Can a DON make a real Difference?

TeresaB930, BSN, RN · Dec 10, 2007

Sue,

I absolutely believe a DON can make a difference!

First of all, you and I are on the same schedule! I graduate in March, take my RN boards and then onto accelerated MN degree, cause........I just can't get enough!!!! :uhoh3:

I also work in LTC, and a month ago, our DNS approved 5 med carts for our facility. Now, 85 residents are divided amongst 5 carts! Very nice! But the point being, she listened to us. We had a survey a few months back, and of course the youngsters listed more pay, whereas those of us with a little life experience asked for a 5th cart to better care for our residents.

The NACs won too. They went to a 9 string for days.

I don't know if she understands the magnitude of what she did. I am seriously thinking of staying at this facility after graduation. I keep hearing about the awful nurse-patient ratios, etc., and think I should stay where they take care of their employees!

My ambitions are greater, however it may be the best move to stay until I finish my first career.......school!!

txspadequeenRN, BSN, RN · Dec 10, 2007

i have worked with some rotten don's. i must say my current don is just about the best don i have had. she knows her residents inside and out. she will answer lights ,toilet people and feed in the dining room. but another thing that makes a outstanding don...my don stands up 100% for her staff... that makes a huge difference for me.

caliotter3 · Dec 10, 2007

When our DON walked off the job after a to do with the administrator most of the nurses talked about her as if they respected what she had done. She stood up to the administrator when he was trying to force her to take an admission that we were not prepared to care for. However, it is unfortunate that she did not come back and fight the administrator tooth and nail about a lot of things. I had never heard anyone talking about her good or bad prior to her dramatic exit. And of course, when she left, the place became more chaotic than it was already. She didn't do us any favors by standing up to the man and leaving over the issue.

There have only been two other DONs that I have really thought were worth their paychecks. Both were obviously involved with caring about the patients and about the nurses and CNAs doing a good job taking care of patients. To some extent, all of my other bosses have been paper pushers or desk jockettes. One of them was just collecting a check from the company while drawing disability and coming and going when she pleased. Never saw her even produce any worthwhile paper. Don't know how she did it. I would feel ashamed of myself to come to work at 10 in the am and be gone before 1 pm.

oramar · Dec 10, 2007

Yes they can make a big difference. However, a lot of them are hamstrung by CEOs and CFOs that are mostly about the dollar.

Daytonite, BSN, RN · Dec 10, 2007

Can a DON make a real difference? YES.

But here's the thing. . .and this is what I learned when I became a head nurse and unit supervisor. . .as a DON you will have a lot of job responsibilities that you will have to fulfill that as a staff nurse you were not aware of. In fact, most of the staff are not aware of the DON job responsibilities that you will have, nor will they understand them. When you come up from the ranks of the staff you tend to have the situation of what is going on with the staff in your heart. It's naturally because that is what you know and you know it well. You won't know the job of DON as well, so it will be very enticing to regress back to doing staff nurse things. Being a DON will give you the authority to influence the attitudes of the nursing staff. It won't be easy. In fact, I'll venture to say that in most cases it is going to require that the ones who viewed the residents as so many animals, to be fed, watered, and put away will need to finally quit and leave. To some extent you can influence that by putting some pressure on them. It will be through your efforts in hiring and delivering a serious speech to new hirees about your philosophy on how you want the residents treated that these changes will come about. Addressing behavior and making workers change their attitudes is a very difficult thing because you can't really put any disciplinary action on it. You can call people into your office and have one-on-one talks with them, but they are only going to go back out and talk about it with the staff who have their sympathy (attitudes! you gotta love it). You can write them up and address it on their yearly evaluations, but it won't really affect their employment though it may affect their job satisfaction and influence their decision to finally move on. Only through attrition of the old staff and your hiring of new staff will you finally see things start to change. And, that may take some time. So, the question is how much patience do you have to see this out. The homes where there is great attitude are usually led by a DON who has been there a while and has had a chance to have their influence make a difference.

If you have never interviewed and hired anyone, that is a new experience in itself. People can be very deceptive during the interview process. And, the time to get rid of a bad worker is during their probationary period. If you do not have charge nurses who are going to help in writing up or calling indiscretions to your attention you could get stuck with a real problem employee. One of the first CNAs I hired who I thought was good in her interview turned out to be a big liar and ended up getting fired for falsifying charts and got involved in a big incident where she accused one of the nurses of some wrong doing. You don't know how relieved I was to be rid of her and how much I learned about job interviewing.

