Educational Med Pass Audit Deferred ...

[TheDailyBuzzherd]

... Good Nurse Out of a Job.

Greetings.

First of all, a big :bowingpur to all nurses everywhere who are on the front lines and suffer greatly giving care to the needy.

I am not a nurse, rather my wife is, I shall refer to her here as "Bea". Bea, you see, is a little nervous posting on boards as these, hence my presence. She will read any response this thread provides.

Here's the scenario:

Bea is an active LPN in Connecticut. She's been out there for nearly 20 years, and has never experienced what I'm about to relate. The question I raise regards the retaliatory practices of management against a nurse in good standing who tried to defer an Educational Med Pass Audit.

She worked at one CT nursing home for the better part of a year after serving another corporate home for over 15 years. Much as everyone else here who works in geriatric care, she's watched as the for-profit industry continually has applied more pressure on its workers as it gobbles up the non-profit independents. She also witnessed, unfortunately, the negative outcome when a nurse misjudges the corporate culture of her new employer in comparison to that of her old one.

THE FACTS:

• SAFETY FIRST: Audits slow down staff. Isn't the Hippocratic Oath the Golden Rule here? Isn't proper staff-to-patient ratios the surest way to prevent a crisis? Shouldn't this be the norm, particularly during an audit, rather than the exception? Sure, a nurse has to make patients' health the #1 priority, but shouldn't protecting her license be a close second?
  
  
• CT State Survey audits prove flexible: a nurse can ask for a postponement and get it. Not a day, just until things on a floor calm down. An hour can make the difference.
  
  
• Corporate culture differs from home to home. Where one will allow flexibility, another won't.
  
  
• Fairness: If a healthcare facility knows the state's coming, shouldn't a nurse be told an in-house audit is looming?
  
  
• Transparency: Isn't it a little disingenuous for a home to suddenly find staff support for a nurse during a State Survey? Where'd these people suddenly come from?
  
  
• Bea was a nurse in excellent standing with this home. She recently enjoyed a citation for perfect attendance. She has mostly honored all the overtime thrown at her. She's caught a lot of mistakes. She's never used drugs, yet she worked for a place that had nurse drug problems. ( Perhaps this fact says much about the administration's handling of her case. ) She fought for months to get 1st shift after getting excuses. She has NEVER been reprimanded by management for a single infraction.
  
  
• This is Bea's second employment as an LPN at a geriatric care facility in 18 years. This was her first internal audit at the home, and the first time she would witness a state audit. Unfortunately, she wasn't around long enough to witness that.
  
  
• Said home got a new Director of Nurses after the one who hired Bea steps aside noting insurmountable "politics" being the reason for her leaving. This occurs three months into Bea's tenure.
  
  
• The new DoN turns out to be a pit bull; the firings begin. Recently, a number of nurses left a number of 2nd shift vacancies, creating an obvious problem for all. It also appears to figure large in our lives, as you'll read.
  
  
• Bea is the mother of a young child, so 2nd shift is not preferred.
  
  

THE PROBLEM:

Two weeks ago, Bea knew a State Survey was looming, so she prepared mentally for it. One day, she was placed on a floor she hadn't been on for at least two weeks and it was "The Problem Wing". Which was OK by her, excepting the Home Office decided to throw a Surprise Educational Med Pass Audit® on her when she was the sole nurse manning the floor on a particularly difficult day. The pharmer doing the audit walks in unannounced, and is surprised when Bea asks for a postponement. Really? The company is notified of a time window when the State Survey will happen, yet the Home Office springs this on her at a most inopportune moment. Since Bea got more room to move when audited by the state, she was very surprised that this place considered in-house audit times to be COMPLETELY inflexible. Sensing that there could be trouble, Bea restated to the pharmer that she wish the audit could be done another time, but if necessary, she'd do it. Not good enough for Ms Pharmer. Seems that the only education Bea learned from this audit is that company policy is worse than the state's.

THE RESULT?

• Bea gets pulled into the supe's office the next day before lunch, is told The Pharmer was "refused" her services by Bea when she appeared for the audit. FALSE. Rather, The Pharmer was inflexible, and rewrote her story to make it appear Bea was simply insubordinate. Did lack of tenure figure here too? Guess 15+ years at another facility didn't count.
  
