SNF/NF survey tip—Professional judgment vs. surveyor interpretation in IJ citations—no harm & potential risks
By Michaun Shetler | March 28, 2025 | SNF/NF providers
The distinction between professional judgment and surveyor interpretation in the context of no harm versus likelihood or potential of harm is critical in determining whether an immediate jeopardy (IJ) citation is warranted in long-term care facilities.
Professional judgment vs. surveyor interpretation
- Professional judgment:
- Professional judgment refers to the expertise of clinical staff (e.g., nurses, physicians, or care managers) within the facility; they assess residents' health and safety needs based on established standards of care and the specific circumstances of the resident
- This judgment involves making decisions about the care needs of residents, identifying risks, and determining whether those risks are being properly managed
- For example, a nurse may assess that a resident's fall risk is higher based on certain conditions (e.g., post-surgical state, cognitive impairments) and decide to implement additional interventions, such as a fall mat or extra supervision
- Professional judgment may conclude that no harm has yet occurred, but it’s essential for the facility to address a potential risk to avoid future harm. In some cases, no immediate jeopardy may be recognized, but the risk is still noted for future corrective action
- Surveyor interpretation:
- Surveyors have specific guidelines and criteria to follow when conducting inspections and assessing facilities
- Surveyors are trained to look for compliance with federal and state regulations, assessing whether a facility meets the required standards for resident care, safety, and other critical issues (e.g., staffing, infection control, medication management)
- Their interpretation often includes examining whether potential risks to residents (even if no actual harm has occurred) could be considered immediate jeopardy—meaning that the likelihood of harm is so high that immediate corrective action is required
Surveyors are typically more focused on regulatory compliance rather than the clinical assessment of individual residents. They may interpret the presence of potential risks through the lens of what the regulations require, often erring on the side of caution in cases of uncertainty.
Key differences in the context of no harm vs. likelihood or potential risk
- No harm:
- Professional judgment might conclude that while no harm has occurred, a situation is still being managed appropriately, and corrective action may be taken within a reasonable timeframe.
- Surveyor interpretation, however, may still categorize this situation as immediate jeopardy if they believe that, given the circumstances, there is a high likelihood of harm unless corrective actions are taken right away—even if no harm has yet been caused
- Likelihood or potential risk:
- Professional judgment may assess that the potential risk is manageable or unlikely to result in harm, particularly if preventative steps are being actively taken
- Surveyor interpretation might focus on whether the facility is in compliance with regulatory standards, even if no harm has yet occurred; for example, surveyors may determine that the facility has failed to mitigate a likely risk (e.g., improper supervision of residents with a history of falls) and that this potential risk qualifies as immediate jeopardy because it could lead to severe consequences
Examples of no harm vs. likelihood or potential risk
- Example 1: Inadequate supervision
- Professional judgment: A nurse might assess that a resident has a low risk of falling based on their current health status and mobility, determining that no immediate harm has occurred; the nurse may decide to continue with the current level of supervision, adjusting as needed
- Surveyor interpretation: A surveyor might interpret the same situation differently, based on regulatory standards for supervision of high-risk residents; even if no falls or injuries have occurred yet, the surveyor may cite the facility for immediate jeopardy, arguing that the lack of sufficient supervision creates a potential risk that could lead to serious harm
- Example 2: Infection control
- Professional judgment: A facility might be aware of an infection control issue (e.g., a resident with a communicable disease who is in isolation), but the situation has not led to an outbreak or harm to other residents; the staff might feel that the situation is being properly managed, and no immediate harm is happening
- Surveyor interpretation: The surveyor might interpret this situation through the lens of regulatory compliance and see the potential risk of an outbreak as an imminent danger to residents; the surveyor could issue an IJ citation, even though no harm has occurred, because the lack of full compliance with infection control procedures presents a likely risk that could lead to a serious outbreak
Balancing professional judgment and surveyor interpretation
- Professional judgment is based on clinical understanding and individualized care, whereas surveyor interpretation is more focused on adherence to regulations and overall safety
- Surveyors may issue IJ citations when they believe that regulatory noncompliance presents a risk that is likely to cause harm in the near future, even if no harm has occurred yet; this can lead to a situation where no harm has occurred from the perspective of clinical care, but from a regulatory perspective, the potential for harm is deemed to be imminent
While professional judgment focuses on individual care decisions, surveyor interpretation is more concerned with the broad application of safety regulations and standards. In cases where no harm has occurred, surveyors may still issue an IJ citation if they believe that the likelihood or potential risk of harm is high, and that the situation could result in serious consequences without corrective action.
Michaun Shetler | Vice President of Regulatory Affairs |
mshetler@careproviders.org | 952-851-2484