With staffing shortages and specific, regulation-mandated job duties, nurse assessment coordinators (NACs) today may feel that taking time for vacation just isn’t possible. The NAC must ensure the facility has MDS assessments in place, makes appropriate skilled Medicare decisions, identifies significant changes or the need for Interim Payment Assessments, correctly determines whether a resident meets the criteria of an interrupted stay—and the list can go on and on. However, everyone needs a break, and NACs have been through a lot this past year. With some pre-planning and careful coordination among the NAC, the director of nursing, and the entire interdisciplinary team (IDT), processes and systems can continue to operate smoothly while the NAC is out of office.
Here are some strategies NACs can use to achieve time off and have a stress-free vacation away from work.
1. Share your knowledge
“Often, NACs feel that their workload is too large to take any time off or that they are the only one in the entire facility that can do their job. If that sounds familiar, it may be time to share the load,” says Jessie McGill, RN, RAC-MT, RAC-MTA, curriculum development specialist for the American Association of Post-Acute Care Nursing (AAPACN). “Coordinate with your coworkers so that you can support them when they take time off, and they can support you when you take time off. For example, offer to help the director of nursing services (DNS) or other IDT members while they are out of the office and request that they do the same for you.”
“If the NAC is the only one in the facility that has any MDS experience, it puts the entire facility at risk. Everyone in the facility should have someone else that knows how to do their job, or at least the day-to-day basics of their job” says McGill. “It can cause too much stress and siloed workflows if the NAC has no backup help available. Also, if possible, try not to rely on just one backup. Use a multidisciplinary approach to have several people who are trained in different areas, such as MDS coding, interviews, scheduling, or beneficiary notices, who can take on these tasks to help reduce workload or cover for some much-needed time off.”
“When the NAC goes on vacation, know that the backup person only needs to focus on those day-to-day, must-be-done elements of the job that can’t be pushed off until later,” notes McGill. “Some of the bigger picture items NACs handle can be moved around, such as triple check, MDS submissions, and managing Quality Measures (QMs). Focus on key elements that, if not done, could result in penalties or survey citations. For example, missing Medicare PPS assessments can lead to the provider being liable, and late PPS assessments result in default payment. Facilities can receive survey tags for MDS scheduling, accuracy of coding, timely completion and submission, and timely identification of a significant change.”
“Some NACs may be wary of sharing their knowledge and responsibilities because they may fear becoming replaceable,” says McGill. “This can leave you with an overwhelming workload and no available help. Think of it more in terms of training someone else so that you can have flexibility in your job. Don’t fear replacement. There are so many positives of knowledge sharing, like better understanding of the MDS among floor nurses and IDT members and improved documentation when direct care staff see how their documentation is used. The backup help won’t be doing everything for you, but they will get an idea of the incredible amount of work that you do and can bring that back to their role with a new perspective.”
Note: To help the NAC’s backup organize their day when covering for the primary NAC, AAPACN developed the MDS Daily Startup for the NAC Backup Tool. The primary NAC must provide details for facility-specific meetings and processes, as needed, for the NAC backup person, but backups can use this tool as a helpful guide for daily work. It is also a great tool for NACs to use when planning out their day!
“Having a backup isn’t the only thing you can do to make your time off go smoothly though,” says McGill. “You also need some pre-planning.”
2. Plan ahead for your vacation
Don’t wait until the last minute. “To have your backup person ready to take on your role, you need to plan and start training them months in advance,” advises McGill. “The RAI process is complex, and they aren’t going to be able to pick it up in less than a week. So, work with your DNS and team months in advance, if possible, to start preparing for your vacation.”
“Another item that requires advance planning is that you may need to submit a request for your backup person to become a user of the QIES ASAP system, so that they can review MDS submissions and final validation reports or print quality measure reports in your absence,” says McGill. “Typically, facilities are allowed two users; however, you can apply for additional users if needed.”