  
• Suddenly, Bea is told "she is not daytime material," despite the fact she has never been disciplined. Hmmm ... politics at work here? Is there someone else they'd rather have on days?
  
  
• Bea, anxious, unfortunately signs a Written Warning confirming her subordination. This is key here, as this is the only testimony she's allowed. Attempts made by her to explain her reasoning to the Director of Nurses is rebuffed. "Administrator Bighead agrees with us in this matter. Case closed."
  
  
• Bad Wisdom. NOBODY should have to go through this, PERIOD.
  
  
• Bea is given three choices:
  
  
  
  1) Go on 2nd Shift as soon as the next schedule goes out;
  2) Finish today's shift and tender your resignation within 30 days; or
  3) Leave now, but don't come back.
  
  

Bea opted for #3, mad because the REAL reason for this meeting is most likely retaliation: OUR HOME NEEDS 2ND SHIFT NURSES, AND WE HAVE SOMEONE ELSE IN MIND FOR YOUR SHIFT. Politics and no more. Hard to prove, but most likely, otherwise, why the hardball?

Their reaction? They were mad. They said that if she applied at another home she wouldn't get 1st shift. WRONG. Bea was passed up for 1st shift within her first month there for a newly hired grad, so that's just a lie. No, Bea didn't like that either. Their little plan to silence the lamb didn't work. Instead of getting a nice little subservient type who would tow their line and work the shift they pulled from her, they got a nurse with a bit of a backbone.

The company also didn't bother to pay Bea for all she was due. But they did find time to mail out a certified letter of a dubious nature that we will refuse. What's that about?

NOTE TO ADMINISTRATORS: Considering retaliation on your nurses? Actual Results May Vary.

Bea's in conference with NSO about this incident, and she may take it higher. She mailed a letter explaining herself in detail to her former administrator, who got an eyeful on what's fair game. 'cuz folks, THIS AIN'T FAIR. 'nuff sed from all the types who love to parrot these clichés: "Life Isn't Fair" and, "Cry a river, build a bridge, and get over it."

Lastly, isn't it telling that the Surprise Audit® was conducted days before the state's? Where the hell were they the rest of the year? Heh!

This whole thing has thrown us into turmoil. Not only is Bea out of a job, but she has a whole lot of fallout to deal with concerning this, not the least of which is this place filing a complaint against her license to the state, which fortunately has not yet occurred to our knowledge. But, who knows what the hell they're thinking?

Well, thanks for reading. We're sure this is not an unusual situation, and we know some of you may think it was unwise to even try deferring that audit. But she did it before, and the state proved far less of a ball buster than administration was.

So, what's fair here? Did Bea truly do anything unethical? Administration? What are her rights? Any thoughts are appreciated, and thanks again for this community. We should've sought it out sooner.

Wiser and poorer.

Up Above and Loaded,

Dat ol' DailyBuzzherd

[TheDailyBuzzherd]

Ooops, typo within, sorry. At one point, it should read, "insubordination".

Thanks for reading, we truly appreciate it. We hope it helps anyone else out there in the ether who may be going through a similar situation. 'cuz it SUCKS.

[CoffeeRTC, BSN, RN]

First off...it doesn't sound like a place that I would want to work.

I'm not sure what the surprise audit is in CT. In PA, our pharmacy sends a nurse out and they do occasional med pass observations. They do it to help us as a facility before the state comes in for the yearly. It is very low key, they do write up an observation thingy for us to review, but it isn't disciplinary in nature (unless of course something totally wrong occured) I've never heard of anyone being able to tell them no or delay it since they rarely do these type of evals. Again...it is relaxed.

I'm not sure on the legalities, but it sounds like she shouldn't have signed anything. ( I wouldn't have) and since she did???? What type of letter did they send out?

Sounds like you already have legal help (NSO)?

I don't think that she will have any difficulty in getting a new job either.

