I realize it has been awhile since the posting regarding what agency nurses see when going to LTC facilities, but I did want to add that in our facilities we make it a practice of following all workers when they are being observed by a surveyor. There are several reasons that we do this- there have been several times a surveyor doesn't quite recall the way a procedure was carried out, a 3rd pair of eyes and notes made during the procedure go a long way if end up in IDR. Staff get nervous when with surveyors and reminders or a familiar face can make a difference. There is a nursing shortage and we have begin to experience nurses job hopping due to competitive wages and benefits. Those homes that have used agency instead of the DON and supervisors working have had surveys that are not quite as good...possibly due to unfamiliarity with the home or lack of dedication to the home/facility, etc. It is a very hard job and we do experience in some facilities, large turnover-but for those meant for the job...there is no other place.