On the Case with a Health Facilities Evaluator Nurse
Keeping staff and patients safe by enforcing state and federal regulations
The streets outside the skilled nursing facility were quiet and dark as Bel and I pulled up at 2 a.m. We were there to investigate allegations of elder abuse, and I had so much adrenaline that I didn’t need coffee to keep me up.
My coworker Bel had lured me into joining her on this late-night facility visit with the promise of a breakfast buffet after we finished our assignment, but by the time 10 a.m. came around, I had yet to see so much as a glass of orange juice and a blueberry muffin. Bel was still interviewing staff while I reviewed the facility’s records.
At 4 p.m., Bel called an “Immediate Jeopardy” (IJ). Under the federal regulations that govern all Medicare and Medicaid certified providers and facilities, an IJ is the most serious type of deficiency: a situation in which a facility’s noncompliance with health, safety, and/or quality regulations “has caused or is likely to cause serious injury, harm, impairment, or death” to a patient, resident, or client.
Identifying and correcting an IJ can literally be a matter of life and death.
While 2 a.m. facility visits like this are out of the ordinary — we typically work normal business hours — this is one example of the important work an HFEN does.
What Is an HFEN?
According to the California Department of Human Resources, the role of a health facilities evaluator nurse (HFEN) is to “conduct inspections, investigations, surveys, and evaluations of health facilities for conformity with licensing and certification requirements of the Department of Health Services and for compliance with State and Federal laws, rules, and regulations relating to medical care.”
In other words, we’re kind of like the nurse police.
California first established the HFEN role back in the early 1970s. While I’m new to the field of nursing enforcement, with barely two years of experience, I have met nurses who have spent 20 to 30 years with the department, with many stories to tell.
HFENs are responsible for proving or disproving allegations of regulatory noncompliance by a healthcare facility. We investigate allegations of abuse or neglect as well as quality of life, patient rights, and quality of care issues that affect patients.