CathRN

go to Florida's state page, google florida regulatory services for nursing facilities

www.cms.gov then appendix p, pp and q. PP is the regulations (tags), P is the survey process, and Q is the Immediate jeopardy appendix

My mother was a heart transplant recipient, had implanted medi-port due to being a hard stick from so many previous surgeries prior to transplantation...Anyway.......when I would take her for her checkups, the lab staff are not allowed to access any type of port (they are not nurses) and mom refused to be stuck. This major hospital asked me if I was a nurse, mom replied for me and from then on, the lab would ask me to access her port and draw the labs. Did I feel comfortable? No. Did I do it for my mom? Yes. Did I talk to her Dr about it? Absolutely! He also wrote orders for me to access and draw labs for her. I drew the line when they asked me to change her Foley! There were parts of mom I just didn't need to see!

Try State Surveyor jobs, lots of travel, but easier on the body, but it is stressful. How about home health, hospice or MDS coordinator for a nursing facility? Weekend RN supervisor for nursing facilities, home telephonic case management, the possibilities are only limited by what you desire.

Actually, I would cite it as Neglect. They are neglecting to provide proper care for the resident by refusing to use the lift. They are also neglecting to follow the plan of care.

For the posters who didn't know what SOC was, you can go to www.cms.gov and type in OASIS, and it will take you step by step on OASIS. In Texas, there are seminars everywhere that you can go to for OASIS training as well.

Oh my, it seems like I'm OCD and share traits with most of the posters here. Even though I don't work in the hospital setting, my brain sheet is a MUST! I can't function without it. And yes, I catch a lot of "flak" about it.

I am a new DON, previous surveyor and investigator. I'm very upfront and blunt. I also had one of "those" family members which every other sentence was "I'll move him (her husband who was very pleasantly confused Alzheimer's) to another facility. I would ask her if she wanted me to notify his physician to get a transfer ready and when would she like to pick him up? (He was total care). I felt that it was my responsibility to back my staff. She would yell and scream at them and I would go to his room and ask "What's the problem here?" I can hear you in my office and you cannot under any circumstance other that he is actively dying raise your voice to my staff. Of course, she would get mad. She also got mad when I self - reported when she slapped her husband, yes, an investigator came out and unsubstantiated, but from that point on, she made an effort to be a little more pleasant. When I shipped him out on day to the ER, she made sure that he was transferred to another facility at my urging that the other facility was closer to her home and she wouldn't have to drive so far and since this was the facility he was at originally, wouldn't she be happier there? I tried to kill her with kindness, when that didn't work I set hard boundries and make sure they were followed. It worked for us

www.cms.gov. That will take you to the main webpage. On the right upper side there is a search box. There you can type in Appendix P, which is the survey process - what the surveyors look at and why; Appendix PP which is the tags; and Appendix Q which is the Immediate Jeopardy information. If you need any help, message me.

As a new DON and former surveyor, www.cms.gov. I saved mine to my Ipad under IBooks. Download appendix PP (the regulations), appendix P (the survey process), and appendix Q (the Immediate Jeopardy guidelines). In the regulatory (appendix PP), the bolded type is the regulatory language, when it reads "a facility MUST" that is exactly what it means, there is no leeway. Then read the guidelines, that may help you in staying away from a tag. A must read is the appendix Q, that could keep you out of an IJ

As a state/federal investigator, I have seen this all too often. And yes, I do call IJ's when this occurs.

Were we separated at birth?

I forgot to add that I did speak with the attending physician and he said to go for it! He told me years later that he appreciated they way I treated his patients, that his patients and/or family would tell him that they enjoyed having me as their nurse. That was a heart warmer.

I have "bent" the dietary rules for my patients in the past as well. On my unit in the hospital we regularly received overflow oncology patients. I did get written up several times and many verbal warnings, but if one of my oncology patients requested a particular food item, I went out of my way to make sure that they received it. One time, I had an elderly, dignified gentleman that was an oncology patient, his family were always present and the kindest people you could ever run across. This gentleman's wife mentioned one day that he really loved red and black seedless grapes. The next day when I came on duty, they received two large bags of freshly washed and refrigerated (he preferred them cold) red and black seedless grapes. As his disease progressed and the end was near, there were many times I saw his wife squeezing the juice from the grapes into his mouth. If that is all it takes for a patient and family, then of course, I would do it. That was just one example of "bending" the rules. The gentleman was not on any dietary restrictions, just "meals as tolerated" and the previous nurses deemed it safer for him to receive a soft, bland diet. UGH.

LOL SummitAP, the same goes for me. "I have some blood in my caffeine stream." So true.