour looking up every med and condition to do the RAP properly, while I can whiz thru it in 15 minutes.  In most of our other facilities, the RN does that RAP, but she's positive because she's new "They'll find out" she can't do all of her job.  Waste of her valuable skills, in my opinion.   Corey ----- Original Message ----- From: joan11 To: [EMAIL PROTECTED] Sent: Tuesday, January 06, 2004 2:49 PM Subject: Re: RNAC per facility numbers Interesting!!!  What do you base these observations on? ----- Original Message ----- From: Corey Ali To: [EMAIL PROTECTED] Sent: Monday, January 05, 2004 8:08 PM Subject: Re: RNAC per facility numbers With all due respect to the many overworked, underpaid SNF social workers out there (and there are many), I do not think it reasonable to have a non-medical person work on a delirium RAP.  There are too many complex items in the mix: medicines, illness, change of psychosocial status, loss of home, pain, and then mix in a possibly pre-existing dementia.  It's unreasonable to expect a BSW, or even an MSW  w/o special medical training to work their way thru that RAP.  I think they can do cognition (most of them), mood & behaviour, but have often found the Activities person to be much more capable of doing psychosocial than social workers, although they are almost always the ones assigned to it. Corey ----- Original Message ----- From: claudia farrell To: [EMAIL PROTECTED] Sent: Monday, January 05, 2004 8:57 PM Subject: Re: RNAC per facility numbers It is good to hear that I am not the only Cord that puts everything into the MDS. I do require that the therapy's check the minutes before I transmit to the state, and currently my ADON/ DON are doing the nutrition/dehydration/tube feeds, raps, assessments and progress notes. We have an activity director and social worker that put absolutely nothing into the MDS. Our s.w. is not capable of complexed thoughts. Sorry that sounded ugly, but so true. I have the activity director and social worker, read the raps, review the MDS sections that they should be filling out and require their signature. It is very draining to do this much work, it takes me anywhere from 3-6 hrs to do raps and further time for a good care plan...................By the way what are the sections a good social worker should be filling out....? I feel that delirium, cognitive, psychosocial, behavior, depression and mood are appr for a s.w.? any suggestions out there. Thanks Claudia >From: "Cheryl Walker" <[EMAIL PROTECTED]> >Reply-To: [EMAIL PROTECTED] >To: <[EMAIL PROTECTED]> >Subject: Re: RNAC per facility numbers >Date: Mon, 5 Jan 2004 19:37:57 -0500 > >I work in a 370 bed facility. I function as the RNAC manager and I have a floor of 80. I have 4 other RNAC's/MDS coordinators, they each have their own floor of 65-80. We do all the nursing sections of the MDS and care plans. >Cheryl >   ----- Original Message ----- >   From: MDSNancy >   To: [EMAIL PROTECTED] >   Sent: Monday, January 05, 2004 2:18 PM >   Subject: RNAC per facility numbers > > >   Would anyone kindly tell me how many RNAC's are in your facility?  Or how many residents you have if you are the only RNAC? >   Thanks, I just found out I'm losing my assistant! >   Nancy > > >------------------------------------------------------------------------------ >   Do you Yahoo!? >   New Yahoo! Photos - easier uploading and sharing Tired of slow downloads? Compare online deals from your local high-speed providers now. /---------------------------------------------------------- The Case Mix Discussion Group is a free service of the American Association of Nurse Assessment Coordinators "Committed to the Assessment Professional" Be sure to visit the AANAC website. Accurate answers to your questions posted to NAC News and FAQs. 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