During their first days on the job, new nurse assessment coordinators (NACs) can expect paperwork and orientation videos as they are introduced to their role. But what should a new NAC expect by the end of the first week, first month, and beyond? Unfortunately, if the position was vacant for any period of time, many NACs find a full caseload and late MDS assessments as soon as they onboard. Ideally, facilities will avoid this circumstance, so that the new NAC can acclimate to the position in an organized manner. While each orientation schedule will be unique, based on the experience of the new NAC, the facility, and the organization, here is a general timeline for the NAC’s first month and beyond.
The NAC’s first week should be dedicated to orientation to the facility, the position, and the residents. While each facility or organization will have its own unique orientation process, these typically involve required paperwork and setting up benefits, such as insurance selections. Often, facilities schedule an orientation meeting for the new employee to spend five to ten minutes with each department for a brief introduction to the basics of what that department does.
After the required facility orientation, training will focus on the position. If the NAC has little experience, MDS-based education must also begin. While basic training on MDS line-by-line coding could be completed in as little as a week, full NAC orientation can last ten weeks or more, as the training goes into greater detail and expands to the other areas the MDS impacts, such as reimbursement and Quality Measures.
Note: AAPACN’s 10-Week Nurse Assessment Coordinator Orientation Guide Tool can help the new NAC understand what topics to expect for orientation and training and can guide the trainer in what to review over the next 10 weeks.
Getting to Know the Residents
During this first week, it is also important for the NAC to start becoming familiar with the residents. The NAC will need to develop a mental baseline status for each resident, knowing how each resident typically completes activities of daily living (ADLs) and what key services they receive. Eventually, this will help the NAC identify potentially significant changes quickly. For example, if the NAC notices that a resident who typically walks to meals is using a wheelchair this morning, it should be a trigger to investigate why—but that can only occur if the NAC recognizes the change.
Here are a few tips to get to know residents better:
- Stop by resident rooms, introduce yourself, and get to know the resident.
- Once training for scripted interviews has been completed, conduct interviews with residents with assessment reference dates within the next day or two.
- Join a small activities group, like morning coffee, to greet residents.
- Assist in passing meal trays.
- Shadow a nurse during medication pass.
- Join care conferences.
Advanced Training and Applying Skills
The second week on the job becomes more hands-on. By this time, basic MDS training, if needed, should be concluding, and the NAC should be able to code some or all sections of the MDS. Scripted interview training should be completed, and all interviews should be conducted timely. While the education will continue for several weeks, the NAC must start applying the skills already learned.
By the end of this week, the NAC needs to organize his or her office, gather current resources, and identify what additional tools are necessary to do the job. For example, if the NAC is responsible for assigning ICD-10-CM codes, an updated coding manual is a necessary resource. These resources may be physical manuals or available online. For online versions, the NAC will need to either develop a document of needed URL links or add bookmarks in their browser.
Here are some key resource pages the NAC may need to access:
- RAI User’s Manual
- ICD-10-CM Coding Manual
- Medicare Internet-Only Manuals
- Five-Star Technical User’s Manual
- Quality Measures User’s Manual
- Professional association (AAPACN)
Since resources can be updated frequently, a common practice with online resources is to bookmark the webpage that houses the resources. Most of the manuals and additional resources on CMS.gov are located at the bottom of the page, under the downloads section. However, when accessing the ICD-10-CM manual, the user must select the desired fiscal year on the left side of the page first, after which the downloads section becomes available.
Establishing the Communication Process
By the third week, the NAC should be familiar with most staff and residents and now needs to establish a strong communication process with other interdisciplinary team members (IDT) regarding assessments, completion dates, and other key items. It is likely that the team has some type of communication process that is currently or previously used. This is a great opportunity to discuss this process as a team and determine what has worked well with this process and what did not work well. Taking the time to address gaps in communication now will help to ensure a smooth and effective process later.
Assigning MDS Responsibilities
Additionally, the IDT will need to discuss who is responsible for each section of the MDS, scripted interviews, care area assessments, and the interdisciplinary process for care planning. Once the delegation of MDS items has been set, identify if there are any gaps in education for any team members. For example, if the social services team member is going to start completing the PHQ-9 mood interview, evaluate the need for scripted interview training for this team member. It is also a best practice to determine who will complete these items in the absence of any of the team members. Setting up this system early and identifying the education needs of primary and back-up team members will minimize any gaps in MDS completion in the future.
Identifying Necessary Meetings
The new NAC may find him- or herself overwhelmed by week four as training and workload continue to increase and expand. By this point, the NAC may have already attended most or all of the daily, weekly, and monthly meetings. As with all staff, it is important that the NAC is present in the right meetings and excused from unnecessary meetings. One way to identify if a meeting is necessary for the NAC or not is to answer these two questions:
- What does the NAC bring to the meeting that benefits the purpose or outcome of the meeting?
- What does the NAC take away from the meeting that benefits the purpose or outcome of his or her job?
If neither the NAC, the team members, or the meeting’s purpose benefit from the NAC’s presence in the meeting, facility leadership should consider excusing the NAC from this meeting.
What to Bring and Take Away from Meetings
Along this same line, once the NAC has identified the necessary meetings to attend, he or she must identify what is required for each meeting and what to do with the information obtained.
For example, the daily team start-up meeting generally includes an overview of all admissions, discharges, deaths, and transfers. The NAC must use this information to ensure all assessments are in place or adjusted as needed due to the discussed event.
Lastly, by the fourth week, the NAC should be aware of all additional duties he or she is responsible for. These tasks may include running quality measure reports weekly, serving as a meal supervisor, rotating on a manager on duty schedule, or answering the phone during certain hours. Often, the NAC will be allowed time to fully adjust to the new position before being required to take on these additional duties; however, it is important to be aware of these duties early on to allow for future time management and planning.
Confidence Takes Time
The saying that “you learn something new every day” applies to both new and experienced NACs. It takes many NACs two to three years to feel fully proficient in their role. Often, much of what NACs learn comes from experience, as their facility is the subject of audits and surveys that result in MDS-related tags. NACs often use networking, from the AAPACN community forums to online groups, to connect with peers and ask input on difficult coding situations.
Being a NAC does not become mundane. Every year, and sometimes more frequently, the Centers for Medicare & Medicaid Services (CMS) releases updates on MDS coding and Medicare billing, which often directly impact the NAC’s job. NACs should expect the job to change regularly; to be successful, NACs should also cultivate their ability to adapt.
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