[doxima]

Originally Posted by CapeCodMermaid

OK...first off...I really like most of the CNA's who work at my facility and I trust most of them, but why would a licensed person, RN or LPN, go get pain medicine without ASSESSING the patient herself??? Surely all y'all don't rely on your CNA's to do pain assessments.

Took the words right out of my mouth! Any nurse that will give a med without doing an assessment should have her job and license questioned!

[doxima]

Originally Posted by chimama

I have been DON in three LTC facilities. The only thing that is going to change the "culture" of where you work is for you to be able to pay your staff more and start over. That is not going to happen. LTC is a lose-lose situation.You will have no life as long as you are there and when the state comes in they will treat you like a criminal who only went into LTC to abuse and neglect the elderly. I advise people to never go to a Nursing Home. Go on welfare and keep your loved one at home.Do something, anything but a NH. And you should turn in your resignation today. You are in for a miserable time untill you do.

Here's hoping that you are no longer in LTC. Negatives need not apply! And thank goodness I have never had to work for a DON with your attitude.

[alintanurse]

Originally Posted by doxima

Took the words right out of my mouth! Any nurse that will give a med without doing an assessment should have her job and license questioned!

You're right--she was waiting until after she prepared the injection and brought it to the patients room before doing her assessment. Although she wasn't giving the med,she was basing it the information she was given,---but don't you question the motive of the cna ?

[alintanurse]

Originally Posted by chimama

I have been DON in three LTC facilities. The only thing that is going to change the "culture" of where you work is for you to be able to pay your staff more and start over. That is not going to happen. LTC is a lose-lose situation.You will have no life as long as you are there and when the state comes in they will treat you like a criminal who only went into LTC to abuse and neglect the elderly. I advise people to never go to a Nursing Home. Go on welfare and keep your loved one at home.Do something, anything but a NH. And you should turn in your resignation today. You are in for a miserable time untill you do.

I still agree with this response,it may be negative but it is honest. I went to LTC with an open mind and heart,in fact I was excited about my new position but it didn't take long before I saw the realities, ie; dangerous care of pts., poor attitudes of staff etc.

[knockandhello]

Been there , done that 2 years as charge nurse of small LTC.Left a bitter and twisted sister.No support from management, so the culture of the centre didn't change.I was constantly battling to introduce changes.Simple things that one would expect staff to do e.g continence care,base line observations on admission,charting, BPs, weights,just basic care.Dont even think about report writing..Left with high blood pressure and depression.The majority of the carers were relatives of the manager so I was repeatedly having to defend my nursing decisions to management.My suggestion is get out before you burn out.

[alintanurse]

Originally Posted by knockandhello

Been there , done that 2 years as charge nurse of small LTC.Left a bitter and twisted sister.No support from management, so the culture of the centre didn't change.I was constantly battling to introduce changes.Simple things that one would expect staff to do e.g continence care,base line observations on admission,charting, BPs, weights,just basic care.Dont even think about report writing..Left with high blood pressure and depression.The majority of the carers were relatives of the manager so I was repeatedly having to defend my nursing decisions to management.My suggestion is get out before you burn out.

True!True!True! Thank god we got out!

[kathi yudin]

when i first became don where i am.. all of my nurses decided to quit!!.. these were the same nurses that complained bitterly about the don i replaced... be fair.. and be equitable.. don't be afraid to show them that you are willing to do the work as well.. have staff meetings and listen to them..if they are not doing what you have asked them to do.. that is insubordination.. write them up if talking does not help..you also need the support of your staff developer and administrator.. that is so important.. i am very lucky... my administrator has guided me each step of the way.. go to conferences for don's.. if you are in california.. cahf(california association of health facilities) has one every year in vegas..it is on jan 25/26 this year and is at harrahs... on the 24th they are haing one on leadership.. they are well worth going.. join nadona.. national association of directors of nursing.. lots of good advice there as well.. the best advice.. be consistant.. fair... and remember you can't be their friend because it is hard to give orders to friends.. hope that some of this has helped...it has taken me almost 5 yrs.. and multiple staff changes to finally feel comfortable in my shoes.. persevere.. seek advice.. and you will survive!!!

