State Requirements in LTC

CRNAsoon · Mar 26, 2004

To get appropriate training for your goal career,you will have to get out of the nursing home.

I believe you are correct, bargainhound. I'm learning all the wrong things, all the time. It's very discouraging. Unfortunately, for the residents at this facility, I will be leaving after graduation in order to move to Cardiothoracic ICU. I just feel awful, but it's difficult to be the beam of light in this type of work environment.

RN4ustat, BSN, RN · Mar 30, 2004

Hello to my fellow Oklahomans!! Glad to see you here!! I recently accepted a position as DON at a LTC in rural central Oklahoma. It was a little bit of a difficult transition for me as all my previous experience was in the ER or acute care setting and I had no management experience. One may think I was nuts to make this change, but the administrator and ADON have been very supportive and so far it has been a good change for me. I don't know if LTC is a permanent change for me at this point, but my gut feeling is that I'm in it for the long haul....LOL. I have to say that I would agree with you Bargainhound to a degree. There are many days when I wish my charge nurses had more acute care expeience. With LTC being the most heavily regulated industry and society being so sue-happy, I would love it if they charted a little more "acutely" and more defensively. I am glad to make your acquaintance and would like to get to know you more........maybe share war and/or horror stories as well as hints, tips, and advice. Hope to hear from you all soon!!

ktwlpn, LPN · Mar 30, 2004

As my signature states, I'll be graduating with a BSN in May, so I'm still actively learning. .

The day any of us stop actively learning is the day we need to retire ....I too will check out those links-I hope I learn something new....the words "The state is here" sends chills down the spines of the most stalwart LTC nurses-not always because we doubt our abilities but because administration tends to go NUTS....I loathe survey time.....ugh..

robin_mds_nurse · Apr 17, 2004

I have been working in LTC since I was 16. That's quite alot of state surveys! I always found that even when I was a CNA, if I got in the habit of doing something everyday not just when the state is here, it is not a problem. For nurses on the floor, med pass & dressing changes are the most common things that a surveyor will follow you to do. Our Center has a consultant Pharmacist that goes with the nurses to make sure we are following the protocol. Some of the big issues they focus on are physical & chemical restraints, pressure ulcers (especially in-house aquired). We have a whole list of QI's (quality indicators), these are all things the state looks at. Good luck in your new position. I love LTC, I can't imagine doing anything else! ~Robin

Alast · May 6, 2004

The main thing to remember is if you do your best to do your job the right way all the time, then when "state" comes in the LTC facility you work in you will not have to worry about how you are suppose to do something when state is there or not. Its called good nursing all the time, to the best of your ability. Its what your patients/residents should be able to recieve from you any day, any time, no matter who is there are not.

What you do all the time is what you will do when "state" is there. It will become a habit. You will do it without thinking. So do it the right way all the time.

CapeCodMermaid, RN · May 6, 2004

I can tell none of you are from Massachusetts. I'm telling you it doesn't matter if you do things right all the time. The state will always find something you did wrong. It's what they do here. And every year they concentrate on something different. And on top of that, they are arguementative and downright rude. I had 3 surveyors last year scream at me:Who are you and what are you doing here? Jeezlies Peezlies -- all they had to do was either ask me, or read my name tag. We had one surveyor who wanted to give us a G tag for a "horrible med error"---oh yeah, really horrible--the nurse gave the person a mulitvitamin with minerals instead of a multivitamin. None of the surveyors have been in the real world for years. I don't think any one of them could do what they expect us to do.

CoffeeRTC, BSN, RN · May 6, 2004

The state is here=== one week of IBS. I cant really complain, for the last 5 years I managed to avoid them. :rotfl: I'm sure my time is coming soon.

leslie :-D · May 6, 2004

I can tell none of you are from Massachusetts. I'm telling you it doesn't matter if you do things right all the time. The state will always find something you did wrong. It's what they do here. And every year they concentrate on something different. And on top of that, they are arguementative and downright rude. I had 3 surveyors last year scream at me:Who are you and what are you doing here? Jeezlies Peezlies -- all they had to do was either ask me, or read my name tag. We had one surveyor who wanted to give us a G tag for a "horrible med error"---oh yeah, really horrible--the nurse gave the person a mulitvitamin with minerals instead of a multivitamin. None of the surveyors have been in the real world for years. I don't think any one of them could do what they expect us to do.

i'm from massachusetts and i've been through quite a few surveys. one time we had the same surveyors for 3 yrs. in a row! on the 3rd year, the feds were also in so that is when they were nit-picking. but i've also dealt with some doozies. what i hate most is when staff sucks up to them. anyway, the ones we've had haven't been grossly unfair; we were given warnings for the minor things and wasn't even reflected in their findings.

ktwlpn, LPN · May 6, 2004

The surveyors are in our area now-we expect them before then end of June...argh.

Blackcat99 · May 7, 2004

It is practically impossible to follow every reg. every day. The med pass rules are patently absurd...they were written when nurses in LTC handed out aspirin and colace.

This is so true! I remember seeing a report from the state and they complained because a nurse didn't offer water to a patient who had absolutely no medications ordered.This was at a LTC facility where the nurse had to give out meds to 40 plus patients. :uhoh3:

sharlynn · May 8, 2004

However, I find that some rules are contradictory.

For example, it is my understanding that (at least in my state - PA), some years ago, it was decided that patients should not be segregated because of their different infirmaties.

So Alzheimer's and dementia residents were roomed with mentally alert but physically incapacitated residents.

I have worked in nursing homes in Arkansas and Nebraska. Most had separate wings or separated units for dementia residents. The few that didn't would transfer people to another facility that did. This benefits everyone, staff and residents alike.

Where I am working now an alert resident would never be put with a resident with severe dementia. We go so far as to consider resident's temperature preferences. Someone who is always cold is never put with someone ( like me )who wants to run the air coditioner as soon as the thermometer hits 75 degrees!

smjlpn · May 10, 2004

I have been through 4 state surveys now, including one survey where we had state and federal surveyors at the same time. I have met good and bad surveyors, so I try not form an opinion of them based on past experiences with surveyors. I have had ones who treat you like you are an ax murderer and I have had patient understanding people who seem to be able to understand the difference between rigid rules and the human mature of the residents that we care for. The first time I had to do the med pass with them I was very nervous. As we went down the MAR getting the meds out, I noticed on the Miacalcin nasal spray that the nurse on duty the day before me had not signed the MAR. When the surveyor looked to see what nostril to spray she stated right nostril. But that was for the day before. Well to make a long story short. I spent the whole time giving my patient meds trying to figure out what to do. When I got down to the nasal spray I told her you have that marked as right nostril but it is actually the left nostril the nurse yesterday did not sign it out. I gave the spray in the left nostril , when we got back to the med cart she looked at it told me your right and thanked me. We passed our check with no errors caused by the floor nursing staff.