Rumor? Re: RN's in LTC & Medicare

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Specializes in OB Labor & Delivery/PP/Nursery/Hospice.

i attended a hospice conference last fall. the speaker, a very high ranking nurse in her field, was talking about ltc.

she mentioned that in iowa, medicare is going to require an rn to be on the premises 24 hours per day. she told everyone that "yes, it is coming soon. within a year."

i have not heard anymore about this. i can't find info online.

while working home health our lpn was taken off of her duties as case manager as she could no longer supervise/evaluate cna's, which was a weekly duty. she could still do home visits. this change came from our state (iowa) nursing newsletter. our home health was county based. she was "demoted" in a sense from something she had been doing for over a year or more.

so, has anyone heard about ltc requiring an rn to be on grounds 24/7?

wish i could find my papers from that conference and be able to contact the speaker. she was great.

thanks, once again, for your answers!:nurse:

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Specializes in Med-Surg, ER, Mental Health.

ltc facilities where i live, in nova scotia, canada, are already required by the government to have an rn on the premises at all times.

during day shifts, a nursing supervisor, called "care coordinator", is on premises and is an rn...on nights and weekends, at least one unit in the building has to have an rn as the nurse working and is considered the "nursing supervisor" for that shift.

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nursescarlett, emerg rn :nurse:

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Specializes in hospital/physicians office/long term car.

The LTC facility I work for is in trouble if that happens in Illinois. We only have a couple of RN'S one being the DON and all the rest of us are LPN's

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Specializes in Geriatrics, WCC.

In MN and WI it is based on census. The 8 hour day shift needs an RN but, the rest is dependent on what your census is.

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Specializes in LTC.

At my facility we have to have a RN available on-call if there's not one on site. Oh, wait. Now that I think about it, there is at least 1 per shift. (Dozens of them on days). Interestingly, they are hiring more and more RN's and "need to cut nursing hours", but it's LPN's that are getting cut. Hmmm. Being replaced, we are. Nevermind, that's a whole new rant...

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Here in CT there is always an RN in house 24/7 in LTC. As far back as I can remember there was always an RN in house all the time.

But thinking about it, back in the day, there were more RN's working the floors in LTC than LPN's. I am now seeing that now, there are more LPN's working the floors and the RN's that are on staff are in the DNS/ADNS positions, and one or two per shift on the floor working as a supervisor.

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Specializes in OB Labor & Delivery/PP/Nursery/Hospice.
The LTC facility I work for is in trouble if that happens in Illinois. We only have a couple of RN'S one being the DON and all the rest of us are LPN's

What do you mean that u are in trouble if what happens? Having an RN THERE or NOT there?

We have our DON and ADON to call if needed. But when I am not working, there are no other RN's on duty. ALL the other nurses are LPN's.

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I'm not sure what is its in PA, but in just about all of them, an RN was on duty at all times. In one place it was under 50 beds so if we were really desperate and LPN worked 11-7 but I think an RN had to be oncall and withing a certain range of miles? Rarely does this ever happen because we've had alot of picc lines and IV pushes.

I really don't see this as a bad thing for LTC.

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Specializes in hospital/physicians office/long term car.
What do you mean that u are in trouble if what happens? Having an RN THERE or NOT there?

We have our DON and ADON to call if needed. But when I am not working, there are no other RN's on duty. ALL the other nurses are LPN's.

I just mean that if it happens in Illinois we only have 2 RN's that work for our facility and we do not have one there on the premises 24/7. Our DON is always available but not on the premises.

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Specializes in OB Labor & Delivery/PP/Nursery/Hospice.
I just mean that if it happens in Illinois we only have 2 RN's that work for our facility and we do not have one there on the premises 24/7. Our DON is always available but not on the premises.

Okay. I see. Is Illinois required by the state to have an RN on site/nearby?

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Specializes in Geriatrics, WCC.

This is what I found for you for the State of IL It is stating an RN is not needed around the clock.

TITLE 77: PUBLIC HEALTH

CHAPTER I: DEPARTMENT OF PUBLIC HEALTH

SUBCHAPTER c: LONG-TERM CARE FACILITIES

PART 300 SKILLED NURSING AND INTERMEDIATE CARE FACILITIES CODE

SECTION 300.1240 ADDITIONAL REQUIREMENTS

Section 300.1240 Additional Requirements

In addition to the staffing requirements, in Section 300.1230, the following staffing requirements also apply to all Skilled Nursing Facilities and Intermediate Care Facilities:

a) There shall be a licensed nurse designated as being in charge of nursing services on all shifts when neither the director of nursing or assistant director of nursing are on duty. If registered nurses and licensed practical nurses are on duty on the same shift, this person shall be a registered nurse. This person may be a charge nurse on one of the nursing units. (A, B)

b) There shall be at least one person awake, dressed and on duty at all times in each separate nursing unit. (A, B)

c) There shall be at least one registered nurse on duty seven days per week, 8 consecutive hours, in a skilled nursing facility. (A, B)

d) There shall be at least one registered nurse or licensed practical nurse on duty at all times in an intermediate care facility or a skilled nursing facility. (A, B)

e) There shall be at least one registered nurse or licensed practical nurse on duty on each floor housing residents in a skilled nursing facility. (A, B)

f) The need for licensed nurses on each nursing unit in a skilled nursing facility and each floor or nursing unit in an intermediate care facility will be determined on an individual case basis, dependent upon the individual situation. If such additional staffing is required, the Department will inform the facility in writing of the kind and amount of additional staff time required, and the reason why it is needed.

g) The need for an additional licensed nurse to serve as a "house supervisor" will be determined on an individual case basis. If the Department determines that there is a need for a registered nurse in a skilled nursing facility or a licensed practical nurse in an intermediate care facility on certain shifts whose sole duties will consist of supervising the nursing services of the facility, the Department shall notify the facility in writing when and why such a person is needed. This person shall not perform the duties of a charge nurse while serving as the "house supervisor".

(Source: Amended at 16 Ill. Reg. 17089, effective November 3, 1992)

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Specializes in hospital/physicians office/long term car.

I don't know for sure but they must not require one to be on site because the DON leaves about 5:00 and then it is all LPN's. We can call her at any time but there is not one there the rest of the time.

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