Written by Michael Daniels, RN, DNS-CT, QCP, RAC-CT, RAC-CTA
All one needs to do is peruse the long-term care (LTC)/skilled nursing facility (SNF) job openings online for a few minutes to realize that something is amiss. Frenzied healthcare staffing recruiters seem to crawl from the woodwork as they compete to fill the plethora of vacancies and dominate the ads. AHCA/NCAL’s recent survey “State of the Nursing Home Industry” has revealed, in quantifiable measure, the reason behind the job board pandemonium. LTCFs and SNFs have been battling a staffing dilemma that has morphed into a full-blown crisis with no end in sight. The AHCA/NCAL survey found that “98% of nursing homes are experiencing difficulty hiring staff, 87% are facing moderate or high staffing shortages, 61% are limiting new admissions as a direct result of these staffing shortages, and 73% are concerned they will need to close due to staffing shortages” (AHCA, 2022). These numbers are staggering and deeply troubling.
Given the current state of affairs, it’s time for nursing home providers to take a closer look at the role of the MDS coordinator/nurse assessment coordinator (NAC). The AHCA/NCAL survey found that “providers estimate costs have increased by 41% in just one year, 6 out of 10 providers are operating at a loss, and more than half of nursing homes can’t sustain their current pace for more than one year” (AHCA, 2022). Nursing homes are hemorrhaging revenue, and the potential Medicare cuts on the horizon are insult to injury. In these uncharted waters, an experienced MDS coordinator provides a lifeboat of reimbursement essential to keeping struggling facilities from sinking below the line. Unfortunately, in this current climate, recruiting and retaining a qualified MDS coordinator is not without difficulty. Below are five tips for recruiting and retaining skilled MDS coordinators.
1. Recognition and Acknowledgement
There is no substitute for knowing you are a valued member of an interdisciplinary team who is recognized for your unique and valuable contributions and accomplishments. Unfortunately, a common concern among MDS coordinators is that this needed recognition is not often displayed with any measure of enthusiasm or consistency. The role of the MDS coordinator is one of the most misunderstood roles in the LTPAC arena. Successfully navigating the MDS processes requires a meticulous eye and exceptional analytical skills. Interpreting the various required manuals and guidelines (RAI User’s Manual, ICD-10-CM Official Guidelines for Coding and Reporting, Medicare Benefit Policy Manual, Medicare Claims Processing Manual, The State Medicaid Manual, MDS 3.0 Provider User’s Guide, CASPER Reporting User’s Guide for MDS Providers, and the list goes on) is no small feat. It requires dedication and a substantial commitment to continued education to stay apprised of the myriad of changes within this field. If you are hoping to recruit and retain a quality MDS coordinator, making a concerted effort to understand their specialized skill set and to recognize and acknowledge their unique contributions is a necessary and impactful first step.
2. Don’t Pull Your MDS Coordinator Away From MDS
In an increasingly problematic trend, MDS coordinators are being regularly pulled to the floor and away from their specific role. Many routinely take call and are expected to fill weekend-long staffing vacancies to cover clinical nursing needs. The expectation is that they then return Monday morning to complete the tasks that only they are trained to do. Not surprisingly, being overworked and under-supported leads to burnout, poor performance, and turnover. While it is the responsibility of all nurses to provide patient-centered care, not all nurses choose to provide direct patient care. Many nurses who have pursued or will pursue the MDS coordinator role, do so precisely because they want to step away from direct patient care for various reasons. If these nurses are ostracized for their decision and pressured into ‘taking one for the team” by stepping into routine direct patient care duties, one could likely expect their resignation to follow. To clarify, most MDS coordinators are more than willing to “take the keys and work the cart” when there is an immediate need or in a crisis. It becomes an issue when providers continuously make a practice of filling the holes in their nursing schedule with MDS staff.
3. Beef Up Your Onboarding Experience
First impressions matter. A lackluster onboarding experience can leave an MDS coordinator considering their exit within the first few months. A robust onboarding experience starts with the right interview. Experienced MDS coordinators know their skills inside and out. Consequently, they will size up their interviewer’s MDS knowledge based on the interview questions. If the interviewer has limited understanding, it may communicate to potential candidates that the facility’s leadership does not understand the MDS role well. Therefore, having someone well-versed in MDS present during the interview is vital.
Additionally, this person should be able to provide insight into facility-specific responsibilities. Once an MDS coordinator has accepted their new position, leadership should customize their role-specific training to ensure that any gaps in their knowledgebase be addressed. Time and resources should not be wasted covering areas in which they are already proficient. This customization will help keep the new MDS coordinator engaged and enthusiastic.
4. Invest in Education
Investing in education and promoting involvement in professional organizations such as the American Association of Post-Acute Care Nursing (AAPACN) will help MDS coordinators stay apprised of the many changes within their specialty. Additionally, it allows them greater opportunities to grow professionally and connects them with other MDS coordinators within the LTPAC community. The industry gold standard certification for the nurse assessment coordinator is the Resident Assessment Coordinator—Certified (RAC-CT™) certification program offered by AAPACN. Providers who offer tuition reimbursement for RAC-CT courses and certifications are at an advantage.
5. Have Support in Place
Because MDS is a specialty that other nursing team members are not usually trained in, MDS coordinators often have difficulty finding coverage for their deserved PTO. As a result, many end up not using their PTO, working while on PTO, or doubling up on work before and after taking PTO. This has a negative effect on work-life balance and job satisfaction. Many facilities can overcome this obstacle by allocating needed resources to cross-train other nurses. Additionally, larger companies can ensure adequate support at the corporate level by instituting strong regional support, which could include a mobile MDS coordinator to fill in for coordinators on PTO.
Employing these five strategies will help providers attract and retain qualified MDS coordinators. Implementation of these strategies does require significant investment and planning; however, the effort may well be worth it for providers losing revenue.
American Health Care Association. (2022). State of the Nursing Home Industry: Survey of 759 nursing home providers show industry still facing major staffing and economic crisis. https://www.ahcancal.org/News-and-Communications/Fact-Sheets/FactSheets/SNF-Survey-June2022.pdf