A bunch of questions...

  1. A little histoy for you I work in a 50 bed LTC unit for the last 9 years (Taking time off for materninty leave) I've worked as staff nurse, RNAC, Supervisor, and temp DON. The last 5 years I've been part time and prn. (Yes I've seen an incredible amt of turn -over in the nursing and DON positions) Questions... recently have a new DON who will not help the nursing staff out and only works part time hrs. We recently have a rash of call offs (cant use agency nurses) and only have 2 RNS and 2 staff LPNs to choose from (I'm part time and do help when I can) Is it unreasonable to think that the DON can help occasionally to fill a few hrs or even help out the charge nurse on a really busy day? Our building is really small and in the past our DON has pitched in to help (I now I did) sometimes just aswering the phone or making copies, or calling the drs.... Sooo the really question is How much involement does your DON have in nursing care???

    Sorry this is soo long
    Last edit by CoffeeRTC on May 2, '03
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  2. 14 Comments

  3. by   Disablednurse
    Michelle, are you sure that you live in PA. Your post sounds so familiar, that I had to look to see where you live. I too have been in this situation and when I read this post, I read it to my husband. HE thought that it sounded like you worked with me. I too worked in a LTC for 12 years before having to apply for my disability after working myself into permanent nerve damage. I have also had your misfortunes with DONs and such. You can PM me any time and I will be glad to listen as I know what you are living thru. I never understood why when I was acting DON, I was expected to do all things including my original job, but the DON was not expected to do even half as much. Keep on plugging.
  4. by   ChainedChaosRN
    Michelle, I worked as an interim DON in a 50 bed LTC facility for about 5 months. I had to help on the floor or I was bored to death. We had two charge nurses and 6 CENA's for dayshift. I also audited and thinned every chart, rewrote all the care plans, and helped with MDS's...and I was bored out of my tree.

    I'm currently in a 160 bed skilled facility...and I never seem to be caught up. There isn't enough hours in the day to do what I want to do. I give very little help on the floor except for answering call lights I pass. Most of my day is literally directing, educating and nurturing staff, patients, family and the physicians, and consistently monitoring that systems are in place and functioning properly.

    F Tag 354 states that an RN must be on duty 8 consecutive hours a day 7 days per week. If your DON is not there 40 hours, she has to have someone designated as sharing the responsibility of a DON. A DON can work as a charge nurse if under a 60 bed facility. Over 60 beds, even if the DON would work the floor she's not counted as being there for patient care. Actually this is a good law and helps from a facility running a DON ragged and skimping on there RN coverage.

    Usually an interim DON is just a "figurehead" to get by state regs. Usually interims are there to keep things running at a even keel. When a DON takes a position she should be constantly and consistently leading, pushing and educating to take the staff, facilty and residents to their maximum potential while following state and federal guidelines.

    Well anyway...I'll quit here. I could write a whole essay..but I'll spare you
  5. by   CoffeeRTC
    I would love to work with you! We do have an RN in the building at all times. I should look up that tag though. Does the DON have to put in a minimum hrs also shouldn't the nurses have access to her at all times. If we need to contact someone, we have to call our administrator. Also, is there a max amt of hrs a nurse is permitted to work in one week?
  6. by   ChainedChaosRN
    The facility HAS to have an RN on a fulltime basis. If the DON is not there...she has to have someone designated as sharing her job requirements to total 40 hours.

    I can not imagine not having access to your DON or a designee at all times. I'm not sure if this is a requirement though.

    I think the maximum amount of hours is probably regulated by the state. In Michigan, 16 hours per day is max and it's also a Michigan tag that a nurse cannot work 3-11 and 11-7, they can work 11-7 and 7-3 as a double though, or 7-3 and 3-11.

    You probably need to get a hold of your state regs and see what it says about staffing. Hope this helps.
  7. by   Rnltc
    Michelle,

