HospitalInspections.org

Based on document review and interview, it was determined that the interim Director of Nursing (current acting DON) is not qualified for the DON role on a psychiatric unit. She does not have a master's degree in psychiatric mental health nursing or sufficient education and experience in the care of mentally ill patients to provide leadership to nursing staff. Failure of the facility to employ a qualified DON results in lack of adequate supervision and oversight of nursing services.

Findings include:

A. Document Review

1. Review of the interim DON's application for employment and resume revealed no evidence of qualifications of psychiatric nursing training. There was no evidence of continuing education or training in the care of psychiatric patients across the life span, specifically child and adolescent patients.

B. Interviews

1. In an interview with the hospital CEO and Medical Director on 11/16/11 at 11:45 a.m., the CEO told the surveyors that he recently became aware that the hospital's former Director of Nursing was not implementing the required training on seclusion and restraint, so he terminated the (former) DON on 11/14/11. The CEO reported that the current DON is the interim DON until he is able to recruit a qualified DON. He acknowledged that the current DON's qualifications do not include a master degree and/or psychiatric nursing experience.

2. In an interview on 11/16/2011 at 2:30 p.m., Physician 2 stated that there is a lack of trained staff on how to work with psychiatric patients, and that is the reason there is a lack of consistency on how to manage psychiatric patients on all three shifts.

3. In an interview on 11/17/11 at 9:45 a.m., the current (interim) DON reported that she was a nursing supervisor prior to her appointment as the interim DON. She reported she has a 2 year Associate Degree in Nursing. She reported that she is not familiar with several of the policies and procedures. The DON was not aware of the role of a master prepared psychiatric nurse consultant, and she stated that there was significant confusion on the part of all staff, including herself, regarding what does or does not constitute a restraint or seclusion event. The DON was not able to explain or describe the procedure for seclusion and restraint, and not able to demonstrate how she would guide and direct nursing staff to safely use seclusion and restraint.