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Tweety Tweety (Member) Expert Nurse

Wednesday April 26, 2017

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Herring - I read with great interest your comment about the "life an death" situation being illegal. Please share with me, either privately, or in this thread how it is illegal. The staffing level isn't illegal as I don't live in a state with ratios. Very curious about this, as I am a new nurse. There are so many unethical things about this facility.

Lil Nel:

Actually I was just saying that as difficult as it was for Ted having so many patients in the ED at worst they had to wait in pain, fear, and discomfort because the nurses were so busy with others.

A life threatening situation would have been much worse.

It is illegal because of the requirement that an RN be immediately available to any patient when needed. It's the same section of the CMS regulations for all acute care hospitals that provide care for any Medicare or Medicaid patients.

Survey Protocol, Regulations and Interpretive Guidelines for Hospitals

(Rev. 151, 11-20-2015)

Interpretive Guidelines §482.23(b)

The nursing service must ensure that patient needs are met by ongoing assessments of patients' needs and provides nursing staff to meet those needs. There must be sufficient numbers, types and qualifications of supervisory and staff nursing personnel to respond to the appropriate nursing needs and care of the patient population of each department or nursing unit.

There must be a RN physically present on the premises and on duty at all times.

Every inpatient unit/department/location within the hospital-wide nursing service must have adequate numbers of RNs physically present at each location to ensure the immediate availability of a RN for the bedside care of any patient.


We have found nationwide that with documentation vis Assignment Despite Objection (ADO) forms stating facts with date, location, time and such it is possible to get hospitals to improve staffing without a report to the government. It is best not to wait for a tragedy. Sometimes a report is needed because the facility continues to place patients at risk.

The ADO has several copies. One is kept by the nurse(s). We usually made a copy for everyone who signed it.


Full Text Statements of Deficiencies Hospital Surveys can be accessed as an EXCEL document here:

Hospitals - Centers for Medicare & Medicaid Services

Here is the page describing what happens when a report is made:

Survey & Certification - Enforcement - Centers for Medicare & Medicaid Services

Here is a Statement of Deficiencies describing a tragic death that, to me, was staffing related:


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Good Morning!

Had a very nice day off, yesterday. With Amy feeling a little bit better, we went out for a "Dinner and a Movie". We ate at one of our favorite Chinese restaurants, P.F. Changs. Afterward we saw the movie, "Going in Style" which was quite funny. Interestingly, we were probably the YOUNGEST couple there, at this matinee. It was good to relax and laugh outside our home.


Hi Ted ! I saw "Going In Style" over the weekend....so great! I adore Michael Caine. And how about Ann-Margaret, still as gorgeous as ever! Also Christopher Lloyd was an unexpected pleasant surprise .

Happy Wednesday!

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Hello all!

Busy day at work, but not crazy.

Tomorrow is my Friday for this week.

Thursday note we practice with our fiddler and Friday we pack up the rig and drive to Temecula, to camp at a large ranch where the Temecula bluegrass festival will be held.

Dh and I will play on one of the stages Saturday afternoon sometime, and do two gospel sets on Sunday.

We hope to get in some jamming and visiting, as well as camping.

Looking forward to a mini-working vacation. :-D

I will check in tomorrow and Friday, as well as Sunday nite. :)

herring, you are such a wealth of experience and information! And lots of good stories! Thank you for being so willing to share them!

Ted, so glad Amy is better!

Hope your continuing Supervisor orientation goes well.

Tonite I am doing last minute laundry and making lists for food and what-all to bring/pack.


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I had soup for supper, or as someone sort-of aptly once called it, "Garbage Soup". But it is more than that. Here was my recipe for tonight:

{The amounts and the contents are entirely dependent upon what is in your fridge}

* leftover cooked baby spinach,

* leftover red sweet-pepper and gouda soup,

* leftover black-bean soup,

* leftover sauteed mushrooms and onions

Directions: Stir it, heat it up, stir it again, and then put it in your favorite mug and enjoy!

Oddly, it had no predominant flavor at all. It was quite dense, hot and hearty, satisfying, and MY GOSH . . . the FIBER! I felt my halo positively glow while I was supping!

All I could think of was Frank Zappa's song, "Call Any Vegetable" (call it by name. / somethingsomething true, the vegetable will respond to you)

But alas, there was no rutabaga in my soup, so it would have been futile to yodel, "Ruta-bayee-ayga, Ruta-beyee-ayga, Ruta-bayee-ayga, Ruta-beyee ayga, Ruta-bayeeeeee."

I reckon some of you might think I have lost my mind but I know there's lotsa yez that have, at the very least, some passing familiarity with the references, and some of yez that could probably reference me right under the table!

This has been "An Evening Of Stars", brought to you by the good graces of AN.

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