DNS Served as Charge Nurse Despite High Census
Penalty
Summary
The facility failed to ensure that the Director of Nursing Services (DNS) did not serve as a charge nurse when the average daily occupancy exceeded 60 residents. Record review showed the facility's average daily census ranged from 75 to 85 residents, and the staffing plan required a full-time DNS to meet resident care needs. Despite this, interviews with the administrator, resident care manager, staffing coordinator, and DNS confirmed that the DNS and other nurse managers rotated on-call duties during weekends and were required to work as charge nurses if staffing coverage could not be found. The DNS acknowledged working the floor as a charge nurse under these circumstances, even though the facility census was consistently above the threshold where this practice is not permitted. The facility's contingency staffing plan allowed for interdepartmental staff support to address staffing shortages, provided licensure and certification requirements were not violated. However, the DNS and other nurse managers regularly filled in as charge nurses during staffing shortages, contrary to regulatory requirements for facilities with an average daily census over 60. This practice was confirmed through multiple staff interviews and review of facility records, which documented the ongoing use of the DNS in a charge nurse role despite the facility's census and established staffing policies.