State Requirements in LTC

  1. I just started working in a LTC facility (only worked 4 shifts so far), and am curious about state requirements. I keep hearing everyone say things like, "don't do this when state comes" or "state requirements are ..."

    Where do I find out what the requirements are that I must adhere to in my nursing practice? I browsed through the procedures manual on the floor, but it looks pretty antiquated.
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    About CRNAsoon

    Joined: Mar '04; Posts: 193


  3. by   Brian
    you can find all the boards of nursing in the united states at the following pages:

    for states beginning with letters:

    your state bon should be able to point you in the right direction. hope that helps.
  4. by   CRNAsoon
    Brian ... Thanks for the information. I'll check it out. For some reason, I thought "state" meant medicare/medicaid regulators or something along those lines.
  5. by   elkpark
    Your co-workers probably do mean Medicaid/Medicare surveyors when they refer to "the state." Every state has a state agency that licenses and regulates hospitals and other healthcare facilities, inc. LTC, and has state rules and regs that apply to each type of facility. The surveyors who enforce the state rules also enforce the federal, CMS rules and regs through a contractual agreement with CMS. I work for that agency in my state. These state and federal rules specify what agencies/facilities must do, as opposed to regulating individual nursing practice, which is what the BON does.

    The OK agency that does this is probably a division of the state Dept. of Health and Human Services (or whatever it's called in OK), and the rules are probably on-line at their website (that's how it works in my state). It can be complicated to figure out which sets of rules apply to which types of facilities, though, and reading through the rules may not actually clear up much confusion -- probably exactly the opposite! :chuckle I don't want to sound like I'm discouraging you from taking an interest in what rules apply to your facility, though.

    I hope you will exercise good judgment in deciding what it is OK to do as long the "the state" isn't looking ... My agency, in addition to doing annual routine surveys, also investigates complaints, which may be related to incidents that happened recently or quite a while ago -- so you never know what records we'll be looking at or what occurrence we'll be asking you questions about. Very little of what we cite in our investigations is related to something we saw someone do in front of us ...

    In all the years I've practiced clinically, I've never understood what the big problem was with just following the rules in the first place -- Best wishes for your new position!
  6. by   CapeCodMermaid
    In the state of Massachusetts, we are surveyed by the Department of Public Health. Waiting for them to come is like waiting for the Gestapo to march into town. They are downright rude and arguementative, and in 1000 years could never do what we do. It is a horrible thing to go through and I work in one of the best LTC's around! The rules are antiquated and the surveyors are power hungry.
  7. by   veteranRN
    In indiana we are surveyed by the Indiana State Board of Health and I think you can go their website for the regs. Probably close to the same thing in your state. Please just remember, follow the state regs at all times, not just when you are under survey.
  8. by   CapeCodMermaid
    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.
  9. by   RNPATL
    Do a search on google for Center for Medicare and Medicaid and that will bring you to the web site that has the Federal Nursing Home regulations. However, please recognize that there are several different sets of regulations that nursing homes must comply with on a daily basis.

    If your facility is certified to provide Medicare services, then the Federal goverment will inspect your facility at least every year. If your facility is certified to proivde services paid for by Medicaid then your facility will be surveyed under these regulations as well. Please remember that Medicare is a Federal program and is therefore surveyed under Federal guidelines. Medicaid is a Federally funded program that is State administered and therefore, Medicaid is surveyed under the guidance of the State inspection team. Then there is licensure and certification regulations. Each State has their own set of regulations that are generally referred to as Administrative Codes. For example .... in Florida, the FAC is also known as the Florida Administrative Code. These regulations are chapters that define requirement for a nursing home to hold a licensure to operate in the State of operation.

    Finally, most of the time the "State" refers to the insepction authority. When you are inspected by your State, the inspectors will actually survey your facility to ensure your facility is in compliance with all the applicable rules and regulations that govern the operation of your facility. The State inspectors mostly survey the facility for both State and Federal requirements. However, please note that there are times when the Federal government can and will send in their own team of Federal Inspectors to assess your facility's compliance with Medicare standards of participation.

    Did I ask you why you are working in a nursing home ..... oh, I digress .... anyway, most new nurses need to read their State's regulations so you have an idea of what is expected of you. However, you can read the facility policy and procedure manuals and this will give you a reasonable idea of what you must do as a nurse to ensure that you are compliant. Also, as an RN in a nursing home, you will be responsible to ensure that your nursing assistants and other ancillary help are compliant as well. Rules that seem to be the biggest target are generally the following:

    1. Resident's Privacy and Dignity
    2. Resident right to make choices
    3. Residents are free from abuse :angryfire
    4. Infection Control Issues
    5. Please lock your med cart when it is not attended.
    6. The resident has a comprehensive resident assessment (MDS) and care plan that is completed within 14 days of admission (for the MDS) and 21 days from admission (for the care plan).

    and the list goes on and on ..... if you have any more questions about this, I would suggest that you schedule an appointment with your Director of Nursing and ask her for resource information so you can learn the mirad of rules and regulations.

    Bravo to you for asking. So many nurses that go into long term care do not even have a clue about the regulations and many of them do not bother to search out the information.

    I am not just an RN, I am also a licensed nursing home administrator .... hope this helps!
    Last edit by RNPATL on Mar 25, '04
  10. by   leslie :-D
    and another notable target is the use of restraints and assessments to reduce the uses of such. no matter how antiquated you find these regs to be, i cannot emphasize enough how important it is for you to know them, or have a basic understanding of them. these people take their jobs very seriously, so even if you disagree, please get into the habit of doing things the right way. i too, work at an excellent, deficiency-free facility and am extremely proud of the nsg staff i work with. but please believe me when i say that dph's rules/regs/expectations are nothing to be taken lightly.
  11. by   CRNAsoon
    Thank you all so much for sharing this information with me. Obviously, I have a long road ahead and a lot of research to get through. I want to practice nursing to the best of my abilities and I'm very concerned about the state regulations and the persons training me. As my signature states, I'll be graduating with a BSN in May, so I'm still actively learning. But almost 80% of what I see going on at this facility is not what I've been taught in school. Compound that with the mantra of "state's coming" and I'm torn. I'm fearful that I'm not being trained properly to begin with. I'm definitely going to make an appointment with the DON and research the agencies that everyone wrote about. Once again, thank you all so much.
  12. by   bargainhound
    To get appropriate training for your goal career,you will have to get out of the nursing home.
  13. by   jyoung1950
    In all the years I've practiced clinically, I've never understood what the big problem was with just following the rules in the first place -- Best wishes for your new position![/QUOTE]

    On the one hand, I am glad that things were set in place to make life more comfortable for the poor souls who have to go to a nursing home.

    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'm a CNA and I have to say that, to me, that is abuse of the mentally alert. How would you like to have to room with someone who yells or cries constantly day in and day out. How would you like to room with someone who is free to wander into your area and go through your things and take them and not be able to do anything about it?

    My dad's in the nursing home I work in and for some 5-6 months had to bear with a guy who sporadically all night long. I wonder if the stress of this caused him to have more TIA's.

    I won't mistreat someone with Alzheimers or dementia ever but to put them with the mentally alert under the guise of patient dignity???? Come on, get real. What about the dignity and welfare of the ones who have to put up with them?
  14. by   CRNAsoon
    Quote from bargainhound
    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.