Our Blogs…

Read more: Our Blogs…

You don’t have to look far to see the increasingly high number of long term care cases threatening nurses licenses growing at a rapid rate.

WHY???

You have to understand the background and inner workings of Long Term Care to recognize why complaints, errors, neglect and malpractice issues happen. Long Term Care and Skilled facilities are governed by federal rules and regulations set by the Centers of Medicaid and Medicare (CMS), which means facilities must adhere to these guidelines, thereby allowing for strict over-site of their daily operations. This is the most common payor for resident’s in these facilities and changes occur rapidly, putting facilities behind the curveball many times, resulting in harsh penalties and potential cuts in funding. These regulations are designed to ensure patient’s are receiving proper care and facilities are operating in a manner that is approved by CMS. This is a good thing because it sets the framework for what we should be doing.

Unfortunately, a large majority of nursing facilities are being bought out and set up to abide by corporate guidelines which, lets face it, have a different focus in mind.

Policies and procedures set by corporations seem to have financial benefit as the motivator for what is done, as opposed to focusing on the care of the residents that are entrusted in their care. The biggest areas affected are typically staffing and training. When staffing levels are directly tied to the number of patients, acuity levels are not considered. Setting guidelines that encourage running on the least amount of staff possible, regardless of training, benefits corporations. As both a floor nurse and Director of Nursing, I have witnessed both sides of the coin, and nursing staff is being set up in positions that threaten their licenses daily. CMS provides “suggestions” on appropriate staffing levels, but that is just it, a “suggestion ” as far to many facilities run well under those guidelines by establishing their own policys.

How are licenses being threatened?

The most common way a nurse can lose their license is by MEDICATION ERRORS. I’ve been notified of nurses giving a wrong dose or type of insulin (worse one was to a patient that was not even diabetic). This causes one of the most detrimental effects on patients. Is it poor or lack of training or is it nurses rushing through med passes to meet facility time limits because of short staff and the need to take care of far too many patients for one nurse? I lean twords the latter. Not only are facilities neglecting to train or orient appropriately, but many times they are also setting unrealistic timelines that must be met as it relates to getting meds passed. According to the National Institute of Health, “adverse events resulting from unsafe patient care rank among the top 10 causes of death and disability worldwide.” (Tariq RA, et al. StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK519065/). In addition, it relates that “In the United States of America, preventable adverse events lead to an estimated 44,000 to 98,000 hospital deaths annually, surpassing the number of deaths attributed to motor vehicle accidents.”

Another dangerous pitfall surrounds failing to do COMPREHENSIVE ASSESSMENTS TIMELY and THOROUGHLY. There is an incorrect misconception that nurses in Long term Care are just there to push carts and pop pills. This couldn’t be further from the truth, as facility nursing is one of the most difficult nursing jobs out there. Patient levels are too high and growing as corporate owners and executive leadership push to fill beds. This large patient load leads to eliminating practices such as conducting bedside report which fosters an attitude of complacency because these patients seem stable, which in fact could be furthest from the truth. In recent news (and not the first time) an elderly woman was found deceased after wandering out of the facility, without anyone noticing her gone for 8 hours. Unfortunately, that patient died outside in the snow. The nurse will not only lose her license – but she is also facing homicide charges.

Failure to DOCUMENT. Who hasn’t heard “If it wasn’t documented then it wasn’t done?” I’m sure all of us had that burned in our minds in nursing school, yet it is becoming a common practice because there is such little time during a shift to document. Accurate documentation can save your license and protect you if an adverse situation arises. CMS is a stickler on documentation, as are other insurers, because it is how we prove that we are operating as mandated. We have to program ourselves to make documentation a priority, with rich, supporting evidence and proof of care. I see statements like “patient lying in bed with eyes closed” or “ongoing assessments will continue” another one “patient is pleasant sitting in her wheelchair.” I cringe when I see this because this is sure to get run over by the legal train if something occurs. There is actually a documenting guideline and checklist developed by CMS and is available to all providers which tells you exactly what to say…ask for it if you haven’t seen it. Fun fact: None of the above phrases are on it.

What Can You Do?

BE CAUTIOUS AND MINDFUL IN ALL THAT YOU DO!

• Ask for help if you feel pressured and unsure of your ability to provide safe care (and yes, your managers are responsible for hitting the ground and helping you…but we will save that for a later day)

• Think about your patient load before accepting the responsibility. One nurse to 60 patients is unreasonable and un-safe

• Lay eyes on and meet every resident before starting, during and ending your shift

• Become a strong partner with your ancillary staff (CNA’s, Restorative, PT/OT)

• Review the Policy and Procedures for your facility. Make it a practice to let your daily duties follow their lead. Ask questions if you don’t understand. Advocate for yourself and your license

• Stay Positive. Try to avoid the negativity that can develop among your colleagues because it will not help you keep your livelihood and will affect your ability to communicate with your manager in an objective manner and be taken seriously

• Express your concerns, request additional training, track suggestions and questions in writing and follow your chain of command. Having a paper trail will protect you by showing your issues were voiced to your manager

Long Term, Skilled Rehab and Assisted Care can be one of the most rewarding specialties because you get to learn so much more than in a hospital setting, you get to know your patients better and you learn how to advocate. If you choose this area of nursing as a career, the sky can be the limit. It’s not for the faint of heart, nor for those trying to just get a paycheck. Knowing the dangers and developing a strategy to keep your self safe makes all the difference.

Let me hear your thoughts…