How many deficiencies does your facility have?

[TheCommuter]

How many state-issued deficiencies does your workplace have?

I think that the facility in which I am currently employed takes the cake in this category. The most recent full book state survey of the nursing home where I work yielded a whopping 47 deficiencies, 8 of which were IJ tags (immediate jeopardy).

[SuesquatchRN, BSN, RN]

It used to be like that at the facility I left yesterday. There is a union and somehow the thought was those people had jobs for life no matter how bad they were. We aren't making widgets, people. I've fired 3 people since I started. Is it annoying to have to dot every i and cross every t and show you followed the disciplinary procedure? Yep. Is it more than annoying to have to sit in arbitrations for hours until YOU feel like YOU'RE the guilty one? Yep. Is it worth it to make sure we have the best nurses possible taking care of our residents? You bet it is. Don't let the incompetent ones reign.

I'm up against a wall, CCM. The anger on my unit is palpable. The job I took was because the old manager died and he's related to half of the staff. The old doc is now working a different unit and they don't like the new one. If I ask if a patient had a BM I hear a shouted, "I'M NOT STUPID!" I have an evening nurse who never signs a treatment. A night RN who is so passive-aggressive it's infuriating. Had a resident come back from the hospital Weds and the eve LPN does the body audit (I asked her to) and the RN was supposed to sign off. LPN notes "band-aid" where there's an open area. Eve RN got jammed, forgot to sign off the assessment, called night RN. She said, "I already did that." Come in, a day LPN tells me it wasn't signed off. I don't see it - the assessment. I am doing weekly wounds, 7 body audits, and MDSs. Make a note to checker her out later. I call eve RN to ask if she had done it. Next thing I know another day LPN is banging things around and SCREAMING at the DON's door about doing other people's jobs, yada yada yada. I had already been to the DON that a.m. because I KNEW she was going to go off. DON knows it isn't me.

I don't know how to deal with this nonsense. I just don't know how to deal with it.

[noc4senuf]

I have had other departments and supervisors ask what it is I do all day long (if they don't see me). My NHA and I have decided I am now "HR". Daily, I spend time working on documentation for union issues, terminations, arbitrations, unemployments hearings, Board of Nursing and now a discrimination claim. I keep reminding my boss that they didn't teach any of this in nursing school. This upcoming week i have on Monday a union grievance; Tuesday an unemployment hearing; the pharmacy bill, x-ray bill, lab bill and other bills will be in and i need to code them all out for payment; the budget for the upcoming fiscal year will need to be handed in within the next two weeks ( capital, operating and 80 employee wages with vacations and sick time) that is along with all my other duties as the DON. Gee, i guess i don't do much of anything.....

[RNMLIS]

I found it interesting that observing nail care was part of the survey process.

Pretty basic care and a very telling clue. Not noted in our survey as a defiency. I do not remember if that duty was picked up by management during survey time.

One of my pet peeves was nail care...the nails were filthy - I brought it up many times - I was told to tell the aides to do the nails - sorry, yeah right, that was not going to happen...the women's nails were painted. The filth was left under the nails. I was told that it was not the job of the activities person to clean the nails as she painted the nails....Management never told/asked the aides to clean nails but it was written in monthly meeting notes as suggested activites for the aides.

When not 'busy' the aides were busy watching tv or 'driving' towards the anticipated end of evening when they would eat and watch tv.

One is not inclined to go that 'extra' step whe always working understaffed and my guess is that nail care is one of those tasks than'can' be put off and ends up put off by eveyone.

I did not have time either, I told many family members to perform that care themselves or speak up and ask for that care...

something 'may' be documented but did it happen

with all the tasks that need to be done for proper/basic care given the patient to nurse ratio in LTC/sub acute skilled nursing facilities - there will be gaps in care and the more a facility 'gets' away with the minimum the more that facility tends to continue count on skimming on staffing to meet budgeting and so it goes..here is where finger pointing is real useful.The management blames the staff for being incompetent and the nurses blame... the enviromment becomes more and more toxic, the and the system rots and the residents suffer.

Does one call the BON anonymously and with out management not 'quessing' who called. I still believe that there are alot worse places than where I worked and there is something inherently 'wrong' with the LTC industry.

[debRN0417]

Chart reviews are important, but the most important thing is the resident. That is what we are all there for. If the resident is happy, then we are happy (when I say we I don't only mean as a surveyor, but as a caregiver). Facial hair, nails, mismatched ratty clothing, unkept appearances, bed head hair...all that is very important. We need to look at our residents as how we would want ourselves to look. Also oral care is a big thing. I have walked into rooms where the bad breath odor permeated the room- now that is bad....