Winona Health Services

“PQ-NURSE MANAGER-12 MO RN+6 MO DIALYSIS CFR(s): 494.140(b)(1) (1) Nurse manager. The facility must have a nurse manager responsible for nursing services in the facility who must- (i) Be a full time employee of the facility; (ii) Be a registered nurse; and (iii) Have at least 12 months of experience in clinical nursing, and an additional 6 months of experience in providing nursing care to patients on maintenance dialysis. This Standard is not met as evidenced by: 40945 Based on staff interview and job description review, the facility failed to ensure that at least one full time qualified nurse manager was responsible for the dialysis unit. This had the potential to affect all 28 patients. Findings include: Review of the 4/25/25 report to the State Agency identified the complainant (C)-A had concerns with staffing. C-A reported the staff in the ESRD unit was told by administration in January of 2024, they were closing the unit as it was no longer profitable to keep it open. Since January of 2024, it was alleged 13 staff members had resigned due management issues. The acting nurse manager was reported to be a social worker. During the entrance conference on 4/29/25, at 2:38 p.m. the facility administrator (FA) stated the facility did not have a designated full time nurse manager for the dialysis unit. The FA, who is a social worker by trade, stated the nurse manager role is shared by herself, the hospital Chief Operating Officer and the Vice President of Primary Care. The facility manager then stated all nursing staff would report to the VP of primary care. On 4/30/25, at 7:50 a.m. during an interview with the FA stated the role of nurse manager for the dialysis unit was actually shared between the VP of patient care and the nurse practitioner (NP) for the dialysis unit. The FA further stated she was under the understanding the nurse manager was a role could be shared between more than one nursing staff. The VP, who is an RN, was available for concerns throughout the day, however was not physically onsite in the ESRD daily. On 4/30/25, at 8:50 a.m. during an interview with the NP, the NP indicated she was not responsible for the oversight and direction to direct care staff that provided dialysis and nursing care in the facility, including hiring, evaluating, and terminating staff. The NP provided clinical oversight of her patients while in the unit seeing to their medical needs, but did not provide oversight to staff. Review of the March 2025 VP of Primary Care job description identified she oversaw 10 different departments and/or clinics to include the ESRD. There was no mention in the job description of actively being onsite in the ESRD or ig the VP could dedicate the required time to the ESRD to fill the nurse manager role. Review of the 3/24/20, NP ESRD job description identified she was responsible for examining, assessing, planning, and implementing the health care of assigned patients under a licensed physician’s supervision and direction. The NP obtains patient histories, performs physical examinations, orders laboratory tests, develop and implement treatment plans, performs diagnostic and treatment procedures, record findings, and provides patient education and counseling to enhance effectiveness in providing primary care for inpatient admissions. In addition to her ESRD duties, it was noted the NP must be available for consultation to other services: including ED, surgery, anesthesia and DBM [unknown department] (including performing H&Ps for DBM as requested). She must respond to emergencies in house (Code Blue, Doctor STAT, etc.) including participating on the Rapid Response Team. If census and/or acuity is such that the Hospitalist needs additional support/help, any/all of the IM [internal medicine] or FP [family practice] physicians can be called for assistance. There was no indication how the NP was to provide oversight in potential job sharing dedicated to the ESRD and not be called away for other duties.”