[barbyann]

I am sorry Bea is having a hard time with this situation. I think the facility has a point though. They need the staff to be "auditable" at any time. The state or feds could walk in at anytime to audit any number of scenarios and the employer needs staff that will cooperate as needed. Most of the time these inspections happen on 1st shift, rarely 2nd. That may be the reason for the offer of shift change. I did not even know it was possible to ask for a postponement. I do know that there are a lot of call outs on the 2nd and 3rd days of state audits though.

[oramar]

... Good Nurse Out of a Job.

Greetings.

First of all, a big :bowingpur to all nurses everywhere who are on the front lines and suffer greatly giving care to the needy.

I am not a nurse, rather my wife is, I shall refer to her here as "Bea". Bea, you see, is a little nervous posting on boards as these, hence my presence. She will read any response this thread provides.

Here's the scenario:

Bea is an active LPN in Connecticut. She's been out there for nearly 20 years, and has never experienced what I'm about to relate. The question I raise regards the retaliatory practices of management against a nurse in good standing who tried to defer an Educational Med Pass Audit.

She worked at one CT nursing home for the better part of a year after serving another corporate home for over 15 years. Much as everyone else here who works in geriatric care, she's watched as the for-profit industry continually has applied more pressure on its workers as it gobbles up the non-profit independents. She also witnessed, unfortunately, the negative outcome when a nurse misjudges the corporate culture of her new employer in comparison to that of her old one.

THE FACTS:

• SAFETY FIRST: Audits slow down staff. Isn't the Hippocratic Oath the Golden Rule here? Isn't proper staff-to-patient ratios the surest way to prevent a crisis? Shouldn't this be the norm, particularly during an audit, rather than the exception? Sure, a nurse has to make patients' health the #1 priority, but shouldn't protecting her license be a close second?
  
  
• CT State Survey audits prove flexible: a nurse can ask for a postponement and get it. Not a day, just until things on a floor calm down. An hour can make the difference.
  
  
• Corporate culture differs from home to home. Where one will allow flexibility, another won't.
  
  
• Fairness: If a healthcare facility knows the state's coming, shouldn't a nurse be told an in-house audit is looming?
  
  
• Transparency: Isn't it a little disingenuous for a home to suddenly find staff support for a nurse during a State Survey? Where'd these people suddenly come from?
  
  
• Bea was a nurse in excellent standing with this home. She recently enjoyed a citation for perfect attendance. She has mostly honored all the overtime thrown at her. She's caught a lot of mistakes. She's never used drugs, yet she worked for a place that had nurse drug problems. ( Perhaps this fact says much about the administration's handling of her case. ) She fought for months to get 1st shift after getting excuses. She has NEVER been reprimanded by management for a single infraction.
  
  
• This is Bea's second employment as an LPN at a geriatric care facility in 18 years. This was her first internal audit at the home, and the first time she would witness a state audit. Unfortunately, she wasn't around long enough to witness that.
  
  
• Said home got a new Director of Nurses after the one who hired Bea steps aside noting insurmountable "politics" being the reason for her leaving. This occurs three months into Bea's tenure.
  
  
• The new DoN turns out to be a pit bull; the firings begin. Recently, a number of nurses left a number of 2nd shift vacancies, creating an obvious problem for all. It also appears to figure large in our lives, as you'll read.
  
  
• Bea is the mother of a young child, so 2nd shift is not preferred.
  
  

THE PROBLEM:

Two weeks ago, Bea knew a State Survey was looming, so she prepared mentally for it. One day, she was placed on a floor she hadn't been on for at least two weeks and it was "The Problem Wing". Which was OK by her, excepting the Home Office decided to throw a Surprise Educational Med Pass Audit® on her when she was the sole nurse manning the floor on a particularly difficult day. The pharmer doing the audit walks in unannounced, and is surprised when Bea asks for a postponement. Really? The company is notified of a time window when the State Survey will happen, yet the Home Office springs this on her at a most inopportune moment. Since Bea got more room to move when audited by the state, she was very surprised that this place considered in-house audit times to be COMPLETELY inflexible. Sensing that there could be trouble, Bea restated to the pharmer that she wish the audit could be done another time, but if necessary, she'd do it. Not good enough for Ms Pharmer. Seems that the only education Bea learned from this audit is that company policy is worse than the state's.

THE RESULT?

