Any LTC DONs out there?? - page 2
I am a DON in LTC... am interested in meeting other DONs to share ideas and concerns... Hope to hear from you soon!! Thanks... Tim... Read More
Oct 1, '01LTC DONs need love, too!!
Great to hear from you all!
We should start our own website, eh???
Oct 2, '01Hi Tim
I am also a DON. I have been in a long term care facility for the past 3 years. My facility is in Indiana. According to the NADONA Association the average length of stay for a DON in Indiana is approximately 8 months. I must admit I am a little burned out. Any suggestions for survival?
Oct 2, '01Hey all,
I'm a ADON in a 120 bed LTC facility in NC. Same problems as every one else. Can't compete with agency, nursing shortage, the ever rotating staff from one facility to the next. We have tried a bonus program for CNAs. 50 cents per hour bonus for no write ups, no unexcused absences, no missed documentaion and a positive attatude. This is reviewed monthly. We had a grand total of 4 CNAs qualify last month and 4 this month. The biggest response to the bonus was " only 50 cents, it's not worth it."
We tried employee recognition with an extra credit board in the main enterance. Residents, family or staff can spotlight the extra effort an employee gives. This was popular for about two weeks, then the nominations stopped. Ladder program for CNAs; refused to participate. Every one wants a couple bucks more an hour, but no can do. Especially if I have to argue with you to do oral cares, or wipe food off someones face when your done feeding, or follow crushed meds with a drink.
I have run out of ideas, any suggestions???
ok i'm done venting now, and feel better i think
Oct 3, '01Peter73... I feel your pain!
I am up against most of the same issues. Good to know it is no different everywhere else. I just keep trying... have not given up yet!
Good to hear from you ALL!
Oct 6, '01peter...what a thought, at least i am glad to know that i'm not the only one fighting these day to day battles! if i had a dollar for everytime i have said, "what did you do oral care with? silly putty?" i would be a rich woman. a reality check i came up with about a year into my stint as don---about half of my staff actually cares about the resident, the other half doesn't, but cheer up, the ones that don't care will be gone shortly. if you could actually cheer up about something like that. all i can say now, after three years, is thank God for the half that cares.
Oct 7, '01Tim,
I've been a DON in LTC for 8+ years w/MFA. Started out in Fl relocated to Indiana, now VA. Cherrydale LTC is located across the Potomac from the Pentagon! MFA has relocated me too Bowling Green,VA. Newer facility w/120 beds
Oct 10, '01o k how loud does every one else have to yell to get supplies and equipment? and not get the blame for the effect of not having them?
I have been bugging my admin for four months for shower chairs. We have 2 and 120 beds. I finally got the ok to order them today after getting cited on our anual last week for not promoting tioleting for 2 residents that could maintain contenence if able to get to the tiolet and were CP for this. We were not cited for the ones not CP for tioleet use, even though they could in my opinion be contenent if tioleted. I told her when i took this position that this is a wide spread prolem in the facility and we would be cited if i didn't get the supplies for staff to use. That a bedside comode was not an option in every room, not enough of them. That some of our resident can't be manuvered into the bathroom if not on wheels, and shower chairs are a good bet because when not used for tioleting they can be used jfor what else getting the showers done! 2 birds one stone. ( the bathrooms are small and funky shaped, hard to impossible for a 2 person transfer with any safty at all)
Now, after 4 months of begging and complainig and being put off, It is ALL NURSINGS FAULT! My performance and effectivness is being judged by these tags that I well informed them of and told them what I needed to fix them and was denied months before the survey. Is this short term memory loss common? Did I not stress the importance of the issues?
How does every one else get the things nursing needs to prevent a tag? Should I be snotty and tell the owner I DID predict the tags and have been asking for 4 months for the things we needed to fix it, the next performance = tag # speech?
Why is there a wall and why do I keep hitting it?????
what a crappy week!
Oct 15, '01I am A LTC DON also. I would really love to talk with others dealing with the same problems I am dealing with.
At this time, I am dealing with a staffing problem. The noc shift nurse has called in 4 weeks solid due to knee problems....grrrr. Because of FMLA, I cannot term her. It is burning me and the other nurses right out. I can only work so many night shifts. We cannot use agency. So it has been the Adon and me covering shifts. To make things worse, The weekend night shift nurse is off for an extended period of time due to CA. I feel so bad being upset that these shifts need covered...esp because it is not the nurses fault. oh well...hopefully things will look up.
Anyone can email me anytime. Thanks for listening.