Originally Posted by nursemid02

Hi I am im great need of information regarding DON's how to deal with staff that wont listen and people who wont work as a team is there anything i can do to help improve our quality of patient care?? I have been working my hardest but have been pretty much doing it myself!!! Im pretty much tired of doing and am to the point i could just walk away with a different job!!! If anyone can help please let me know!!! THANKS SO MUCH

[kathi yudin]

If you choose to stay as a DON in ltc, this is my advice: try to have a positive attitude (I know it's so hard at times with all the unrelenting pressures we face from all directions).. be willing to jump in there.. praise your staff.. give incentives... bring in goodies.. let them know that they are appreciated.. that is all that they want.. to feel appreciated.. i can tell you from my own experience that it is possible to succeed and have positve surveys.. no one likes surveys.. but.. they do serve a purpose.. to weed out the bad...!!!... openness.. honesty.. and positiveness all lead to good surveys.. my facility is proof of that.. whatever surveyors ask for.. including copies of incident reports which we don't have to hand over.. we hand over.. no one likes surveys.. but.. if your documentation is there... the residents look clean and well taken care of.. it is possible to have good surveys.. we do..!!.. they look and look but find only minor things...i say to you don't give up.. persevere.. meet with your staff.. be fair.. monitor the documentation.. and careplan documentation.. document everything.. give inservice upon inservice.. and you can succeed!!!.. good luck and keep us posted!!

Originally Posted by chimama

I have been DON in three LTC facilities. The only thing that is going to change the "culture" of where you work is for you to be able to pay your staff more and start over. That is not going to happen. LTC is a lose-lose situation.You will have no life as long as you are there and when the state comes in they will treat you like a criminal who only went into LTC to abuse and neglect the elderly. I advise people to never go to a Nursing Home. Go on welfare and keep your loved one at home.Do something, anything but a NH. And you should turn in your resignation today. You are in for a miserable time untill you do.

[kathi yudin]

i stopped having mandatory meetings.. inservices are done any time staff is around.. if i have some one come in such as a drug rep or hospice.. i do it 2x during the day.. the first at 7 am for my noc and part of my am shift.. and at 2:30 for my 3-11 shift... i also post a sign a week before to give them notice so if they are off.. they may be able to come in.. they punch in/out to get pd for them as well...my door is open.. and i listen listen listen.. i have gotten to the point where when i am down a nurse on 3-11.. i give them the schedule and they fill it in...!!.. we have never used registry.. we started with bonus's and now i don't even do that.. no need to..it takes perseverence and patience..

Originally Posted by Blackcat99

If you want to be a well-liked DON don't have weekly mandatory meetings and don't expect your noc shift to ruin their sleep by having to attend meetings at 2pm. I wish you the best of luck.

[kathi yudin]

great advice.. if you set high expectations.. you will receive them.. but first you must let your staff know what is expected of them.. also.. you must always be an example.. in otherwords.. if you want accurate and complete documentation.. you must do it yourself as well.. this is not a do as i say not as i do situation... do things in small steps... you can not expect to change things overnite and above all.. don't set yourself up for failure.. i have been don for almost 5 yrs.. i started as an mds coordinator which i knew nothing about either.. within 5 months i was officially the don.. my administrator saw something in me that i did not see in myself.. while i have been an rn for almost 30 yrs.. i took off 16 to raise my family.. i went to an associate degree program in ny.. moved to california 6 yrs ago.. worked ltc for 1 yr prior to arriving at my present facility.. i was a babe in the woods.. it took a lot of tears.. a lot of encouragement .. a lot of perseverance.. and lots of changes to staff.. but.. because of great management support.. i have been able to succeed.. you will too.. just stick to it!!.. and above all.. be fair..give kudos when needed.. give little notes as thank yous for support.. all your staff wants to know is that they are considered part of the team.. good luck.. you won't be able to fix it over nite but.. it will happen..



Hi Nurse Mid.. I was a DON for 6 years. It sounds like you are putting out small fires and can't yet see what is causing the blaze. First things first..hold a mandatory staff meeting and let the staff know what is expected, what will and will not be tolerated. Be very clear in your expectations. Next, evaluate the results. You will know rather quickly who wants to be on the team and who doesn't. What was the last DON like? Perhaps she/he was very lax and didn't expect very much. It is also very important for the staff to see that you are buying into your own program. I have seen many DON's with the attitude of "do as I say, not as I do". Being an effective DON takes a lot of time and hard work. To be an effective (and respected) DON, you will spend very little time in your office and alot of time on the floor. How large is your facility? There are many things to think about, priortize what is most important and don't try to fix everything at once. I wish you all the best.[/quote]