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.
14 thoughts on “Is my exempt boss double dipping?”
One thing I’m always sure to tell people who are new to HR and Compensation, is that it’s not wrong for (for-profit) businesses to want to make a profit. They are an investment, and none of us would invest our money in a venture if we didn’t expect a return. Companies have to make decisions for their bottom line. While that does have to be balanced against employee needs (because the business needs employees to function), it does have to happen. This is an unfortunate situation, but entirely understandable.
So many people think making a profit and being fiscally responsible is a bad thing, but the reality is, if you aren’t able to make a profit, you’ll end up going out of business–and that means everyone is fired.
I am absolutely sure that the Administrator and DON have no desire to do the RN’s job, but that’s how it goes.
The only exception that I could see to your answer is if the nurses are unionized. In that case, the contract would spell out what to do in these types of situations. Otherwise you are, as usual, full of common sense!
When it said double dipping, I thought it meant the admins got salary and hourly nursing wage. But it doesn’t sound that way. The only problem I see is if the hourly nurse needed a second person for lifting or whatever and the admins refused to help. I don’t hear that either.
A lot of home care nursing agencies look for nurses to work per-diem when the regular nurse is sick or has a car breakdown or any emergency. If you sign up with one or two agencies you could probably earn enough around your schedule to make up for lost work.
I work in healthcare, in Compliance, so I know something about this. It may vary by state, but your state department of health would have the answers. In IL, where I live, the administrator/director/manager does not count as an RN if you are paying them and treating them as an administrator/director/manager. It’s not just that someone has to be an RN and have a current license. They have to keep up all the other certifications and continuing education that’s required at the national and state level. Also it’s unlikely your facility is paying their workman’s comp insurance as if your administrator was an actual RN, which is a violation.
Ah-ha! That makes a big difference and explains why the violation. If that is the case in her state, I think an anonymous call to the state licensing board would fix it really quickly!
To me, this sounds more like a compliance issue then a Human Resources one. I’d check your hospital’s internal website for a compliance department or hotline (ours is anonymous) and go from there.
I also second the comment above about looking for per diem work with a local home health or hospice agency – the organization I work for is always looking for good people.
Another possible issue is the exemption status of an exempt person whose predominant work activity is of a nonexempt nature.
I think that would be an issue if they were taking care of 6 or 7 patients,but 2 patients (When they can have 10 each!) tells me that the majority of their time is not spent in patient care.
RNs, though, can be exempt regardless.
It does vary by state. If the person is a licensed RN, then the regs may very well be satisfied by that in your state. If so, then your employer is trying to make a fiscally responsible decision and sounds like they may be going through a tough time with low census. As others have stated, businesses DO need to keep making profits in order to keep their doors open. What’s good for the business is usually, in the long run, good for the employees because a business that goes under leads to a lot of lost jobs and a tougher job market overall.
Slightly off topic, but seriously, 10 skilled nursing facility patients per nurse? That is unsafe staffing in anyone’s book. Also, I dont work in facilities that don’t have a union. If you happen to get a crazy boss (it happens) or make an honest mistake (it happens) you can not only get fired, you can get your license revoked (I’ve seen it happen). When you are a mid-career professional nurse, you really can’t risk that. We don’t always like them, but a union is a necessary evil when you are a nurse.
It sounds to me like this facility is probably failing if they have twenty beds and only two are full. That’s very suspicious. Hospital social workers are often scrambling to find SNF beds, so I suspect this facility is either substandard (10:1 patient ratio is super crazy) or somehow in violation such that hospitals won’t admit patients there. I’d start looking elsewhere. No nurse needs to have her hours cut. There’s just too much work out here to put up with that. We are practically recession-proof, and have beans for decades.
Can’t say, because I’m not a nurse or involved in health care, but you may be right. It may be a horrible facility for all the reasons you named.
“Have beans for decades” should be a thing.
I think that the non-exempt nature of most hospital administration is why this is questionable. Also, for anyone who has watched Nurse Jackie, there was one episode where Akalitis, the hospital administrator was found lacking by the then higher ups and had to go work on the floor. Akaltitis had done floor work at one time, but hadn’t done it recently. She was back in administration due to the inability of her replacements. I think that could be a risk with RNs who work their way up to administration but don’t do regular floor rotations.
BTW, it’s a pet peeve of mine when RNs who work their way up from the floor and direct patient contact call themselves nurses. They do enough to keep their licenses but would be useless if called to ER. One particular relative made a big show about how she was a nurse during my late grandmother’s last weeks. The reality is that she has been a diabetic educator for most of the past two decades and it has been a very long time since she had regular rotations with patients. I don’t think my grandmother got the best care under her and her attitude towards the nursing home staff was incredibly condescending. They probably work a lot harder and help more people than she does despite her making far more money.
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