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?
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 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.....Last edit by Joe V on Nov 4, '16
About VivaLasViejas, ASN, RN Guide
Joined: Sep '02; Posts: 26,646; Likes: 43,114
RN and blogger extraordinaire; from OR , US
20 year(s) of experience in LTC, assisted living, geriatrics, psychJan 11, '14So excited for you ****. Only piece of advice is remember not to allow yourself to get too revved up. They give you 6 months for a reason. I am totally confident you can do this and do it well. Just remember to monitor your mood overall.
Hope that didn't come off as a debbie downer moment. It was motivated by concern.Last edit by Esme12 on Jan 13, '14 : Reason: TOS/NO NAMES PLSJan 11, '14Quote from txredheadnurseI know. I'm going to need every moment of those six months to learn and absorb all the wisdom I can from other surveyors. That means I'm going to have to sit on myself and listen when I'd rather talk, and yes, I know I have to monitor my mood. I have good meds and a sleep routine, and I also have PRNs and a battle plan if things start getting wonky.So excited for you ****. Only piece of advice is remember not to allow yourself to get too revved up. They give you 6 months for a reason. I am totally confident you can do this and do it well. Just remember to monitor your mood overall.
Hope that didn't come off as a debbie downer moment. It was motivated by concern.
Funny you should mention it though. Did you know you can make a psychiatrist spit Diet Coke across the room by telling him that you've really only been going through an existential crisis for the past two years and that his diagnosis was wrong? Happened to me.Last edit by Esme12 on Jan 13, '14Jan 11, '14Good for you.. I am sending lots of well-wishes and good thoughts to you... And, they are lucky to have you.. Hugs..Jan 12, '14Best wishes in your new position! I have been through a bunch of surveys, and, truthfully, although a bit nervous, not really afraid. I was not easily frightened because I knew my stuff! MSDS book? On the shelf behind the nurses' station! How to do 'x' -look in the procedure manual. Types of isolation? Policy manual!
But the best was - - I was being questioned about my patient who was on contact precautions with MRSA, and the surveyor had his chart on her lap. And she would lick her fingers and then turn the pages. Ewww! After a few times, I leaned in very close to her, and asked her to please stop doing this! The entourage behind us - the DON, my head nurse and supervisor, and others - collectively gasped. The surveyor looked at her hand, then looked at me and said that she just never thought about this habit. And that it was inappropriate! When she finished her perusal of the chart, and her questioning of me, she shook my hand and thanked me! My employers were not impressed with my 'forwardness', and let me know. The next day, I was in the cafeteria, and the DON approached me. She said that the surveyor couldn't stop talking about what I said and was glad that someone stopped her from doing that! BTW, our unit got a perfect score, and I was the only one she spoke to!
I remained unafraid of surveyors, no matter when or where they appeared, because they are only humans with clipboards! Or computers, these days!
Try to put the individual nurses at ease, most are intimidated by your very presence!
Again, best wishes!Jan 12, '14Enjoy this new adventure. Try to not get yourself too worked up yet. Take your time with learning the material. You'll do great things with this position and help keep patients safe. Good luck and take it easy on yourself!Jan 12, '14Thank you all. I know what it's like to be that nurse quaking in her Danskos as the surveyors follow her on a med pass, so I don't think I'll be too intimidating. Inquisitive and thorough, yes, but I don't see the need to go on a power trip (and I know there are surveyors who do).
And, I am trying to pace myself. I'm really, really excited (as if you didn't know) but also well aware of my tendency to go overboard at first. I've always been a sprinter, not a marathon runner, and I know that's got to change if I want to last longer than a couple of years. Fortunately, there are built-in constraints during the training period---I literally CAN'T take on too much responsibility, or advance more quickly, because they won't let me. They want new surveyors to learn the job thoroughly, because there are many times when a facility will appeal a citation and we have to be able to make it stick if it goes to an administrative law judge.
So don't worry too much, folks. I'm under no illusions that I can do this without taking care of myself. I know I still have limitations, and it's almost like I have to live a double life in order to have a "normal" one. But I'm finally well, and for now that's good enough.Jan 13, '14I know how hard the transition can be from a "normal" (floor) nursing job to a more outlying position. Your job is vital, and critical to the welfare and safety of patients, and I believe that you are just the kind of person that is needed in that job! I am so happy for you, and know you will become the most awesome surveyor ever. Happy trailsJan 13, '14Congratulations! You will be a great surveyor. Be certain to let us know how it is coming along. I can't wait to read your updates.Jan 14, '14Congratulations 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.Last edit by llKristenll on Jan 14, '14 : Reason: added comment
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