The VP of hospital operations recently came to our skilled nursing facility, which is a part of the hospital. She asked what our census was, 2 patients, and then pulled our administrator into the office for a talk. When she emerged 30 minutes later our administrator followed shortly after. She, then proceeded to inform me and another nurse that until our census comes up somebody has to go home. I was then told not to come to work the next day and they would let me know what would happen Friday.
Sounds pretty right, right? Wrong! The issue I’m having is the state department of health set guidelines that regulate how many staff and nurses have to be present when there are 1-20 patients, which is 2. At least one has to be a R.N. And wouldn’t you know our administrator is a R.N, but she is obligated to do a job which makes her an exempt employee. We also have a Director of Nursing. She is also salaried, an R.Na., with her own set of job responsibilities. What has happened now is whenever the DON and/or administrator are working, practically everyday, the nurses that are scheduled to work are either cancelled or forced to work alternate shifts in order to get hours of work. So basically the director and administrator are salaried employees doing their jobs plus the jobs of the staff in order to cut costs or double dipping as I like to call it.
My question is, despite the blatant violation of department of health regulations, is it legal for our employer to do this? I and my coworkers have tried contacting human resources, but they have offered no answers or assistance. In fact, they have completely blown us off and will not return anyone’s phone calls. No one can provide a policy on cancellations or standards of practice when the census of the facility is low. We all attended an orientation with a handbook provided via the intranet, but most of the policies within the handbook relate directly to the hospital which is an entirely different entity with its own set of rules and regulations, most of which don’t coincide with our facilities rules and regulations.
Thank you for your time. I sincerely hope you have an answer that can help me understand.
First of all, a disclaimer–I don’t know squat about nursing regulations, so I’m going on this based on exactly what you said which is:
1. For up to 20 patients, two people are required to be there, one of which must be a licensed Registered Nurse.
2. There are only 2 patients.
3. Both the Administrator and the Director of Nursing are R.N.s.
Now, as I said, I’m not familiar with staffing ratios for your state, but I fail to see how having 2 available R.N.s violates the regulation. It sounds like they are doing patient care when you are sent home. Feel free to correct me if I’m wrong–if, for instance, the regulation states that people who hold administrative positions can’t count towards the number of nurses required, then they would be in violation. But, from what you’ve said, it seems like there is an R.N. available.
The second thing is, if there are only 2 patients, there isn’t nearly as much care needed as if there were 20. So, having additional staff does seem like it isn’t needed. Again, I’m not a nurse, but if I could take care of 10 patients on my own (2 nurses needed for 20 patients), then having 2 R.N.s taking care of 2 patients and doing administrative duties doesn’t seem that terrible.
The third thing is what you labeled “double dipping.” Exempt employees get paid a set amount, regardless of the amount of work they do. So, if the Director of Nursing has to also do patient care, she doesn’t get a bonus. She gets the same paycheck. She gets the same paycheck whether she’s putting in 40 hours per week or 60. She’s not financially benefitting from doing this.
Someone is financially benefitting though, and that’s the business. If they don’t have to pay people on top of the salaried employees, whose costs are fixed, then they are doing well. It’s no wonder that they want to send you home if there isn’t enough work to do.
So, the problem doesn’t appear to be a violation of law and it doesn’t seem to be an ethical violation. It seems to me, that the problem is that you’re not getting to work. And, because you’re not getting to work, you’re not getting paid. That flat out stinks and is a HUGE problem. HUGE. You can be justifiably angry by it. But, complaining about legal violations when there don’t appear to be any won’t help your case.
What you need are more patients. Unfortunately, it’s illegal for you to go around knocking people’s kneecaps out so they need to be in a skilled nursing facility. You’re just going to have to wait.
Now, the question is, is this normal? Is the census frequently that low? If it is, it’s time to start looking for another job because this one is not going to pay enough for you to get by. If it’s not normal, and you expect that, come next Tuesday, there will be 43 people in your facility, then this is a temporary problem.
You can certainly ask if they expect the numbers to go up. You can ask to be transferred to another facility. You can look for a new job or take a per diem job temporarily. You can ask that if only one person is needed that you and your coworkers rotate through so it’s as fair as possible.
But, otherwise, this looks like a financial decision made by the business. Which totally stinks for you. It does. But, until you have more patients, you’re probably out of luck.