Defining the Role of the NAC Nurse in Post-Acute Care SNFs
The American Association of Post- Acute Care Nursing (AAPACN) defines the role of a nurse assessment coordinator (NAC) as the nurse who is accountable for coordinating and overseeing the full collaborative, interdisciplinary assessment and care planning process in post-acute care (PAC) skilled nursing facilities (SNFs). The ultimate goal of the assessment and care planning process is to promote the resident’s quality of care and life in a SNF, including individuality, safety, wellness, satisfaction, and dignity. The NAC is a champion of person-directed care and facilitates this through the assessment and care planning process.
A NAC Nurse Job Description
As defined in Appendix A of the RAI User’s Manual, the NAC nurse role in a PAC SNF, a position sometimes referred to as an MDS coordinator, is “an individual licensed as a registered nurse (RN) by the State Board of Nursing and employed by a nursing facility and is responsible for coordinating and certifying completion of the resident assessment instrument.” The NAC is ultimately responsible for adequately assessing skilled nursing facility (SNF) residents’ needs using the federally mandated Resident Assessment Instrument (RAI) process and for coordinating individualized resident-centered care.
Employed by SNFs post-acute care (PAC) facilities, the NAC works with the interdisciplinary team (nursing, therapy, dietary, social services, activities, etc.) to develop, revise, update, and maintain a comprehensive care plan and ensure that compliance is maintained with state and federal guidelines.
The NAC is responsible for attesting to the completion of the Minimum Data Set (MDS), which is the key driver for Medicare payment and many Medicaid reimbursement systems. The NAC serves as the expert resource for the Patient-Driven Payment Model (PDPM) and is responsible for complying with ethical standards when setting ARDs, completing assessments, and upholding Medicare requirements.
Finally, the NAC assists with the coordination of care delivery by applying advanced nursing clinical skills, completing assessments, analyzing data, educating team members, and coordinating the exchange of resident information across the care settings.
A Career as a NAC Nurse
Getting Started as a NAC
A career in MDS as a NAC can start from any direction within the nursing department. If you’re currently in an entry level position in a clinical setting, you can work up to a position within a clinical, quality, compliance, or reimbursement domain. The role of a NAC in a PAC SNF falls within the reimbursement domain, as the MDS drives reimbursement for the facility and a care plan for the resident. You can work up to a Medicare nurse, a care coordinator, or a unit supervisor; these are all roles that can help you get to the end goal of becoming a NAC. If you’re in a supervisory role and looking to get off the floor but remain involved in the resident’s life, the NAC role can be a perfect fit for you.
Qualities of a Successful NAC
NACs have many important qualities; however, these are key qualities needed for a successful in the role of a NAC in a PAC SNF.
Learner/adaptable – The PAC nursing environment is always changing. New government regulations are updated and changed every year (the RAI User’s Manual, Quality Measures, Medicare, etc.), new systems (from processes to technology) are being implemented all of the time, and the NAC has to keep up-to-date with all of it. To be a successful NAC, you must challenge yourself to continue to learn and stay current in your field. You have to adapt your knowledge to the environment and field that you are in, and this field is always trying to improve resident care. By staying up-to-speed, you will help deliver the best assessments, the best care plans, and the best quality of care for your residents while staying compliant and achieving accurate reimbursement for Medicare.
Detail-oriented/excellent time management skills – It almost goes without saying that a NAC needs to pay crucial attention to detail. Filling out an MDS is complex work and requires you to know important technical information (the RAI User’s Manual is currently 1419 pages long!) and be able to interpret and implement that knowledge correctly while doing so in a timely manner. NACs have to keep track of deadlines – assessment reference dates (ARDs), entry and discharge into the facility, observation (look back) periods, MDS submission times – just to name a few. And not only do you have to keep track of the deadlines, you have to meet them. Time factors can impact accuracy and weigh into the success of your job.
High quality judgement/critical thinking – Assessment is a big part of the NAC’s job. You have to be an expert at using your clinical skills in order to determine a resident’s condition and level of care needed. You need to be able to determine significant changes in behavior, mood-related symptoms, ability to complete activities of daily living, what their needs are for maintaining or improving their well-being, and so much more. This job is not just sitting in an office filling out a form; it requires all of the clinical knowledge you learned in nursing school, analytic skills, root-cause analysis, and more.
Team player/compassionate/interviewing skills – Resident assessment, interviewing, and care plan creation is a process that requires working with multiple people in the interdisciplinary team (IDT), in the resident’s family, and even more now than ever with the resident directly in order to achieve the best results. You need to be able to communicate well, have patience, know how to handle pushback and difficult topics, let people know what you need from them and when, and have compassion for everyone’s position and time.
Desire to help – Many people choose the rewarding career of a NAC because they want to help older adults achieve the best possible care and well-being. When you work as a NAC, you know every day what you do is in service of others and makes a real difference in people’s lives. To be a successful NAC, you have to hold on to that passion and that desire to help our elders and always remember why you became a nurse. The desire to help is a driving force amidst all of your daily tasks, and it will absolutely reflect in your work.
Education and Certification Needed to Succeed in a NAC Role
Most NACs have an RN degree, as that is needed to sign the MDS; however, LPNs may complete the MDS and have a supervisor sign off. NACS are required to understand the extensive and complex regulatory body surrounding the RAI/MDS process and regulations are always changing. Coding correctly and having keen assessment skills are also very important parts of a NAC’s job, which lead to the best care possible for residents and accurate Medicare reimbursement for your facility.
Nurses new to the MDS and the RAI process should consider supplementing their clinical education with a foundational course in the MDS such as MDS Essentials from AAPACN. After six months to a year in the NAC role, nurses wishing to thrive as a NAC in today’s SNF profession and provide the best care for our elders, earning a professional certification is a must.
Certification is certainly not an easy path, and the courses will test you extensively in all that you need to know. However, it is the most rewarding moment to finally say, “I am now a certified nurse assessment coordinator!” It is a moment of pride and of knowing that you have reached a milestone in your career. You have achieved a level of knowledge and expertise in the RAI process that is nationally recognized as top-quality and the gold standard, so you can have the confidence to move through your career and take a leadership role in resident care.
Earning your RAC-CT certification is about testing your knowledge in a career that you love, ensuring that you know the best practices and expectations for your field, affirming to yourself and your employer that you have the expertise to lead resident care forward, and gaining the ability to create the best future possible for our elders.