• Bea gets pulled into the supe's office the next day before lunch, is told The Pharmer was "refused" her services by Bea when she appeared for the audit. FALSE. Rather, The Pharmer was inflexible, and rewrote her story to make it appear Bea was simply insubordinate. Did lack of tenure figure here too? Guess 15+ years at another facility didn't count.
  
  
• Suddenly, Bea is told "she is not daytime material," despite the fact she has never been disciplined. Hmmm ... politics at work here? Is there someone else they'd rather have on days?
  
  
• Bea, anxious, unfortunately signs a Written Warning confirming her subordination. This is key here, as this is the only testimony she's allowed. Attempts made by her to explain her reasoning to the Director of Nurses is rebuffed. "Administrator Bighead agrees with us in this matter. Case closed."
  
  
• Bad Wisdom. NOBODY should have to go through this, PERIOD.
  
  
• Bea is given three choices:
  
  
  
  1) Go on 2nd Shift as soon as the next schedule goes out;
  2) Finish today's shift and tender your resignation within 30 days; or
  3) Leave now, but don't come back.
  
  

Bea opted for #3, mad because the REAL reason for this meeting is most likely retaliation: OUR HOME NEEDS 2ND SHIFT NURSES, AND WE HAVE SOMEONE ELSE IN MIND FOR YOUR SHIFT. Politics and no more. Hard to prove, but most likely, otherwise, why the hardball?

Their reaction? They were mad. They said that if she applied at another home she wouldn't get 1st shift. WRONG. Bea was passed up for 1st shift within her first month there for a newly hired grad, so that's just a lie. No, Bea didn't like that either. Their little plan to silence the lamb didn't work. Instead of getting a nice little subservient type who would tow their line and work the shift they pulled from her, they got a nurse with a bit of a backbone.

The company also didn't bother to pay Bea for all she was due. But they did find time to mail out a certified letter of a dubious nature that we will refuse. What's that about?

NOTE TO ADMINISTRATORS: Considering retaliation on your nurses? Actual Results May Vary.

Bea's in conference with NSO about this incident, and she may take it higher. She mailed a letter explaining herself in detail to her former administrator, who got an eyeful on what's fair game. 'cuz folks, THIS AIN'T FAIR. 'nuff sed from all the types who love to parrot these clichés: "Life Isn't Fair" and, "Cry a river, build a bridge, and get over it."

Lastly, isn't it telling that the Surprise Audit® was conducted days before the state's? Where the hell were they the rest of the year? Heh!

This whole thing has thrown us into turmoil. Not only is Bea out of a job, but she has a whole lot of fallout to deal with concerning this, not the least of which is this place filing a complaint against her license to the state, which fortunately has not yet occurred to our knowledge. But, who knows what the hell they're thinking?

Well, thanks for reading. We're sure this is not an unusual situation, and we know some of you may think it was unwise to even try deferring that audit. But she did it before, and the state proved far less of a ball buster than administration was.

So, what's fair here? Did Bea truly do anything unethical? Administration? What are her rights? Any thoughts are appreciated, and thanks again for this community. We should've sought it out sooner.

Wiser and poorer.

Up Above and Loaded,

Dat ol' DailyBuzzherd

Poor Bea. Could this be a situation where the new managment wants to clear house of staff that served under old managment? Believe me I have been there and done that. Chances are that they were just waiting for that one moment of bad judgment that gives them the excuse to get rid of you. The give away is that the person is not given a warning or a suspension they are just fired outright.

[racing-mom4, BSN, RN]

Your post is very long so I must admit I just skimmed for some facts. What I gather is Bea requested some additional un supervised time before "pharm" observed her passing the meds.

I must agree with the facility, I do not think you are allowed to ask for notice before being supervised.

Why was is that she needed more time??? If I was in the shoes of the person who was coming to observe my 1st thought would be "what are you covering up---why are you not prepared for your med pass?"

As far as giving her 3 choices and her choosing to leave right now, I would most likely have done the same thing. If I was at a facility for 15+years with a flawless record I would like that to count for something.I would not want to remain where I was obviously not wanted.

In reality, had Bea have stayed--Mgmts mind was already made up about her and they would have found another reason to dismiss her.

