DON-bonus after survey??

mscsrjhm · Sep 24, 2004

FYI, the last home I worked in, the day shift nurse was writing orders without calling the Doc. I don't mind a tylenol or dulcolax supp. order, those could be verbal from Doc to nurse. I don't, however, think that a nurse needs to play with Roxanol, Haldol, Risperdol, etc.

When I spoke to the DON, he said "she is a really good nurse".

Found out later that the "good" nurse had potentially contributed to a death. Staff said she refused to send an alert resident to the hospital who was c/o abd pain since early a.m. Apparently, 2nd shift sent the poor woman...she died of a bowel obstruction.

I haven't had the opportunity to work in good, LTCs.

I heard they existed... thought it was just a rumor. (hehe)

reneeHW · Sep 27, 2004

I realize it has been awhile since the posting regarding what agency nurses see when going to LTC facilities, but I did want to add that in our facilities we make it a practice of following all workers when they are being observed by a surveyor. There are several reasons that we do this-

there have been several times a surveyor doesn't quite recall the way a procedure was carried out, a 3rd pair of eyes and notes made during the procedure go a long way if end up in IDR.

Staff get nervous when with surveyors and reminders or a familiar face can make a difference.

There is a nursing shortage and we have begin to experience nurses job hopping due to competitive wages and benefits. Those homes that have used agency instead of the DON and supervisors working have had surveys that are not quite as good...possibly due to unfamiliarity with the home or lack of dedication to the home/facility, etc.

It is a very hard job and we do experience in some facilities, large turnover-but for those meant for the job...there is no other place.

Having worked many years through agency at different LTC facilities, I haven't seen too much celebration after survey.
Working agency at LTC usually means:
1. most of their employees have left due to poor working conditions (creating a lack of continuity of care, and lack of nursing knowledge of resident's needs)
2. before leaving, old employees complained to residents and their families, giving them an insight into specific areas of concern, poor care, and even poorer management skills.
3. families will call state due to increase of agency workers, lack of continuity of care, and eventual decline in overall care.
4. administration stays in a state of crisis due to all of the above.
a viscious, "if it weren't so tragic it would be funny" cycle.
5. agency nurses eventually know the state surveyors on a first name basis. (honest- no joking.)
Yes, maybe those of you who work LTC at good, decent facilities would consider the term "wisen up" as a slam. I don't mean to slam you. I congratulate and support you.
Well-run facilities do not have much of a need for agency.
There are terrible places out there, and, unfortunately, when you work agency, these are the places you see.
My agency has a large list of do-not-ever-send-me-there facilities.
I have been pulled aside many times by surveyors, and asked, "what are the problems here", due to seeing them so very often. Don't mind telling you that I don't hesitate to let them know problems regarding patient care.
As far as administration.... I'm agency, I don't want to know anything about the politics.
I was once working at a LTC who was going through survey. The corporate people FLEW IN from different areas of the country. They (at least 6 of them) followed staff INTO ROOMS telling them what to do---during the care, and DURING THE SURVEY.
"don't forget to wash your hands, don't forget to put the call light by the patient, give the patient a drink of water, knock on the door, turn out the light, pull the curtains"
I have never seen anything like it, neither had the surveyor. Poor CNAs were being followed by two people... corporate and a surveyor!!!
The surveyor was attempting to contact her office to see if this was legal... she said it was.!!!!!
This is what we agency see.