State Survey...Advice Please

Specialties Geriatric

Published

HI,

I am a recent LPN graduate working on a temporary license at a local nursing home. I have been there about a month. Anyway, I just completed my orientation and got placed on a med cart alone 2 days ago. I was off today and I was called and told that state had walked in to do the survey and that they would be there tomorrow also, (which I work).. frankly I am terrified, I do not know what to expect and cannot get anyone I work with to tell me much either. The only thing I was told was that an RN would go with me to do invasive procedures to follow the legalities of my temp license. I really do not know what is and is not acceptable to the state as far as med pass because I have had a really shotty orientation. The only thing I have been told is to be sure I was through with med pass in the one hour time frame, which is impossible for me because I have 74 residents and patient safety seems more important to me.. anyway, I am sorry this was soo long but I desparately need some advice!!!

Thanks!!

Leelee

Specializes in Gerontology, Med surg, Home Health.

Management needs to worry and not the staff nurses?!?!?

You're right. I need to worry that the staff nurses have screwed something up royally...something that they should have learned in school but are too lazy or too stupid to do right.

I do my job...I'm not worried about MY work causing a problem or getting the facility an F or G tag. I can not check every chart for every nurse's note or every missed med. Staff nurses need to take responsibility for their actions or lack of actions.

Last year after survey I had to spend 6 eight hour days doing the plan of correction and you know what...NONE of the mistakes were mine.

We have the surveyors in the building now and once again, it's not management making the mistakes.

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Specializes in Emergency Department.

CapeCod...did you have a really bad day?

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Hi you have heard the expression sh--rolls down hill. That is what has to happen. Unfortunatly management is held responsible for what the staff does not do. I have seen many a DON lose her job because a survey did not go well. Most companies seem to feel if the DON does her job then the floor nurses will do theirs. I know from experience that is not always the case. Even with multiple inservices and what seems like incessant reminding things still do not get done. It is management who is held accountable.

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Specializes in Gerontology, Med surg, Home Health.
CapeCod...did you have a really bad day?

LOL...yes, in fact, I did. We are in the middle of survey and the surveyors have already found a few things that we all learned in nursing 101 but somehow some people just don't get it. I am very approachable as a manager and spend most of my time on the floors and not in my office. It still angers me though to have to be the one explaining to a surveyor why something wasn't done the right way when I wasn't the one who didn't do it. I really want to say:"Ask that nurse over there...the one who has been a nurse twice as long as I have ...why she didn't date her assessment or why she didn't medicate someone after she scored them a 4 on the pain scale."

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I have been through so many surveys now that it never bothers me when they come. I have been the treatment nurse and the medication nurse and the charge nurse... you get it. This last survey was very interesting we had no DON so they sent us a corporate nurse and then suddenly our ADON's daughter went into labor - perfect timing -I became the acting ADON basically because I know all the residents and staff and am the longest person employed there. That was more nerve racking then having them watch my med pass. With experience the surveys aren't so bad and many times they can get some much needed action for both residents and floor staff.

:balloons:

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Management needs to worry and not the staff nurses?!?!?

You're right. I need to worry that the staff nurses have screwed something up royally...something that they should have learned in school but are too lazy or too stupid to do right.

I do my job...I'm not worried about MY work causing a problem or getting the facility an F or G tag. I can not check every chart for every nurse's note or every missed med. Staff nurses need to take responsibility for their actions or lack of actions.

Last year after survey I had to spend 6 eight hour days doing the plan of correction and you know what...NONE of the mistakes were mine.

We have the surveyors in the building now and once again, it's not management making the mistakes.

Maybe some suggestions to help the staff nurses would be in order.

Like maybe proper staffing, and not overworking the nurses to the point of exhaustion. Understaffing equals mistakes in alot of instances.

Also, it would be a good idea not to wait until the state inspectors show up to try and make sure everyone knows what to do.

Do some periodic checks yourself thruout the time inbetween inspections, and have some inservices to frequently educate staff and bring reminders up about proper procedures.

Frequently check the medication sheets to make sure everything is right.

You might be doing these things already, but you did say you had alot of mistakes that took a while to correct.

I've worked in nursing homes that just smell "mistake city".

The medication sheets left alot to be desired. No wonder they had so many writeups.

But staff nurses can't do all the checking all the time. It's a difficult job to get the med passes, treatments done, doctor's orders, feeding and observing during meal times, incident reports from resident's falls, etc. Doesn't leave alot of time for periodically checking by staff nurses.

And you might not even work in a NH......but I did, and I know how hard it is.

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We are going to have state surveyors here any day now... I work the 11p-7a shift so it's not likely that they will be here during my watch, but I am still nervous. I keep going over the rules with my LPNs... lock the cart when you step away even for a second, hit the screen saver button on the medcart computer when you walk away so resident information is not displayed (HIPAA), use the alcohol gel between residents but no more than 5 times before washing your hands, etc... it's nervewracking, but just remember- they can't eat you.

Lori

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Specializes in Gerontology, Med surg, Home Health.

Lori-

Our surveyors just left yesterday afternoon. They might not eat you, but they surely chewed us up and spat us out. They were rude, intrusive, and one of them told a bold faced lie to one of the women from corporate. I think it's time for me to change careers.

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Oh my goodness... I am so so sorry. What happened???

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We had our survey about 3 weeks ago and I am thrilled to say that after 12 annual surveys this was the best one as far as the way we were treated. The surveys were polite, friendly, professional. The 3 tags we recieved were expected and thankfully they were D levels. The tried to tag us in another area but allowed me time to sit down with them and explain the reason for the way we handled the situation. Our facility at least this year did not feel that there was any agendas or that the Surveyors were out to get us.

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Specializes in Gerontology, Med surg, Home Health.

Congrats on your good survey. We definitely felt they were "out to get us" especially in the area of pressure ulcers. One of them went on for 15 minutes about how she hated our documentation form...too bad, sister, it complies with the regs. Then when she couldn't tag me on that (I'm the wound queen) she had the unmitigated gaul to ask me why I was doing a wet to dry dressing on a pressure sore which had healthy tissue. I explained to her that this particular woman had been admitted to my facility with a stage FOUR ulcer on her buttocks. It was 7 x 7 cm wide and almost 4 cm deep. Now it is less than 1x1 and about 0.2 cm deep. I told her I would NOT change my treatment plan as long as the wound continued to heal....zowie...she wouldn't even give us any credit for the almost miraculous resolution of this woman's ulcer. To top it off, one of the corporate big wigs was there to 'help'. She was rude to my staff and counter productive and then...are you ready for this...she reported something to the DPH without checking with anyone in the facility...not the DNS..not the Administrator...not me...no one!! Sorry for the rant but first it was the Joint Commission Survey...a week later DPH...I have been working 12+ hour days for more than 2 weeks and it fries my nose (thank you Mumbles Menino mayor of the great city of Boston) to have to put up with corporate snakes.

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Specializes in LTC, Hospice, Case Management.

CapeCod - I read your posts frequently and I am nearly convinced we work for the same corporation (some of these "consultants" are snakes in sheep skins). Anyway, try to keep your chin up. I'm feeling pretty burned out too and thinking maybe I just need a change out of LTC - maybe 20 years is enough! But what to do? I'm gonna PM you my corporate name - let me know if we are the same.

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