From an outsiders perspective who admittedly just skimmed half of one side of the story, it to me sounds as though the facility would like to "clean house" as was stated in an earlier response. This is common in all industries, new mgmt comes in and they like to hire their own new staff. Having worked in the HR field 10 years prior to becoming an RN I have noticed this many times over.

Change is good. This may not be how Bea had planned to for herself to find a new job, but like the wise people say "some things just happen for a reason"

[TheDailyBuzzherd]

WOW!!! Thanks for the quick replies.

Michelle, a Surprise Audit® is just BuzzherdSpeak for your typical audit. She was simply used to one approach to audits which were more forgiving in nature than the response she got from the new place. I told her myself that attempting to blow off The Pharmer ( again, BuzzherdSpeak ) was bad form, and that signing that form made it worse and put all the good cards in management's hand. As you state, the point of an audit is to keep the nurse on her toes, not as a scare tactic or disciplinary device. But if Home Office truly is interested in their staff, they should remember it was her first audit, and should have allowed her to speak her side. If they'd known that her old place had been more lax, perhaps they wouldn't have been so flippant. So, the administration's handling was poor at best. It's not as if Bea had anything to hide - she knows her stuff. It was a question of fairness. If the facility can prepare for an audit, then so should a nurse. The facility did know the state was coming. That's the difference. We don't know what's in that letter; we haven't gotten it to the house yet. Until NSO contacts us again, we won't. They hinted to us it's in our interest to not accept delivery. It's the letter, really, that got Bea in contact with the NSO in the first place. We got the P/O's slip on Friday night. Fortunately, we weren't there to accept it - 'cuz if we were home, we might have.

Barbyann, I understand one shouldn't try what Bea did, but she has in the past, and the state AS WELL AS THE FACILITY was cool with it. But that was another facility. Further, it is possible that state mandates in CT may well prevent this now. It simply was a judgement call on Bea's part. Frankly, if the facility does perform an audit, a good clue to the nurse is that there's extra help on the floor, so expect one. An audit is good, but if it at all possibly could affect patient safety, then why risk it? Management is getting too ballsy, rigid, inflexible. A great way to dissuade people from getting into healthcare.

Oramar, I agree. We both smell a rat here. Bea had been hearing for months that the politics there were particularly bad. The good news is Bea already has a couple of bites on her line, so things can only look up from here. There's lottsa fish out there, and lottsa ponds to swim in. No sense in getting bit while trying to do your job and uphold your chosen profession.

Thanks for the kind thoughts, and keep 'em comin'!

[caliotter3]

As in all jobs, one must concurrently watch one's backside as one's frontside is spinning in circles trying to perform tricks for the employer. Always yes, sir, yes ma'am, how much, where, when, anticipate everything and tell them what they wanna hear. Fail to do that, and sooner or later you will end up on the short end of the stick. If they wanted to give Bea's daytime position to another, that was going to happen one way or another. You just can't win against workplace politics. You either benefit from it or it does you in. Best wishes that Bea finds a good position elsewhere. She might think about second or third shift. Both of these shifts have a slightly less exposure to TPTB.

[TheDailyBuzzherd]

Thanks, RacingMom.

I see your point, and I did point out in my initial post that management had a level of paranoia against its nurses due to some drug issues. I think that was one of the reasons Bea was hired in the first place - she was never a "key restricted" nurse at the first facility - the second place where this all happened had a BIG problem with staff stealing drugs.

However, I don't buy the "clean house" rhetoric. She was a new nurse, and until this happened, they were completely happy with her. I sure as hell wouldn't go back there either; it would be Intimidation City, and they'd work hard to make her wanna quit.

But here's the weird thing: WHY **** OFF NURSES WHEN THERE'S NOT ENOUGH TO GO AROUND?

Answer: Because for-profit organizations don't make money caring for old people. Nursing homes are simply real estate that make money, and when they don't, they're sold, as if they were old mattresses.

So, don't get old, don't get sick.

[TheDailyBuzzherd]

Thanks, Calioter. True ... so true!

If nurses had the ammo administrators had, healthcare would be tad different. Why, it might be better! A little more Jesus, a whole lot less green, y'know?