Deficient Training and Orientation for Registry Nursing Staff
Penalty
Summary
The facility failed to ensure that registry staff, who are nurses working on a contracted or as-needed basis, were effectively trained prior to independently providing care to residents. Multiple interviews and record reviews revealed that registry staff often did not receive orientation or training specific to the facility or their assigned residents. One nurse confirmed it was her first day at the facility and she had not been oriented or trained, only instructed to read and sign documents before starting her shift. Additionally, registry staff frequently lacked timely access to the facility's electronic medical record (EMR) system, resulting in delays in medication administration. A resident with diabetes and moderate bilateral non-proliferative diabetic retinopathy reported not receiving medications, including insulin, on time, particularly when registry staff were assigned. Medication administration records showed repeated late administration of insulin over several weeks. The resident described feeling unwell due to these delays and noted that care was inconsistent and slower when registry staff were present, especially on weekends and at night. Other staff interviews corroborated that registry nurses often did not have EMR access at the start of their shifts, leading to further delays in resident care. The facility had experienced significant staff turnover, including the absence of a Director of Nursing and a Director of Staff Development, which contributed to increased reliance on registry staff. The process for providing EMR access to registry staff was inefficient, particularly when staff were scheduled at the last minute. The facility's own assessment tool indicated the need to ensure all direct care staff, including contracted staff, have documented education, training, and competencies, but this was not consistently implemented. Residents and staff expressed concerns about the lack of consistent care and the negative impact on resident well-being.