The fact is that most of your administrative responsibilities are going to consume your time. You have no clue what they are, but your boss will make them very clear to you. You may find that your communication with the staff will become much harder to maintain or accomplish. I think the DONs who care are the ones you see working longer hours in order to get out onto the nursing units and interact with the staff. It also takes a good knowledge of how to successfully delegate and supervise. As a head nurse I was constantly having to go to meetings or deal with budget problems and staffing and had very little time to actually see what was going on with the day to day problems of the patients and staff on my unit. I found it very frustrating.

I say, give it a try. It's the only way for you to find out what the job is like. But, I would also caution you that you may find yourself unprepared for some of the tasks you'll have to do as a DON. Nursing school really doesn't prepare anyone for being a manager and supervisor. It is something you'll have to learn through seminars offered by business professionals. If you're reticent to go for a DON position at first, go for a supervision or Assistant DON position to begin with.

If a DON is seen actually getting her hands dirty, toileting someone, changing a soiled brief, *gasp* doing rounds with the aides should someone call out (I know, time is an issue, but...) do the employees catch the caring fever?

Not necessarily. What they will say is that the DON is great and will dig in and help. But it can also work against you. If they are short of help, the staff may expect you to help them out, literally. Keep in mind that as a DON you have other job duties that they will not know about or understand need to be completed. Some will see a DON doing staff work as a weakness and lose respect for you. Better to learn how to delegate these things as well.

SuesquatchRN, BSN, RN · Dec 10, 2007

Thanks, Daytonite. You answered a lot of what I was worrying about.

I'm not worried about management, actually. I've had managerial positions in my past life and understand what it entails.

Jo Dirt · Dec 10, 2007

I miss LTC. I am close to getting the RN and plan on going straight for an MSN in case management to make up for my lack of clinical experience. Obviously, I'll have more by then.
I guess my question is: The frustrations of over-regulation and short-staffing will never go away. But one of my biggest problems was with the attitudes of those who viewed the residents as so many animals, to be fed, watered, and put away. And G-d forbid they need to pee off schedule, etc.
If a DON is seen actually getting her hands dirty, toileting someone, changing a soiled brief, *gasp* doing rounds with the aides should someone call out (I know, time is an issue, but...) do the employees catch the caring fever?

I don't believe the aide's are the problem, more like, will administration catch the caring fever?

We have to face it: being an aide is a filthy, incredibly difficult, thankless job. Add to it 40+ needy and sometimes demanding patients +2 aides and you either run it like an assembly line or the whole place turns chaotic. Talk about burnout. I'm sure it would be wonderful if the aides could spend a substantial amount of 1:1 time with the patients but unfortunately, that's not likely to happen. During my short stint as an aide I remember one woman, almost apologetically, remark, "They work you two like a team of pack mules!" She was right, and it's a shame people have to do without and suffer because Mr. Administrative Big Stuff has to keep up his lifestyle and buy his wife some more jewelry.

The local nursing home recently sent me a letter to come apply for some RN positions that had opened recently: Clinical Coordinator and DON.

No thanks.

SuesquatchRN, BSN, RN · Dec 11, 2007

mama, I've worked in better-staffed facilities than that and, while I think most aides are hard-working and caring, I've seen too many treat people cruelly to think that being an aide means being a saint. Or a nurse, either.

Lexxie, LPN · Dec 13, 2007

There are 3 facilities under one umbrella where I work at. I work in 2 of them. Facility A: the DON truly cares about her team members. She is willing to work with you in any situation. Granted she has the same staffing contraints & other BS to deal with, but she makes you feel valued. Facility B: my impression - and I could be totally wrong here - is that they (DON or any other upper management personnel) would stab you in the back in a heartbeat. The company comes first over anything else. I don't feel like a valued team member there. While neither DON gets her hands "dirty", I respect the DON in Facility A and will always accept hours there before facility B.

CapeCodMermaid, RN · Dec 18, 2007

In a word-Yes.

noc4senuf · Dec 23, 2007

I have worked under some very poor DON's in the past that never came out of their office all day (working 9-5) and did not know the residents either. I have also worked under most caring and helpful DON's willing to help you at a moments notice. These DON's worked long hours that were not paid in overtime since they were salaried.

I myself as a DON get to work on a normal day around 6AM and stay until about 4PM. I am able to see and talk with all shifts this way. I do pitch in and help the nurses and aides as much as possible, that is why there has to be some days where I shut my door just to get my own work done. Or the timess where I have needed to go to the bathroom for a couple of hours and when i finally head there, have 3 call lights on that I stop and answer and tend to the residents needs before my own.

I hope that none of my employees in the past or future ever consider me as one of the poor "office" DON's that do not respond to the employee and residents needs.