Failure to Provide Ordered Restorative Nursing Services Due to Staffing Reassignments
Penalty
Summary
The facility failed to provide restorative nursing services as ordered by the physician for one resident with hemiplegia and hemiparesis following a cerebrovascular event. The resident was supposed to receive restorative nursing services three times per week, as indicated by an active physician's order, but records showed that she only received these services two times per week during several weeks. The resident herself reported not receiving her regular therapy services, which she needed to prevent stiffness in her affected hand. Interviews with staff revealed that the Restorative Nurse Assistant (RNA) responsible for providing these services was frequently reassigned to work as a Certified Nursing Assistant (CNA) due to staffing shortages, and no replacement RNA was provided on those days. The Director of Rehabilitation confirmed the missed services and stated that he had no control over staffing assignments. The facility's assignment sheets did not clearly document when the RNA was working as a CNA versus providing restorative services, and the RNA estimated that on more than half of his shifts in the relevant month, he was reassigned, resulting in 20 to 22 residents per day not receiving restorative nursing services.