DON Frequently Assigned as Charge Nurse Instead of Full-Time Administrative Role
Penalty
Summary
The deficiency involves the facility’s failure to ensure that the Director of Nursing (DON) worked full time in the DON role and did not function as a charge nurse when the facility’s average daily census was 60 or more residents. The facility census was 69–70 during the reviewed period. The DON job description outlined extensive leadership, oversight, regulatory compliance, quality monitoring, staff education, and interdisciplinary collaboration responsibilities, emphasizing that the DON is responsible for providing strategic direction and operational oversight to the nursing department and ensuring high-quality, resident-centered care. Review of the nursing schedules and Daily Assignment Sheets showed that the DON was scheduled and worked as a floor/charge nurse on multiple shifts despite the high census. Specifically, the DON was listed as charge nurse on night shift with a census of 70, and on several day and night shifts with censuses of 69–70, and was scheduled to work 5 shifts out of 9 days as a floor/charge nurse. Staff interviews corroborated that the DON was often filling in as a charge nurse. An LPN reported uncertainty about when the DON would have time to complete DON duties, indicating that the DON’s time was being diverted from administrative and oversight responsibilities to direct floor coverage. Further interviews with the Assistant Director of Nursing (ADON) and the DON confirmed that both the DON and ADON were frequently working as charge nurses due to staffing issues, including staff not showing up for scheduled shifts. The ADON stated she worked more than 40 hours per week, was often on the floor, and had not had time to complete audits on wound care and CNA charting. The DON reported working most weekends and one to two nights per week, sometimes staying through the morning meeting, and acknowledged that she had not had time to audit Treatment Administration Records (TARs) or Medication Administration Records (MARs) weekly because of her frequent floor assignments. The Administrator confirmed awareness that the DON was often working on the floor and expected that when she did so, she was the nurse in charge, further demonstrating that the DON was not functioning in a full-time administrative DON capacity as required when the census was 60 or more residents.
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