Oct 16, '01I have always tried to "pad" my staff with at least 10% part time or per diem people. Having your own "pool" of nurses helps, but the wage must reflect this. Advantage is they are employees of the facility and not the agency. Also creating a "12 hour" shift with the second shift doing four hours over and the first shift coming in 4 hours early could help in a pinch. If you think this FLMA will last a while, perhaps advertise for a "temp" nurse with possibility of full time. My budget allowed for a 2nd and 3rd shift supervisor, (with 3 out of 4 days working the shift). With so many people using (or abusing) the FMLA it is wise to suggest a policy from the administration or corporation. Good Luck!
Nov 3, '01I'm a LTC DON........isn't it great!! Actually, it is "ok".....4 1/2 yrs doing this, sure have been lots of ups and downs but I manage to get through it. So much I want to do, so much that could be done, just not the time. I find myself so torn as to where I should be, out and about? behind my desk? I know there has to be a balance, just haven't found it! Am excited to be part of this board!:
Nov 6, '01Hey Guys!
I just found this site tonight and am so glad to see some communication between LTC DON's. I've been in LTC for 20+ years and have always felt the need for a way to communicate with other DON's to share information and ideas. I'm glad to see the number of new DON's- we need you with your fresh new ideas. Yes, it is frustrating many times, but always rewarding. As you leave work each day just think of the special contribution you have made to someone's life.
I am DON at a 98 bed facility in a rural area of North Louisiana. Since reimbursement in Louisiana is nearly the lowest in the nation, we must constantly look for innovative and inexpensive ways to provide care. So I can really empathize with you Peter. After years of begging and screaming for needed supplies I found the solution. First I decide if the item is really a need or a luxury item. It it really is a need, I mention it once to the administrator. If I do not receive a response in a timely fashion, I then send the request in memo form (keeping a copy of course). Since I regularly communicate messages to my staff with memos, it does not appear I am acting in revenge, but rather as a reminder. Works most of the time. However, when it doesn't, I have the copy of the memo to refer to. Somehow things always get more attention when placed in writing.
Hope to hear lots of ideas from you guys.
Nov 18, '01Hello all,
I am having a major problem at my facility with CNA documentation, or should I say the lack of it.
I am moving the BM documentaion to the MAR as squaw nurse has done.
Now for the ADL sheets.
Do your facilities use them?
This is the first facility that I have worked that required them.
The nurses do weekly charting in a four week cycle that covers all ADLs and MDS data. Medicare residents are charted on ADL function daily and all reported declines / acutes are charted on daily, I think it is well covered without the CNAs diong ADL books and creating discrepencies. ( we have had residents that have died or discharged that continued to perform ADLs at baseline)
Inservicing did not help, the staff nurses leave me notes that they did not get done when I'm not there. The nurses do not enforce the documntation and I am not there 24/7 to stand over them nor can I review 120 sheets on a daily bases.
I see the ADL sheets as a rope around our necks when survey shows up and would rather not do them than have them done incorrectly or irregularly.
Also our CNA group sheets list care instructions and base ADL data as a mini care plan for CNAs. They sign and turn them in to state they completed the group as planned and required.
I just feel that we are documenting this to death and increasing the chances of error.
Nov 18, '01
I know what you mean. I always wanted to make sure there was documentation about a certain issue, but no more than one place. It is a RED FLAG when you have several places to document-and there are discrepancies. And BM documentation was always a trick. I worked several facilities in the area thru agency, and the best way that it worked for me (but then again, the charge nurse had to monitor it) the CNA's would document the BM on the assignment sheet for that shift, and at the end of the shift, the nurse has to transfer that info to the MAR. Most of the nurses put a '0" in at the begining of the shift, and by the end, write over with a S,M, or L if they had a BM. There are very little holes, and if there is, you can back track it by checking that shift's assignment sheet.
As for the ADL documentation-I think it is a potential RED FLAG also. I don't know what the answer would be to that, except for "spot" monitoring, trace back the culprit and counsel. But if you think that is time consuming, check this out. Our corporation had a great idea (LOL). They wanted the CNA's to complete a small 1/4 page paper on each shift and each resident. These were to be mounted in the chart. Supposively this was suppose to cut down on copying the previous shifts documentation. The only thing it did was make our charts HUGE!IT was less than 3 months and multiple complaints from the various facilities when that great idea went down the tubes. (Thank God). If I may be permitted to dream a little here, I always have been playing with the idea of computer CNA documentation. A software program that the CNA answers a few short questions about the resident (how many assists, how much they ate for a meal- easily answered questions) and the program saves the answers and compiles them into a "snap shot" of the residents abilities. Of course it would be MDS based. Oh and it will not let the CNA punch out at the end of the shift unless the questions were answered. This would also provide computer compentencies for the staff. And it doesn't have to be expensive- most facilities have computers now. I see a computer set up at the nurses station called the "documentation station". Remember, it has to be simple questions. Easy to do, it can't take more time than they already spend on documentation. Any software wizards out there?