DON states she can't work as a nurse in LTC facility.

oramar · Mar 18, 2009

I really want to be respectful, but i am having a hard time understanding. the times i have been a DON, i have always held nurses accountable and never let them take advantage of me, but i also didn't let them sink either. if there was a "crisis" i was right there to help. I also covered this same DON for 3 months while she was off on medical leave. no one told me i wasn't allowed to help because we were greater than 60 beds! (it doesn't matter anyway...patient care comes first in my opinion)
Someone please help clarify this! It bothers me to know that she has no plans function as a nurse when needed.
At the same time..i don't want to be frustrated if there really is such a rule.

PS. Just want to thank you for being there for your staff. Like you say, it does not mean that I expect that a DON or a unit manager to be doing my work all the time. However, I have had managers and DONs that could do my job and everyone else's job in the nursing dept in a pinch, usually they turned out to the best at doing their own job. I guess they knew everyone else's job because they had vast experience and vast experience is most likely to produce a good management person. I have notice less and less of this type of manager in the last few years

Home Health Columnist / Guide · Mar 18, 2009

federal regulations do not permit don to be counted as staff nor work in that capacity when over 60 beds as needs time for administrative duties....fines have been levied even if done in a pinch. nothing precludes giving a bedpan nor participating in code if occurs during rounds..

from medicare snf cop (conditions of participation)

483.30 nursing services.

part 483--requirements for states and long term care facilities--table of contents subpart

b--requirements for long term care facilitiessec.

483.30 nursing services.

the facility must have sufficient nursing staff to provide nursing and related services to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident, as determined by resident assessments and individual plans of care.

(a) sufficient staff.

(1) the facility must provide services by sufficient numbers of each of the following types of personnel on a 24-hour basis to provide nursing care to all residents in accordance with resident care plans: (i) except when waived under paragraph © of this section, licensed nurses; and (ii) other nursing personnel.

2) except when waived under paragraph © of this section, the facility must designate a licensed nurse to serve as a charge nurse on each tour of duty.

(b) registered nurse.

(1) except when waived under paragraph © or (d) of this section, the facility must use the services of a registered nurse for at least 8 consecutive hours a day, 7 days a week. (2) except when waived under paragraph © or (d) of this section, the facility must designate a registered nurse to serve as the director of nursing on a full time basis.

(3) the director of nursing may serve as a charge nurse only when the facility has an average daily occupancy of 60 or fewer residents.

http://frwebgate.access.gpo.gov/cgi-bin/get-cfr.cgi?title=42&part=483&section=30&year=2001&type=text

regs would apply to acting don's too..

debRN0417 · Mar 19, 2009

Thanks NRSKarenRN- The DON can't be scheduled as regular staff but there is nothing which prohibits her from helping out. I cannot understand how any one would not help out their staff and residents.

noc4senuf · Mar 27, 2009

I can not work as a charge nurse in my facility since have over 60 beds, but when I do help out on the floor, there is always some one else designated as charge. I have known about this reg for years and am always mindful of it. For those that do not know the reg (it's not new) then I wonder what other regs they do not know. My SOM sits on my desk and am always reerring to it.

I have no problem feeding, toileting, making beds, pasing meds ect. I am first and foremost a nurse.

debRN0417 · Mar 27, 2009

I can not work as a charge nurse in my facility since have over 60 beds, but when I do help out on the floor, there is always some one else designated as charge. I have known about this reg for years and am always mindful of it. For those that do not know the reg (it's not new) then I wonder what other regs they do not know. My SOM sits on my desk and am always reerring to it.
I have no problem feeding, toileting, making beds, pasing meds ect. I am first and foremost a nurse.

