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In light of survey, another DON bites the dust—or not!

September 14, 2011
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The cars pull into our parking lot. The alert siren sounds throughout the building.

Survey is here.

I dread these few days out of each year, but have learned to deal with it as it comes. And it hasn’t been so bad—last year, one deficiency; the year before, 0. So I was not overly worried. Little did I know what my facility was in for.

I open the conference room door for them and in they file: one…, two…, three…, four…, five…, six…, seven…, eight! Six state surveyors and two federal. In 20-plus years, this is my first federal inspection.

I wish I could say that this went well and all is great in my world. As many of you know this is often not true when federal and state meet in your building. I cannot even begin to express the chaos and disrespect that my staff and residents endure for the next nine days. Yes, nine days of this torment. My staff is crying and my residents are begging for the surveyors to go away. Then there’s myself, the Director of Nursing, wondering, Why in the world did I choose this profession? Why would I choose nine days of anguish, nine days of scorn, nine days of trying to show the truth to closed minds?

Never have I felt so helpless and disgusted by a group of so-called “professionals.” With the turnover rate of Directors of Nursing at an all time high, I am feeling the full weight of why so many give up. Speaking for myself and my staff, we are an amazing facility. My staff members are all top notch professionals, led by me, Frieda Stewart, RN, who at that point felt about 2 inches tall. My confidence thrashed, my residents’ dignity ignored and my employees’ abilities ridiculed. How do I go on? Why should I go on?

Because of our residents, because of their smiles, because of their love!

I may be bent, but I am not broken. Too many have fallen victim to this industry—I will not be a casualty. In truth, the hope of a brighter tomorrow is in the way we treat our elders today.

In closing, we have yet to receive our official letter of deficiencies, but they left our building threatening 20 areas. From 0 to 20 … what is wrong with this picture?

Author Frieda Stewart, RN, is the PROUD Director of Nursing at Corn Heritage Village in Corn, Okla.; the owner and CEO of VitalAttitudes, LLC; and a public speaker who travels all across the United States.

Frieda Stewart

Author Frieda Stewart, RN, is the Director of Nursing at Corn Heritage Village in Corn, Oklahoma...



I recently went through a similar situation. August 2011 will not be forgotten. August 1st, 5 DHS surveyors visited for our annual survey. This was our first QIS survey. The following week was our Life Safety survey. Then on August 29th, 4 CMS Federal surveryors were with us for 4.5 days. In all of the years that I have been in LTC, this was the most stressful week ever. At the end of the week, a friend of mine wrote me the following poem. I hope it will make you smile like it did me:

No one surveys like the feds
It leaves us all feeling dead
They will give you a "G" for a bug in one's pee
With never a thought in their heads.

We owe them a thank you, it's true
Because even though we're all blue
We do not feel so needy, for it's just like a freebie,
'Cause the state won't find what they do.

Thanks to you Frieda and all of the Directors who are passionate about delivering outstanding person-centered care each day. You are appreciated!

Frieda, as I worked there I had an absolute great time at a great place to work! What I learned when I was there is that no matter what the law say, it is what the residents needed. And you as the D.O.N expressed that to your employees, in return, showed it to the residents... I believe you have the greatest staff and run the greatest facility in the world!! But people in this world do not believe in great, they believe that there is something hidden, something has to be wrong. But only cause they give the opinion, and enforce it... That is whats wrong with the picture.... They have to look hard to find what "they" have a problem with... That is why it took 9 days, they couldn't find anything when you and your staff are strong. They had to wait until they had intimidated you a stress level that they couldn't even handle... I can only speak for the residents up to the point I quit... (Which still feel bad about). But you run a tight 3 shifts, you aways did and believe continue to do an outstanding job... So Frieda.. I ask you, give yourself a great pat on the back!!!!

As a resident I remember very well the first year's survey. I wondered why the staff was so concerned. I thought they did a very good job and felt that the state surveyors would also. The survey was very good that year.

But I did live there for many years and subsequent years when the surveys did not turn out as well. I did see a lot of administrators leave. I do not know how any of them felt they had any job security.

My best time at the nursing home was when we had an administrator who believed in person centered care. It certainly made a difference. But of course, she could not convince all of her staff that person centered care was the way to go.

I am a baby boomer and am quite vocal about what goes on in the nursing homes where I have lived. Baby boomers are also picking out nursing homes for their parents. That is probably why the surveyors feel they have to be extra careful.

After 15 years of living in nursing homes I know the state's rules. I do not like it when I see a violation that is not remedied quickly. But I certainly understand how things could get forgotten.

Most nursing homes treat their residents based on which has the greater need or emergency. That is just the way medicine is. I do not know that will ever change.

I have always felt that nursing home life and communism have a lot in common. Many times I have been told, "You are not the only resident in this facility. We have (the census minus one) to care for". Every time I heard that I wondered why it was said.

Frieda, I just saw this post. You have summed up the feelings of many DONs and Administrators after a grueling survey. Good luck with everything!