Surveyor: The First Week

A brand-new state surveyor learns that her job is a LOT more complicated than the recruiting notice advertised. What kind of world has she stepped into? Will it be possible to learn everything she needs to know? Is she in over her head and about to drown in her own foolishness? And if so, why can she hardly wait to break down the doors of the first facility she surveys? Nurses Announcements Archive Article

I really had no idea what I was getting into.

I thought I knew pretty well what state surveyors did from being on the receiving end of entrance conferences, interrogations, citations, and exit interviews. They always had an air of mystery about them; they were also knowledgeable, inquisitive, and terribly intimidating. I used to sneak peeks at them as they sat in the private conference room, writing busily and talking about what I presumed was the 50 F-tags they were going to give us.

Turns out I didn't know beans about this job. It all started that first day, with signing my life away to the State in exchange for a tricked-out ID badge, a brand-new iPhone, a $2400 laptop that does everything but speak Esperanto (and it would probably do that too if I could find the button for it), and business cards that have my name, title, and unit printed right underneath the state seal and the DHS logo. Then it was off to learn about how the position relates to the work of the state government and, by extension, the federal government (we newbies even have to go out of state this summer for what's called "Federal Basic Training" so we can become certified at that level.)

After that, it was two days of intensive computer setup and training. And I thought I knew a few things about computers......it turned out that I knew NOTHING about this one, and I was fumbling around with it just like my fellow trainee who doesn't even have a smartphone. Then yesterday, it was a day of "free play" in which we were able to get into some of the self-paced core training courses and chat with the experienced surveyors, one of whom told us that they were so glad to have us because they'd interviewed 56 people for seven positions, and we were the only ones to make the cut. We were also told by our manager not to stress too much, because the training period is six months and it takes most surveyors a minimum of two years to feel comfortable in the role.

Now we have two weeks of classroom training ahead, and THEN we'll get our first chance to go out with a survey team and shadow them during a real, live survey. I can't wait to tear into the material we'll be learning, because it's the meat-and-potatoes stuff of which surveys are made and I want to be ready. But even despite the fast pace, my own nervousness, and the enormity of this undertaking, I'm chomping at the bit to get out there and see the survey process from the other side. I want to jump in with both feet and get my hands dirty, just as I did in nursing school when I was so eager to learn.

To say that I'm astounded by this turn of events would be the understatement of this still new year. Two months ago I was on a relentless downhill trajectory, both career-wise and even in my personal life, and now I'm.....well.....here. I'm overstimulated, I'm scared to pieces, but I'm so excited I can hardly stand it. What a rollercoaster ride!

I remember feeling like this only once before in my life, and that was back when I first started my nursing program. Four weeks in, when I put on my white uniform for the first day of clinicals, I suddenly became overwhelmed with fear and told my husband, "I can't do this." Then I thought of all the time I'd already invested in my schooling, and I asked myself "OK, if not this---then what??" There was no answer, of course, because there was no Plan B---it was nursing or bust! So I had no choice but to face down the fear and become the best nurse I could be.....and I did it.

It's no different with this. Yes, like nursing itself, this job is more nuanced and far more complex than it looks on the surface; but now---as then---there are no other options, because THIS is the job I wanted. So I'm just going to push through the hard parts, learn everything I possibly can, and do my best to advocate for residents in a fair and impartial manner (although I can just see myself going "@*!#^&% facility, what makes them think they can give everybody Haldol for agitation?!").

And that was just the FIRST week. Stay tuned.....

Congratulations on your new position! the good news for you is that there is no humanly possible way long term care can escape the tag. We're dammed if we do and dammed if we don't. And for every possible scenario there's at least ten tags to accompany it. The reality is that with all the documentation that's expected, there is little time left for patient care. I predict there will come a day when it will become completely impossible. It's close now. 30 patients for one nurse is too much. That's a worthy tag. Help us? We need legislation. Max 20 patients per nurse. They're not the same LTC patient you had 20 years ago. Nothing personal, just thought I may have an opportunity to have a voice with someone who could maybe make a difference.

Specializes in LTC, assisted living, med-surg, psych.
Congratulations on your new position! the good news for you is that there is no humanly possible way long term care can escape the tag. We're dammed if we do and dammed if we don't. And for every possible scenario there's at least ten tags to accompany it. The reality is that with all the documentation that's expected, there is little time left for patient care. I predict there will come a day when it will become completely impossible. It's close now. 30 patients for one nurse is too much. That's a worthy tag. Help us? We need legislation. Max 20 patients per nurse. They're not the same LTC patient you had 20 years ago. Nothing personal, just thought I may have an opportunity to have a voice with someone who could maybe make a difference.

Believe it or not, surveyors and LTC nurses are on the same side: that of the residents! I only recently left SNF/NF because I couldn't handle the stress anymore. I know those ratios are ridiculous, and that staff can only do so much with so many high-needs residents and so little help.

I also know that at some point, this entire house of cards is going to collapse because nurses and aides are stretched so thin they really can't do more. Unfortunately, some of the documentation that LTC administrations impose on staff after a "bad" survey DOES NOT have a basis in the CFRs (Code of Federal Regulations), and this neither improves patient care nor fulfills the requirements that weren't met in the first place. Believe me, I feel for you. :banghead:

Specializes in Hospice / Psych / RNAC.

Don't forget to advocate for the nurses as well...

Watch out for the me's. I liked to get a surveyor talking about themselves, past career, etc. I ran a tight ship, I always helped staff, pristine documentation. Treated the residents better than my own family. I usually had a deficiency free survey too.

Specializes in Critical Care, Emergency, Education, Informatics.

Reading your post brings back memories. I thought I had it all in my pocket because I had done IG inspections when I was on active duty. I had no clue.

Keep your head up. :)

Specializes in LTC, assisted living, med-surg, psych.

Well, at least now I have a better acquaintance with what I DON'T know. Three weeks in and I've realized that I basically have to throw out everything I know about nursing homes and start over from scratch. Good thing we're never too old to learn new tricks. :yes:

Sounds like you are learning allot. Different when you are on the other side.

Specializes in Ambulatory Surgery, Ophthalmology, Tele.

I was going to say "Go get 'em Tiger!" But that just sounds weird.....:facepalm:

But seriously, congrats to you Viva. :hug:So happy you are enjoying your new adventure. Keep us posted. :up:

Congratulations .. Good luck thank you for sharing it :D

Specializes in LTC, Agency, HHC.

That's great, Viva! I am looking forward to your updates!

I am a new nurse on a med surg floor and I'm miserable. I Iove my patients and most of my colleagues but I find myself running around crazy and the hospital keeps piling on more work and the charting is insane. I feel I have no control of my own practice. I suppose this is what its like in hospitals in general. I'm disappointed. I always planned to go into a nursing specialty that includes a leadership role and involvement in helping community and patients to have their healthcare needs met. Has a anyone moved from floor nursing to a surveyor for The Health and Human Services in TX. My current job pays 23.50 and I feel that I dont want to leave this job unless the surveyor job Im interviewing for is worth my while financially and mentally. Thank you

Congratulations . In what State do you reside ? What is required to become a State Surveyor ? I enjoy all of your articles . S.Reynolds RN