Thank you for what you do for your residents and staff...I hope they appreciate you!

bluegeegoo2, LPN · Mar 29, 2009

I would simply fall over dead in the floor if I saw my DON doing pt care. For that matter, I would suffer the same fate if I saw my UC doing pt care. It's good to know there are some DON's who will pitch in, and not just when state is in the building. Too bad that work ethic doesn't seem to apply at my facility.

freddiebear · Mar 29, 2009

To clarify this issue. There is a regulation that states a DON cannot be counted as a staff nurse in a SNF if the facility is licensed for so many beds but it does not prevent a DON from assisting one resident in an emergency situation or assisting a staff member to perform nursing care if they lack the knowledge or skill. Resident safety, and a residents life comes first. The regulation comes second. It is the DON's responsibility to hire and train adequate staff. Any DON with a conscience will put resident safety over a regulation. In my opinion anyone who would disregard a residents welfare could possibly be violating the nursing practice act. I have no respect for someone who has a nursing license that wont come to a residents bedside and help someone if the situation presented itself. In my opinion a nursing supervisor is responsible for delegating tasks to insubordinates and RESPONSIBLE for the care that is delivered or not delivered. I dont think they can ignore a staff members request for help. Sure they have all the right to expect that the staff they hire could and should be able to take care of residents without their divine intervention and have all the right in the world to discipline or terminate staff who cannot perform their assigned duties competently. But, if a staff member specifically asks for a DON's help, therefore making the DON aware that a resident is in need and they refuse and the resident suffers harm as a result they might be held liable.

Havin' A Party!, ASN, RN · Apr 4, 2009

Karen -- Thanks for jumping in. Was reading the thread and looking for hard regulatory info on the subject. Appreciate the education.

My take is different from what many posted. From my experience, the legalities need to be given greater weight than what most are providing here.

And we need to remember there are two aspects to the federal mandate: the actual terms of the directive; and the interpretation given to the words by the regulators, courts, etc.

Generally, DONs are preempted from furnishing direct care in larger facilities. Participation in a code and momentary assistance while in the course of her required duties would be exceptions.

RochesterRN-BSN, BSN, RN · Apr 4, 2009

I am in a 120 bed LTC facility and they are right now using LPN nurse managers until they can get RNs to be the unit managers.........however until then me and the DON, and one per diem RN that works a few hours here and there are the only RNs employed there! And here in NYS we have to have an RN in the building for 8 out of every 24 hours. There are things they can't do so me and the DON do all the RN only kind of stuff. Our DON does the skin rounds which included undressing, assessing and redressing a wound. She and I do the assessment part of the admits, post fall assessments, etc. She has her hands in the dirty! I wonder if this DON you have is working on a restricted license. We have a couple of LPNs that work on restrictions by the State Licensure agengy--they can't pass any narcs, can't touch them, hold the narc keys, nothing. I wonder if she is on a restriction that allows her to only do administrative tasks. ????? I would look up her license online to see. It would say it there. Here in NYS its the Office of Professions and they list all the people who hold licenses issued by the state and also list things like restrictions, etc on the license. I would wonder about that cause my DON works her A** off!

noc4senuf · Apr 4, 2009

I never stated that the DON can not work the floor. Some people just interpret the reg differently than others. It is 483.30 in appendix PP of the SOM. The whole purpose behind the reg is to ensure that each facility has adequate staffing in place. There is nothing that states that the DON can not work on the floor. I am sure most of us do in some capacity or other. I highly doubt that there is a DON working that is on a restricted license. What others have to realize though is that we haev plenty of other duties that were are responsible for also.

sasha2lady · Dec 24, 2009

Do we work at the same place??? lol...my boss is that way.....she doesnt help us do anything......never drew blood, never took anything to the lab for us, never emptied a foley, never put in an IV, never helped code someone, can barely do any of the assessments...yet tell us how to do them or how they "should" be done......cannot complete a mar, has yet to give the first med, ..you get the idea here. Shes never said she wasnt allowed to do it.....I think she's forgotten or never really knew how to do these things. Once consumed by the all demanding conference calls etc.....actual hands on nursing just kinda fades.

pennyaline · Dec 24, 2009

I never stated that the DON can not work the floor. Some people just interpret the reg differently than others. It is 483.30 in appendix PP of the SOM. The whole purpose behind the reg is to ensure that each facility has adequate staffing in place.

The regulation exists to ensure that nursing department staff are adequately supervised and that department administrative duties are being completed by a DON who is not routinely otherwise occupied with hands-on care delivery. There is no regulation that states a DON can never work the floor or relieve other nurses.

I highly doubt that there is a DON working that is on a restricted license.

There are. I've worked under a couple of them now. One was absolutely no problem. The other was Jeckle and Hyde (mostly Hyde). It all depends on what the restrictions are and what they did to earn them.