A Minnesota nursing home is under the gun.

Sunrise Nursing Home in Two Harbors was given three of the most severe citations possible for inadequate health care after a recent visit by federal inspectors.

The reasons for the citations have been addressed by the home and are now corrected, according to administrator Shawna Jokinen. She has also filed an appeal with the Centers for Medicare & Medicaid Services to have all three deficiency severity levels reduced and two of them rescinded.

Most of the trouble stemmed from one nurse, and LPN, who was reported to have physically and mentally abused patients on several occasions. The nurse, who had been employed at Sunrise since 1998, was suspended and has since resigned. Although some of those incidents were reported to the proper contact person at the home, interviews by the inspectors showed that the policies and procedures set up to deal with such issues were not always followed.

And what did this LPN do?

Federal inspectors’ interviews with residents and staff included the following notes:
• That the nurse in question, whose name was not used in the survey, had repeatedly yelled and spoken “disrespectfully” to the residents, ordering them to “Get back down here, You don’t belong down there.”
• That she was witnessed pulling on a resident’s walker from behind “so hard one time that the resident flew forward and then back onto the seat of the walker.”
• That she forced one resident to take pills that hadn’t been crushed first, despite the fact that the resident said she had a sore throat and couldn’t swallow whole pills.
• Several members of the staff said they had reported incidents to the abuse prohibition coordinator, but that followup hadn’t occurred. At least one staff member said she did not report it again because she was discouraged, since abuse continued.
• Documentation showed that the nurse in question had been given verbal and written warnings and was sent to counseling.
Inspectors found that the facility “failed to develop and implement written policies and procedures that prevented verbal and mental abuse of its residents.”

Wow. A bad nurse can really have an impact on a unit. It’s never a good idea to keep anyone employed who has abused a resident in any way. By keeping them working, management essentially is giving them the ok to continue the status quo.

It was also cited for failing to investigate or report injuries of unknown origin for four residents–which appeared to be unrelated to the nurse’s alleged abuse.

Jokinen said that since the survey results were released and the need for reporting was reemphasized, “the paperwork has exploded.”

“Now, the staff is documenting every scratch, every bump, especially if it’s unexplainable or suspicious in size or nature,” she said. “We look for trends and patterns–is it happening with the same staff member, the same patient.”

Jokinen said that abuse can be difficult to define. Refusal to respond to a call light, for instance, can be called abuse, but some patients can be known to use the call light frivolously.

Where I work every bruise, bump and cut is measured, photographed, examined by an MD and documented in the patients’ medical records. We look for patterns too. Often times patients get these from rough transfers, and the aides don’t realize they are handling very sensitive patients with skin issues. In other words, this becomes an educational matter. When this is the case, we document the educational programs and in services. It’s a lot of work but it is needed. Call lights? Everyone is responsible for answering them: aides, nurses, doctors, maint and housekeeping staff- everyone. It cuts down on problems and serious issues like falls.

Management needs to think outside the typical locked in box of the nursing home model. Be involved. Make rounds. Talk to all the staff. Talk with the residents and their families. Join them for a meal. It’s amazing what can be learned by being out on the units.
You see a lot. And maybe by seeing a lot, you could prevent harm in the process.