Inaccurate Daily Nurse Staffing Postings Across Multiple Shifts
Penalty
Summary
The deficiency involves the facility’s failure to ensure that daily nurse staffing sheets accurately reflected the actual nursing staff who worked on 6 of 7 reviewed days. Surveyors compared the posted daily nurse staffing sheets with the internal nursing staff schedules and found multiple discrepancies. On one day, the schedule showed 5 LPNs and 11 CNAs on first shift and 1 LPN, 8 CNAs, and 3 CMAs on second shift, while the posted sheet showed only 4 LPNs and 9 CNAs on first shift and 2 LPNs, 9 CNAs, and 1 CMA on second shift. On another day, the schedule listed 4 LPNs on first shift, but the posted sheet showed only 3 LPNs. On a third day, the schedule showed 4 LPNs and 1 CMA on first shift, while the posted sheet showed 3 LPNs and 2 CMAs. Additional discrepancies included a day when the schedule showed 7 CNAs on third shift but the posted sheet showed 6 CNAs, another day when the schedule showed 5 LPNs on first shift but the posted sheet showed 4 LPNs, and a day when the schedule showed 1 RN on third shift but the posted sheet showed 3 RNs. Interviews with facility staff revealed confusion and inconsistent practices regarding responsibility for posting and updating the daily staffing sheets. The staff coordinator and two receptionists were identified as responsible for posting the sheets, typically in the morning for all three shifts, and for updating them to reflect callouts or schedule changes. The staff coordinator stated she worked weekdays and expected assigned nurses to make revisions after hours and on weekends, but she was not aware that the sheets had not been updated on the identified dates. One receptionist reported assisting with posting and stated that she, the staff coordinator, and nursing staff were responsible for revising the postings, but noted that nursing staff sometimes failed to communicate changes when staff called out. The other receptionist stated she never made revisions, had not been educated to do so, and had never been told it was her responsibility. The administrator stated that the staff coordinator was responsible for posting and updating the sheets and that he expected the sheets to be updated as needed to reflect the correct number and hours of nursing staff for each shift, and he assumed nursing staff made revisions when the staff coordinator was unavailable.
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