When State comes to visit



Since I am a newly employed nurse, I was wondering what are the rules you have to follow when state comes to a nursing home? Could you, please, share your experiences so you can help me and other new nurses to know what to expect in advance! Today I learned that you can't borrow your key to anyone, even if you have a key where your cna's stuff are placed. The rule is that you have to go with your cna, unlock the door and supervise while he/she is inside than lock it again. There are a lot of tricks, so please share!

Specializes in Critical Care, Med-Surg, Psych, Geri, LTC, Tele,.

Just ask your boss. She / he will likely know the common areas that staff needs to focus on.

Yes, the "key" issue was one for us.

Also, knowing where our "resource" manuals were, incl company policies, drug books, care plan guides, etc.

Be able to explain the reason for giving any med you are giving along with side effects, precautions, etc.

We had some pts with bizarre behaviors. I worked inpatient psych. The surveyors wanted tons of info on these pts to be sure we weren't neglecting them.

And all care plans and charting had to be updated.

The state surveyors are more so looking at your facility, than you as a nurse, as long as you aren't doing anything egregiously wrong.

Oh, I remember I had to move my badge to my chest for the state visit. I usually kept it clipped to my pants pocket. 😀


21 Posts

Has 21 years experience.

Hi! I have been a nurse in LTC for 20 years. When state comes everything is done "by the book". Just like being a student in clinicalls. You will know when state has arrived because every other department is suddenly around and helping the nursing staff. We have medical record girls that suddenly appear to help the CNAs pass lunch trays. The activity department is suddenly appearing to pay attention to the lowest functioning residents. It can, sadly, be comical to see. I have always been honest when questioned by the surveyors. I believe they see thru the "extra" help that appears. Just do your job, be honest, and don't get so nervous. State comes in to make sure residents are properly cared for. As a LTC nurse, I also am there for the same reason.


14,633 Posts

Just do your job the way you should be doing it all the time ... :)

bluegeegoo2, LPN

1 Article; 753 Posts

Specializes in LTC. Has 11 years experience.

Try to remember that state isn't there to get you, they are they to make sure that rules/regs are being followed and that residents are receiving the care that they are care planned for.

If a surveyor asks to watch you do anything, it is perfectly ok to ask for a few minutes to prepare. You can refer to your policy/procedure manual or have your nurse manager/DoN go over the procedure with you. You can even request that your manager be present while you perform whatever state wants to see.

You can never wash your hands or change gloves too much, but you sure can wash/change one time less than you should have. We got tagged on our last survey as a nurse performed a dressing change to the textbook letter, but dried her hands on her scrubs after she was done. Insta-infection control tag. Remain mindful that until the surveyor in no longer in your presence, they are watching even if you're "done" with what they've asked to see.

Never ever, EVER tell a surveyor "I don't know" and leave it at that. My default response is "I'm not sure, but let me find that information and I'll get back with you." Then follow through. They know you don't know everything. What they want to see is that you know how to use your resources and find the information that they've requested. Case in point: I had worked at my current facility a whopping 2 months when state came in for full book and a surveyor asked to interview me. I grabbed a blank sheet of paper (knowing full well I was going to be asked a ton of questions) and went to the interview. Sure enough, I was asked many questions on P&P and that I was unfamiliar with and wrote down the questions. I told him the default "I'm not sure but..." and he agreed to meet back with me in 10 minutes. I gathered not only the answers, but where I found the info and answered his questions. He told me "Very good! That's exactly what you're supposed to do!" (A heartfelt thank you to my wonderful nursing instructors who pounded that nugget of advice into my head.)

Anyway, the surveyors are not beasts nor are they after your license, they just want to make sure you know how to do your job, find needed information, and know your facility policy. It's gonna be ok. :)

allnurses Guide

hppygr8ful, ASN, RN, EMT-I

4 Articles; 4,776 Posts

Specializes in Psych, Addictions, SOL (Student of Life). Has 21 years experience.

What the above poster's said - Know your policies and procedures if possible acquaint your self with Titles 22 and 17 of the US Healthcare Institutions code. Surveyors can be nice and some can be pretty nasty. They are not your friend and the safety of the residents is their only concern. Things they will look closely at: Medications especially expiration dates and labeling of OTC medications. Wounds and wound care plans especially for those which occurred in the facility. Changes of condition SBARS etc... Cleanliness of the unit. All equipment in good working order. Infection control procedures If something is wiped down with a bleach wipe it should air dry and is not safe to use again for 4 minutes. They may ask you this question. CNA's should have their own key that gives them access to those areas they normally have access to. Never give your keys to anyone other than another licensed nurse, your DON, or pharmacist if they ask. If your computer has a screen lock-out use it every time you step away from your cart. Lastly never leave meds at the bedside for patients to take later. If the patient doesn't want them now take them back to your cart. We had a hit because the med said take with food. and it was given with crackers. Surveyor said that was not enough food/ had to be a minimum 100 cals - we are fighting that one BTW.

This year they seem to be really focusing on facility acquired wounds; pressure ulcers, lacerations, skin tears etc.... and falls. So make sure there are prevention protocols that are being followed. If a patient resists being turned they need a non compliant care plan in their profile....

I think you get the picture.