Failure to Maintain a Full-Time RN Director of Nursing
Penalty
Summary
The facility failed to ensure that a Registered Nurse (RN) served full time in the role of Director of Nursing (DON), as required, because the DON simultaneously held the position of Executive Director/Nursing Home Administrator (NHA). When surveyors entered the facility, they were informed that the NHA and DON were the same person, and the DON confirmed she had been functioning in both roles since the previous NHA left. The facility assessment listed the same individual as both Interim Executive Director and DON, and the employee report did not list any separate Executive Director. The DON described her DON responsibilities as including auditing and education, new processes, policy updates, employee issues, payroll and budget tasks, staff meetings, skills fairs, infection prevention meetings, clinical oversight, and IDT meetings, while also assuming responsibility for rehabilitation, activities, dietary, and social work departments as NHA. Due to the dual roles, the DON reported she was one person doing 40 hours of work in two positions, was not always performing quality work, and could not attend certain meetings or complete some DON functions. She stated that her DON responsibilities were delegated to unit coordinators, and staff interviews confirmed multiple delegations from the DON and that access to the DON had become limited. Staff reported the DON was less available to discuss issues and less hands-on with clinical staff than before. The DON also reported she could no longer serve on the safety committee or run the nurse aide training program, which were reassigned to a unit coordinator and staff development RN, respectively. A unit coordinator reported being placed into the safety committee role shortly after starting and learning the role “on the fly,” further illustrating that DON duties were shifted to other staff because the DON was covering both DON and NHA positions instead of serving full time as DON.
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