Document Type

DNP Project


School of Nursing

Date of Degree

Spring 2020


Doctor of Nursing Practice (DNP)

Primary Advisor

Mary Jean Schumann, DNP, MBA, RN, CPNP-PC, FAAN; Edward F. Mortimore, Ph.D.


Immediate Jeopardy, Beliefs, Knowledge, Confidence, Deficiency Citation, Nursing Homes, Educational Session, State Agency Surveyors


Background: The oversight of nursing homes is a shared federal-state responsibility. Under the agreement with Centers for Medicare and Medicaid Services (CMS, 2018), state survey agencies assess nursing homes using standard surveys. Several studies indicate that the type of deficiencies issued to nursing facilities varies significantly by state, suggesting inconsistency in the survey process for issuing deficiencies. For example, variation in Immediate Jeopardy (IJ) citations among state agency surveyors has been the subject of reports from the Government Accountability Office (GAO, 2019) and the Office of the Inspector General (OIG, 2014).

Objective: To determine if a 1-hour educational session about revised IJ regulations can improve the knowledge and confidence of state surveyors regarding the detection and identification of immediate jeopardy findings in a nursing home, increasing immediate jeopardy citations.

Methods: Cross-sectional descriptive study design used; 37 Nevada State Agency surveyors participated in the education session. A reliable, 14-item self-administered questionnaire was distributed among all state agency surveyors before, immediately after, and two months after the educational intervention. The obtained data were analyzed by SPSS (version 26.0) using descriptive statistics and ANOVA at a significant level of α = 0.05.

Results: Of the thirty- seven participants, 75.7% (n = 28) were females, 37.8% (n = 14) had both a bachelor’s degree and master’s degree, and 45.9% (n = 17) had more than twenty years of experience. Analysis of variance (ANOVA) used to compare the means (baseline versus posttest, baseline versus two months post-intervention), resulted in [F (5,8) = 2.99, p = .081] and [F (7,6) = 24.12, p = .001].

Conclusion: This study demonstrated that knowledge and confidence regarding the detection and identification of immediate jeopardy findings in a nursing home were gradually improving among Nevada state surveyors. A better understanding of what surveyors believe about their working knowledge of the IJ regulation will assist the DNP student in devising an effective educational intervention for them. Longitudinal studies are recommended to explore this topic, with the use of case studies as a promising approach.

Open Access


Included in

Nursing Commons



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