Failed Before Getting to Work

 Sufficient, skilled and knowledgeable nursing staff is one of the key issues to quality care in any type of healthcare facility.  

 The nursing staff and other medical staff are a large part of the budget and cost in any type of facility.

 Analysis of the annual Cost Reports filed with the state, Medicare cost reports and staffing schedules is helpful to determine lack of sufficient nursing staff.

 Lack of staff can result in not only abuse and neglect to a resident / patient, but also a gain in profit for the facility.

 Sadly, a nurse may arrive for her shift and she has failed before even getting there because there are too many residents / patients on her care team for her to safely and appropriately provide care.

 The nurse expects knowledgeable and sufficient staff to support her and provide the “Nursing Standard of Care” during her schedule shift.

 The Federal Register 42 CFR 483.35 Nursing Services is specific to a certain degree in defining nurse staffing in long term care facilities.  

 It reads the following:

 483.35 Nursing services[1].

“The facility must have sufficient nursing staff with the appropriate competencies and skills sets to provide nursing and related services to assure resident safety and attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident, as determined by resident assessments and individual plans of care and considering the number, acuity and diagnoses of the facility's resident population in accordance with the facility assessment.” 

 However the question is......, what is the definition of sufficient?   It can mean only a few residents of 3 to 5 on your team or it could mean one to one if necessary to meet the needs of the resident. 

 The above statement for nursing services is extremely important in long term care facilities and other health care facilities as well. 

 An example of failing before getting to work was a case I reviewed. 

 The nurse, a retired military RN, who had worked in many areas of the world setting up MASH units and other acute care facilities. 

 Her skills were top notch and she was even overqualified for the job at this facility.  Yes she enjoyed direct hands on care and she wanted to continue to work after her military retirement.

 When this nurse arrived at work for her shift, the other scheduled staff nurse did not show.  Hence this RN ended up being in charge of 30 Medicare residents by herself, including new admissions from the hospital, post operation patients, hospice residents and patients there for therapy

 She was required to dispense medications and provide ordered treatments for all 30 residents during her 8 hour shift.  This was an impossible assignment and administration set her up to fail.

 Her assigned shift, with no other licensed nurses, it was impossible to provide the “Nursing Standard of Care. 

 The facility had not replaced other nurse nor had any back up  during the 8 hour shift 

 Sadly she “failed” before even getting to work and she did not even know it, until she arrived for work. 

 As of results of this lack of staff scheduled and insufficient staffing by administration, caused abuse and neglect to a resident on the unit resulting in delay of treatment and an early demise due to lack of nursing staff.

 The family took legal action against facility. 

Another example is a case I reviewed regarding an assisted living facility.  The nurse stated she alone for the 8 hours shift,  had 70 residents to pass medications for the entire 70 residents.  In order to dispense all the medications, she stated, "I prepared all the medications at once for all the residents for the shift at one time.  I started at one end and dispensed all the shift medications at once." 

My question to you,….. How many times have you showed up to work a shift and to find, lack of staff due to “call in”, poor scheduling or “no shows”?

 [1] https://www.law.cornell.edu/cfr/text/42/483.35