    You poor thing. I have been a DNS since 1989 in several facilites and states. I can not imange being in your shoes. A DNS role as Chained stated is a very tuff role thses days, but how does a DNS know what is really going on on the floor is she is not out there once in a while. I do work the floor from time to time and this gives my team a great respect for me. I have been in buildings with 50 beds all the way to 120 and still work the floor when things are despirate.
    Is your Admin a L.N.? I think if you check your state regs you will find the DNS does have to be avaiable at all times or another nurse posted to call.
    The reg on how many hours your DNS has to be in the building will be regulated in more detail by your state regs.
    The one thing to keep in mind and carry with you is the DNS is ultimately responsible for ALL nursing care, which includes staffing and coverage. She can be criminal charged.
    If things are as bad as you say they are and I am sure they are I would call the state "hotline" for abuse and neglect. You do not have to give your name. I have done this in some buildings where there was NO corp. support and the staffing was so understaffed and Corp would not allow us to use agency or even consiter looking a wages so we could hire staff. I know that this sounds unethical, but as a DNS I am a resident and staff advicate.
    You would be surprised when I have statred in a new building as perminate DNS or intrem and satff and residents say to me "I can't work the floor that is just not done by DNS.
    I moved from the Midwest to Washington 3 years ago coming out for a LG nursing home chain to do nothing but go around to the buildings and be intrem DNS.......I did this for about 18 months and got tired of the travel and being pulled form one building to the next at a whimps notice. The point of this is I actuall had resident say to me "Your the DNS you CAN NOT help me to the bathroom.....Of course I said sure I can I am a nurse......they would reply I have never seen a DNS do hands on care.......and the staff would just freak when I would answer a call light and actual assist the resident. Or take a Dr. call as I new they were busy or on their lunch break. Or call a Dr. for them. You should have seen them the first time I worked a cart..... I think some of the buildings are still in shock.
    The state of WA does have a reg that says a DNS can work as a charge, but I can not count as the RN in the building no matter what the bed size is. So that reg has allowed a lot of DNS to take that and run and say I can't work the shift. Please give me a break......I am going to be cited for working when there really is no one else.....I am going to be cited for covering verse leaveing them short.....they may write that cite but it would never stand up in a court of law.

    I am so sorry for you pain.....Stories like yours just relly piss me OFF. Being a DNS is extremly stressful and so full of paper work that it is unreal anymore, but I am a nurse and a nurse first.

    There are great DNS out there, trust me.....just have to go through a lot of thorns to find a rose.

    Good LUck
  8. by   Disablednurse
    Being a DNS is hard, no matter how big the facility or how well it is staffed if you do not have the support from the management above you. I have worked as acting DNS many times and as DNS and never got support from management. I just got burned out, there is no way to make it without the proper support.
  9. by   CoffeeRTC
    I agree being the DNS is difficult and very time consuming- never ending job. My question is how can you possible be doing it part time (she has the support of administration) and possibly know what is going on in the building. None of the nurses have the DNS support (except for her good friend she just hired). That is what is frustrating.
  10. by   GAstudent
    I work in a 120bed LTC facility and our Administrator is off three days a week doing work at the local community college teaching LPN students. Our DON is works four days a week and first does any paper work she has to, then does any interviews and hiring (she does the CNA's, PCT's, Rn's and LPN hires). She does walk arounds every two hours on each hall. When she is finsihed if there is a hall that needs an extra nurse or if one hall seems busy that day for some reason every resident is needing something at the same time, then she is there. If we can't find a nurse or an aide when someone has called in or someone needs to leave early then she comes on the floor. Then two days a week when she gets of work at 5 and goes to the local community college and teaches CNA class until 9:30pm. She also works every other weekend.

    We have a wonderful staff, DON, and Administrator. I wish that everywhere was this way. Good Luck and find someone to report this to and get your pts the right care that they deserve. They don't need an overworked nurse or aide caring for them EVER.
  11. by   wif411
    I have worked as DON in a 100 bed facility. I was on call and often had to pull shifts...even as cna when help was short.
    I now work as 11p-7a nurse in ltc. The DON pulls call and works 40+ hrs a week. She also works the med cart when needed, she "oriented me" on 07-04 on 11p-7a.
    It sounds if your DON has a pie job. How can she be keeping up and know whats going in the building. It is her ULTIMATE responsibility to cover the building!!!!!
    Good LUCK!!!
    I will keep you in my prayers.
    I am also here for a shoulder if you need it.
  12. by   shygirl
    Your DON sounds like a slacker! Our DON will help out only in extreme emergencies. She doesn't like to but she will. So does our ADON.

    Shygirl
  13. by   Rustyhammer
    I all depends on the DON.
    Some actually believe that pt. care comes first.
    Some don't.
    Guess which ones will help out when needed.
    -R
  14. by   AlixCoastRN
    In Oregon the Board of Nursing/state regs state that an RN has to be in the building 7 days a week for 8 consecutive hours. Also that an RN must be 'available for consultation' 24/7. As an RCM (resident care manager) I take call about every 3rd weekend and we are fortunate to have an RN in the building (either charge or treatment nurse) every weekend. We rotate holidays, and the DON is oncall during the week. We have about 55 residents right now - 8 skilled, the rest ICF. Right now the other RCM is acting DON - our new one starts 9/2. This system works well for our building

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