Another common reason NACs don’t take vacation is that they are worried they might come back to a mess when they return from vacation. However, McGill advises that “If you work to have someone trained properly in the required daily tasks, you are less likely to come back to a disaster. It is key to have the backup practice these skills on an ongoing basis—even if just for a few hours each pay period—to keep skills fresh.”
“Keep in mind the backup person is just that, a backup,” notes McGill. “This is not their primary job, and it is likely that tasks may not be done exactly as you would have. However, one way to keep all processes and systems running smoothly is to create lists and how-to documents for your backup, organized in a binder or folder. For example, if a new Medicare Part A resident is admitted, create a document listing all the different tasks, from opening assessments in your software to obtaining the initial certification. This will help to ensure that all key tasks are completed in an organized way.”
“Try to lighten the load for your backup. Since this is not their primary job, they will not be able to complete tasks as quickly as you. Use the flexibility allowed for scheduling OBRA assessments, especially the quarterlies and annuals, to the fullest extent,” suggests McGill. “Some of the assessments can be done before you leave on vacation, and others can be done when you return.”
3. Equip your backup to handle the unexpected
“Every NAC knows that as soon as you have everything planned out, something will change—a new admission will come, or an unplanned discharge will occur. Because the NAC role often changes rapidly based on what is going on in your facility, it is important that you train your backup on how to respond to the unexpected,” says McGill. “To prepare your backup for those unanticipated events, make sure to lend them your resources and support network. Train your backup on how to use the RAI User’s Manual and other resources. However, even seasoned NACs sometimes have coding questions after reviewing the manual; reaching out to AAPACN’s MDS General Discussion Community or other MDS support systems can help.”
The support network may also include:
- State RAI coordinator – leave them the phone number to call
- Any social media groups or forums of other NACs that can help with pressing questions
- Sister facility NACs
“You may be wondering, too, what happens if other, more complex IDT processes arise while you are away? For example, what if a facility receives an additional documentation request (ADR)? This is when the IDT can step up to help,” notes McGill. “Therapy or social services, someone familiar with ADRs, may need to take the lead and tell the backup person what they need to do. The same approach may be needed with a task like beneficiary notices. Another discipline, such as social services, might take the lead while your backup supports them. With more eyes from the whole team on both the process and the end result, there is less that is likely to fall through the cracks.”
Note: NACs who are AAPACN members can share useful AAPACN tools with their backup person. Filling out a Permissions Request Form to share a resource with your team member is easy and takes only a minute or two!
4. Focus on balance
“If there’s anything we learned from this past year with COVID-19, it’s the importance of family,” says McGill. “Many times, you may have had to choose your job over your family and sacrifice that precious time to be with them. When you take your vacation, take the time to refocus on your family, to recharge your health, and come back stronger. You are going to be better at your job when you feel balanced.”
That means that, just as they have given precedence to their jobs, NACs sometimes need to prioritize family and self-care time. Use your paid time off, urges McGill. “You earned it. It is a job benefit. Take your time off without guilt, knowing that this is how you take care of you.”
While you are on vacation, here are some self-care tips you can take with you, according to Amy Stewart, MSN, RN, DNS-MT, QCP-MT, RAC-MT, RAC-MTA, vice president of education and certification strategy with AAPACN:
- Spend each day doing something that brings you happiness.
- Make sleep a priority. Sleep has a huge impact on how we act and feel. Vacation is a great time to catch up on sleep.
- Write down five things you are grateful for daily.
- Use one day as a dedicated self-care day. Get a massage, a pedicure, a new haircut—something that makes you feel pampered.
- Read a favorite book.
- Take a cooking class and learn to cook a healthy dish.
- Listen to an uplifting podcast—one that makes you feel happy and valued as a person, not just as a nurse.
NACs deserve a break, just like anyone else. With proper planning, a stress-free vacation is possible, and when you take work-life balance into consideration, worth the extra effort needed to get there.
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