Have you ever worked as a state surveyor?

nightengalegoddess · Mar 28, 2011

I guess there are no RN surveyors on this site? Maybe they don't have the same needs for support as the other areas of nursing? Still waiting...would love to know how they got their positions...I've heard some say they just met the right people. Maybe next time the surveyors come, I will ask them how I can get a job with them.

**canoehead, BSN, RN** · Mar 29, 2011

I would like to know if surveyors prey on weak looking nurses and cna's? i would like to know what I personally can do, to keep myself out of their firing line. It seems like the French Inquisition. Why can't they just look around, watch and take notes? I work nights, and last year they called me over the phone, during a horredous night, and I had a headache and my period, and began to fire weird questions at me during my 6am med pass. Not, that I want them in on my shift, but if your going to question me for an hour, at least have the decency to get out of your fluffy bed and do it.

There is nothing someone could say on the phone at 3amish that would convince me they were a JCAHO official, acting in an official capacity. I'd be fired for saying " Duuuude, get off my ass. Seriously, who is this?"

CoffeeRTC, BSN, RN · Mar 29, 2011

This is coming from a LTC perspective.

Before the surevey begins, the surveyors have a list of residents that they will look at. The get his info from the QI stuff that is pulled from the MDS that they somehow have access to (forgive me for forgetting how). They will also look at your past surveys and follow up on the cites that you got before and see if the same issues are there.

Most often, when they walk in the building they just do a quick observation. If they see a dirty, disheveled person sitting in the lobby with a foley bag viisble and dragging on the floor with a tube feed and IV and dressings that look like they are falling off....they are going to find out who that person is. (dignity, infection control, wound care etc ) If they hear tons of yelling in a certain area...they might head over there and look around. (they might then target psych meds, psych service, behavior program etc).

Within the first half hour or so, the surveyors will get a roster/matrix and it will tell them how many people have what...skin disorders, recent admits, behavior issues, wt loss, falls, foleys etc. If they see that the 15 out of 30 residents have pressure ulcers they will target that.

They will also be supplied a great big book of everything from adm and that will include new hires, and other info.

It seems like they have a few target issues every year that they focus on and the coincide with any changes in the regs.

sasha2lady · Mar 29, 2011

I reposted my question when I thought I'd lost it originally. Sorry bout that. And as for the holes on mars, I was always taught if u don't chart it u didn't do it so if u don't sign for a med you didn't give it. Thus, there should be documentation somewhere explaining why you didn't give it . In one month I counted 51 holes just on half on one unit. There were many more but I got tired of counting them and stopped at 51.

I also find where tb tests are not done or read And 2nd steps are missing. That record is kept in each chart. I find expired meds and insulins alot too so I reorder them and dispose of the old per policy. I've also seen a restorative cna chart that she ambulated xyz patient and didn't do it which is where mds makes alot of money . I reported it but I don't know what came of it..probably nothing. When we are low on med A the facility targets medicaids and restorative to make up some of the difference. The mds nurse goes by what they have documented to code the mds. I'd love to be a surveyor. I hate being questioned or followed but I think being on the other end would be interesting

HealthyNurse · Oct 27, 2011

I would like to know if surveyors prey on weak looking nurses and cna's? i would like to know what I personally can do, to keep myself out of their firing line. It seems like the French Inquisition. Why can't they just look around, watch and take notes? I work nights, and last year they called me over the phone, during a horredous night, and I had a headache and my period, and began to fire weird questions at me during my 6am med pass. Not, that I want them in on my shift, but if your going to question me for an hour, at least have the decency to get out of your fluffy bed and do it.

From the perspective of a home health and hospice surveyor...I do not prey on "weak-looking" staff. I am generally very friendly and respective of all employees of the provider that I'm surveying, especially clinicians. I've found that it's usually easier to get information if I'm approachable and friendly. I go out of my way to make clinicians that I'm observing comfortable before I start the observation. If I'm asking a lot of questions, there is a reason behind it. It could be that I've done a chart review of a patient for which the clinician cared for and I need clarification on something. It could be that there seems to be a system-wide issue and I need to know how the organization has trained staff or if staff know what the policy is. It could that what administrators are saying is happening does not seem to be matching up with what is actually transpiring with patient care.

I always start out by being friendly; however, there are times when I have to be a bit less pleasant. I am never rude, but I will address a situation if someone is lying to me, they are not giving me the information that I need, or they are otherwise impeding the survey process. This issues seem to come up much more with the administrators than clinicians.

