States span the spectrum on the issue of whether TA staff should have surveyor training. In Maryland and Washington, TA staff are required to have surveyor training, while Maine and Missouri have purposely chosen not to hire surveyors. In Florida and Texas, surveyor training is not required but some TA staff who were previously surveyors have been hired as part of the quality improvement program.
States Requiring Surveyor Training
Some states use TA staff that have either survey expertise and/or surveyor training.
In Florida, when the quality improvement legislation was initially enacted, Quality Monitors were recruited from the best surveyors in the state agency, with the new position considered a promotion. When subsequent legislation changed the program, increasing the number and responsibilities of quality monitors, the required qualifications were also altered. The monitors must still be nurses, but they do not have to have long-term care experience or be former surveyors. They must, however, take and pass the Surveyor Minimum Qualifications Test (SMQT). The state has had problems attracting nurses from facility positions, because the pay scale for state jobs is significantly lower than that offered by facilities.11
Maryland TA staff are all former surveyors. Indeed, the lead TA team member was selected because of his experience in quality assurance gained in the military and his reputation as a tough but fair surveyor.
Washington TA staff are masters-prepared nurses. Not all of them have LTC experience but all have survey training.
States Not Requiring Surveyor Training
Some states do not require that TA staff have either survey expertise and/or training.
Maine's TA nurse has no survey training or experience or any advanced degree, but has extensive experience in the field, with strong clinical and psychiatric skills.
Missouri TA staff are gerontological clinical nurse specialists, some with advanced degrees, selected for their clinical expertise and general lack of knowledge of the regulatory process. This TA program emphasizes that the key to effectiveness is to select expert nurses who can help facilities change their belief systems.
In Texas, former surveyors hold some of the TA positions, but surveyor training is not a prerequisite.
11. Originally, TA staff went through the risk management training offered by the University of South Florida, However, risk management training was not provided for those hired when subsequent legislation increased the number of Quality Monitors.