DON Served as Charge Nurse During High Census Periods
Penalty
Summary
The facility failed to ensure that the Director of Nursing (DON) did not serve as a charge nurse when the average daily occupancy was 60 or higher, as required. Record reviews showed that the DON was scheduled and worked as a charge nurse on four separate occasions over a two-month period, specifically on shifts in both the 100 and 300 halls. During these shifts, the facility's census ranged from 116 to 121 residents. Interviews with the Assistant Director of Nursing (ADON), the Administrator (ADM), and the DON confirmed that the DON filled in as a charge nurse when the facility was short-staffed, and that this was not a pre-scheduled assignment but rather a last-resort measure when no other nurse was available. The DON acknowledged that while working as a floor nurse, he was unable to perform all of his DON responsibilities. The ADM and ADON both stated that the DON was only called upon to serve as a charge nurse when absolutely necessary and not as part of the regular schedule. The facility did not have a policy addressing the DON working as a charge nurse. No specific residents or patient conditions were mentioned in relation to the deficiency.