HealthyNurse · Oct 27, 2011

I guess there are no RN surveyors on this site? Maybe they don't have the same needs for support as the other areas of nursing? Still waiting...would love to know how they got their positions...I've heard some say they just met the right people. Maybe next time the surveyors come, I will ask them how I can get a job with them.

I did not know anyone at the state when I got my position. I found it by looking at job postings on my state's employment site and applying and interviewing for the position. I have a background that fits well for what they were looking for- I have experience in the area that I survey, I have a master's degree, I am a writer, and I have experience in quality and patient safety. You don't have to have all of these things to get a job as a surveyor, but I feel that it helped me (I have colleagues that don't have any of these qualifications though).

HealthyNurse · Oct 27, 2011

Has anyone here ever worked as a state sureyor or known one personally? What kinds of things did you tag and why? Did you go into a facility and know what to look for from the start? I notice alot of mistakes when I work on a regular basis..med errors, transcription errors, holes on mars, lab errors and lab order errors. Lack of documentation, incomplete assessments and tb tests that are not signed that they've been done or read or halfway done yet state never catches this stuff when they survey?
Why is this? Can they not tag for it? They always stay in the charts so hoe can all these things not jump out at them?
Did you like your job as a surveyor?

As state surveyors, we follow the Conditions of Participation (COPs for Medicare) when giving citations. Each provider type (type of health care organization, i.e. hospital, home health, ambulatory surgery center, etc.) has their own COPs. A citation is given if there is evidence that the provider is not complying with a COP. State surveyors follow survey protocols for each provider type. There is a process that you follow and certain things that you look at both prior to the survey and during the survey. I can't speak to the MAR issue or the reason why surveyors are not catching issues at your facility. I will sometimes give a citation based on one finding in a record, if it is a particularly egregious situation. One the other hand, for some types of findings, I will wait until it is evident that there is a trend in multiple records before giving a citation. It depends on the situation and also on the provider.

I do enjoy my job tremendously. There is a lot of travel involved though, so you have to be prepared for that. It is very rewarding work in that you have a direct impact on the health and safety of so many patients.

dragonheart, MSN · May 4, 2013

State surveyors use the federal/state regulations for licensing to determine compliance.

Recommendation:

If the Regulations for LTC, Assisted Living, Hospitals, Hospice .... are not readily accessible then use the search engine of choice (Google, Yahoo....) and look up the regulations.

You will see what the regulations are. The survey is not supposed to be/intended to be a mysterious experience.

They are conducted for the purpose of determining compliance with the federal/state regulations or Conditions of Participation. The surveyor team follows a process of survey activities to make objective determinations specific to regulatory compliance.

This survey process includes interviewing new employees and a sampling of different staff types which includes CNAs.

It is typically unannounced so that the observations are based on a snapshot of actual day to day facility practices.

Some facilities have a mock in house survey team. These teams conduct internal surveys and provide their own internal findings to departments. If your facility has an internal survey team, you might request to become member.

All surveys are public documents,and available upon request or if you are willing to research where they posted for review. You could go on- line and review a few to determine what the completed survey process looks like in final form for your facility.

Vincent12 · Dec 12, 2014

What is the surveyor salary and hours?

srercg · Feb 23, 2016

I don't think they should be allowed to do things like "follow" a nurse for a long time. Watching a nurse for a few minutes - "snap shot" so they say - is one thing, but I've seen where they will tag along /watch a nurse for their entire shift.

I would also like to ask that if they realize -especially in long term care facilities/skilled nursing care - that these places provide very little training, and usually don't push rules/regs until they know its the time of year surveyors are coming out? Like if surveyors are there - all of a sudden they have adequate staffing, or unit managers, and administration that usually any other time do nothing with patients or helping on the floor - will all of sudden be helping when surveyors are there. They will all of a sudden have adequate number of CNA's, and right before, or even during will have things like "inservice /training" sessions where they make the nurses quickly sign off on all the "training" they'd be given that they really had not. Administration, and management ignores complaints from staff that this stuff is needed, but never happens until the surveyors come around - and if anything is wrong, the nurses and staff that have been dealing with it all get blamed - and of course there are mistakes, because when surveyors aren't around there is no staff, no help, and more demands on fewer people.

Do surveyors realize this goes on? And if they know - why bother to keep surveying, or why not call them out? I don't get what the point is if the minute you leave its back to the way it was. . .

The only thing I've seen come out of surveyors visits is that the people who work hard all the time with little help get written up, and lose their jobs over it - which isn't helping the patients at all.