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May 15, 2010


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Edie Brous is a nurse attorney who represents nurses. Thank you, Edie for your comment and sharing your experiences representing and advising nurses working in SNFs in Pennsylvania, New Jersey, and New York are similiar to my experiences representing and counseling nurses in SNFs in Ohio, Kentucky, and Indiana.

Edie Brous

Perhaps Nurse Exec should publish his/her success with tips to others on how he/she has accomplished the RN-heavy mix, the lack of RN/LPN conflict, low turnover, low self-reported incidents, no in-house acquired wounds, no pending litigation, and never reporting a nurse to the BON. How has this been done? Others could learn from this. I agree with LaTonia that it is not a common experience for those of us who represent nurses before the licensing boards. SNFs are under tremendous cost-cutting pressure and regulatory scrutiny. If Nurse Exec can share the secrets of these accomplishments under such conditions, it would be a great service to the nursing and SNF communities.


Dear Latonia,

I've been reading your blog for some time now, and have always found it very informative. However, I was very disappointed with today's entry on SNFs. As a DON in a SNF, I found this entry highly prejudicial, and frankly, just plain wrong on several counts, at least by my experience. I have been an RN for 18 years, 11 of which I spent in hospital nursing (ICU/OR) and the last seven in long term care, 6 of which I have been DON--all in the same building I might add. My building has extremely low turnover for the business--30%. I have many nurses and CNAs who have worked in the building since it was built in 1997.

I have a very RN-heavy nursing staff, due to my short-term rehab focus (over 60% of patient mix). I have very few self-reported incidents, no in-house acquired wounds, and no pending litigation, and I have never had to report a nurse to the board. My nurses give great care, and I'm very proud of them. I don't have issues between my LPNs and RNs, I don't go around firing nurses as often as you seem to think it happens, and I have great state survey results (3 tags last year).

Perhaps my facility is the exception, not the norm. Florida does have extraordinary staffing ratios--the best in the nation actually for CNAs and my building staffs nurses 1:20. CNAs are staffed 1:8. It makes a difference.

I love what I do, and I am extremely proud of my wonderful staff. I just wish you hadn't been so harsh on SNFs--lord knows our elders are going to need nurses to care for them. Nurse Exec.

Thank you Nurse Exec for your comment. However this post is based on my legal experiences representing, counseling and advising RNs and LPNs who work in SNFs. I am harsh on SNFs because some SNFs are harsh on RN and LPN employees. Of course it doesn't say all SNFs are bad and yours may be the exception to the general rule. That's wonderful and I wish you the best and success with continuing to make your facility a great place to work. However I stand by my blog post: IMO, SNFs are not the best work environments for RNs.

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