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.

"JUST"?!?!?!?!? You have worked long and hard to get where you are. It is a pet peeve of mine when someone says "They are JUST a (CNA, LVN, floor nurse)......Sorry, I'll get off my soap box, but don't be so hard on yourself, and don't let anyone else get by with it either. HUGS to ya!

anytime

As a state surveyor in Texas, I am on the road A LOT.....if you have small children that is something you have to decide. One of my co-workers has small children, but her husband is a stay at home dad. Works for them. I love my job, but fortunately I'm able to travel, our kids are grown. The state benefits are wonderful!

I would start by looking at your state health and human services website. In Texas, it is DADS - Department of Aging and Disability Services, but each state is different. You might also try CMS - Center for Medicare and Medicaid Services, that is the Federal side. I wish you all the best, and if that doesn't work, let me know and I'll dig further for you.

I do have to say that I was not pleasant, I did not back down, I did tell him to calm down and treat me with respect(at the top of my "mom" voice). Then I called the CVOR coordinator to come relieve me and went to the managers office and lit in the middle of him. Then I quit, then filed charges.

When I worked CVOR and reported the surgeon for throwing scapels, bloody towels, clamps, etc. I was called into the OR manager office and told "The surgeons bring in the money, nurses are a liability" We have worked with this surgeon for over 20 years and that is the way things are. I immediately put in my 2 weeks notice, then told my manager that I would be filing assault charges.

You are obligated to report this to state. NOW!. Also as a previous poster stated, also report it to your state board of nursing. Call your state reporting hotline. ASAP, if not sooner. I am a "state investigator", my mantra is "it is better to report it to be safe, than not to report it and regret it."

As a float nurse, or as a prn pool nurse, my nurse manager (when I was floated) or the house supervisor (my boss when I was prn pool) would often give me little thank you gifts. Especially when I had a rough shift. They did listen when I told them not to call me or send me to certain floors because of the negative experiences I had. As a previous poster stated, I worked prn pool for personal reasons. I was taking care of my dying mother, was a newlywed and was taking online courses towards my masters. Everyone has a reason for the actions they take for work. I did like working prn because I could always say NO, and they knew not to call me. I would often give the house supervisor a copy of my mothers medical appointments and my school schedule and told them I would not be available. Sometimes the charge nurse or nurse manager of a certain floor would call and beg, but they soon figured out that I would only be available to the floors that treated me like they were glad to see me and not dump all over me.

I have experienced "ungratefulness" from the home floor staff. Several times, when I was floated, or when I worked "house pool", I ended up with the heaviest patient load from the regular, home staff. I have spoken up, but was ignored. Finally, I told the house supervisor not to call me for certain floors because of it. That finally got TPTB attention.

Oops. Surveys can leave the building. But cannot exit the investigation or survey until the immediacy is lifted. Often we will inform the Administrator, DON, and whatever other department heads they may want to know. Then we leave the building for lunch or whatever to give them a cool off period. I commend the Administrators and DONs that jump on these. I work very hard to build good relationships with the facilities. The people who benefit from it are the residents. The residents are the reason any of us are there. My normal "speech" runs along the lines of.......many times we (surveyor/investigators) are the last voice a lot of the residents have. That is a responsibility that I take very seriously. I'm not saying you don't. But please look at this as a learning experience, as painful as it may be, we still need to work together for the residents.