Calling all ADON's and DON's in LTC

Vicky-
I realize your desire for change from the ER. I'm sure you have seen enough to last you a lifetime.
I just recently resigned my position as DON in a 43 bed LTC facility to work as a staff nurse at my local hospital. My reasons were many. I worked as an aide, LPN, and RN in LTC (different facilities and all three shifts) and I found as DON, I really missed actually seeing residents and being their nurse. Instead of nursing patients, I was nursing paperwork. QA's, incident report tracking, staffing trends, MDS stuff, chart review, staff evaluations, scheduling (my least favorite part), skin reports, pain control trending, care and quality issues, hiring and firing staff, training, audits, and meetings, meetings, meetings.
I just wasn't cut out for it. I was expected to cover shifts when a nurse was sick, on vacation, or was off for disciplinary reasons, and if CNA's called in, I was the one expected to find replacement personell. In a small facility, there aren't a whole lot of people to help you with your job and you wear a lot of hats.
Having supportive, openly communicating management staff speaks volumes. I had an administrator that was completely unorganized and work was almost more difficult with them there. Thankfully I had an office manager that was also an RN that helped me significantly.
And about the salary, it may be impressive when you accept the job, then you figure how many hours you work during the week (and I was on call 24/7 by phone and worked 45-60 hours a week), you realize that no salary can compensate you for the stress level.
I know that it is not like this everywhere, but beware. The grass is not always greener on the other side.

Harleygirl

Have you ever worked in LTC? Might be a big culture shock. The above poster gave a good insight into the demands of the job.

Culture shock is right!! As my sign in implies, I work as an ICU nurse per diem and DON full time +. I happened to work in my current facility as a CNA for 5years while going to school, so in a way I knew what I was getting into.

I would never be a DON in another facility. My job is much easier than most because we are a small facility that only does Medicaid. Since I don't have to worry about rehab/medicare, our resident turnover is low. This allows us to jump through most of the hoops that the regulations require. (You can never be totally compliant.)

Even with the many advantages at our facility, my 2 years as DON has felt like an exercise in crisis management. I have never felt like I was adequately "on top of things" to really focus on desired Quality Improvement.

Enough rambling. If you are really wanting a change from ER, taking a position as ADON will give you an idea of what is involved in LTC.

When I get to my breaking point as DON, I will return to my first love in ICU.

All depends on the facility! Where I work it's wonderful. Work a forty hour week. Lots of support and terrific staff. If you find a place like this, I think you have a great plan and that it's perfectly attainable. Good luck!

I've only been an LPN a few months, but based on what I've seen working in LTC, Harleygirl paints a pretty accurate picture. Most DON's I have seen do have to be on call a lot of the time; as a matter of fact, in my most recent job, I was scheduled for the skilled unit and given the task of hanging IV ABX to a PICC when I had not yet become IV certified. The DON, therefore, had to come in at 8 pm to hang it for me! While I was grateful for her support, I certainly didn't envy her position.

LTC, as a rule, is back-breaking work for everybody involved, from the administrator all the way down to the housekeeping staff. There are just never enough warm bodies to go around because most facilities are for profit and it's always about the bottom line. Of course there are exceptions; there are some wonderful LTC facilities out there with adequate, stable, staff but, sadly, they are few and far between, IMHO.

HarleyGirl....sorry to hear you had a rough time of it as DON. I am lucky to have a great DON AND Administrator. Have done enough Agency staffing to see what changes in "top brass" can do. The Admin. has been at my facility for 10+ years, and the DON for about 6.

Vicky.....as I always say.....try to be the one who makes a difference.

Suebird

I am the DNS of a 120 bed facility....all of about one week now! I was the ADNS for several years, though, so I basically know the job , the staff and the residents. I feel pretty comfortable so far....I have a great team and I work for a wonderful administrator that supports me. But, I'm nervous. The responsibility of it all is tremendous. I'm used to getting called at all hours and the long work weeks, but I always had the DNS to look to for advice. Boy, do I miss her! She was a wonderful DNS and she taught me so much.The job can be pretty overwhelming, but I think it's worth it. As long as you have a strong work ethic, an even stronger back bone, a good bit of compassion and a huge amount of dedication, you will succed.
I say Go For It! LTC is a challenge. Either you love it or you don't. If you find that you don't, you have a strong background to fall back on. You will never know if you don't try. And we need good nurses with good experience.!! I wish you much luck and please let us know how it works out.

I am current ADON in 91 bed facility; I have BSN/RN degree and have been the ADON for about 2 1/2 years; the DON has been there for 27 years and the adm. for over 10; the DON is wonderful, very caring; some days are stressful and other days one of the residents or staff will say or do just a small thing that reminds me why I have actually stuck with long term care. I guess every facility is different, but if you find a good one (like the one I am at) it can be a great experience. I, like probably most ADONs, wear many hats IC nurse, restraint committe chairman, QA, supervisor, problem solver, counselor to the staff, etc. The DON, adm, and MDS nurses and I rotate taking call each week, I work usually close to 40hrs, occasinally more, the DON works 50+. I would say from my experience go for it!