Help! I'm a new DON

  1. I was asked back in April to "help" a Physical Therapist "startup" his own HHA. At the time, I was only working contingent (admission (SOC) RN) for a large HHA and felt that this would be an interesting challenge. Well, now I am afraid that I have gotten myself in way above my head. We have been working w/a consultant to help us to become JCAHCO certified, but many of the resources that I am supposed to become familiar with are very difficult for me to understand. The conditions of participation, all of the Policies and Procedures, Hiring practices, inservice training, utilization review etc. I have NO experience, other than a staff RN, and this was known to the owners, but now we are due for the survey at any time and I am very afraid. I don't feel that I'm cut out for this. I have a fear of speaking to groups and didn't realize that I would be responsible for so much. My husband and family AND my employer and the consultant are all aware of how I feel and my insecurites and tell me not to worry. I am very worried. Does anyone have advice for me? Thank you so much
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  2. 5 Comments

  3. by   henayneiCLNC
    I just found your post - I, too, have been in a DON position that scared the daylights out of me.

    Have you had your survey yet? How did it go? Are you ok?

    b'Shalom
    Henaynei
    Quote from amjbrick
    I was asked back in April to "help" a Physical Therapist "startup" his own HHA. At the time, I was only working contingent (admission (SOC) RN) for a large HHA and felt that this would be an interesting challenge. Well, now I am afraid that I have gotten myself in way above my head. We have been working w/a consultant to help us to become JCAHCO certified, but many of the resources that I am supposed to become familiar with are very difficult for me to understand. The conditions of participation, all of the Policies and Procedures, Hiring practices, inservice training, utilization review etc. I have NO experience, other than a staff RN, and this was known to the owners, but now we are due for the survey at any time and I am very afraid. I don't feel that I'm cut out for this. I have a fear of speaking to groups and didn't realize that I would be responsible for so much. My husband and family AND my employer and the consultant are all aware of how I feel and my insecurites and tell me not to worry. I am very worried. Does anyone have advice for me? Thank you so much
  4. by   Jo Dirt
    I thought you had to have a CON to do HH and they were not only very expensive but you can't just buy a new one, you have to buy them from an existing HH agency who wants to sell one of theirs....it's so confusing.

    How much do one of those babies cost, anyway?
  5. by   amjbrick
    "Have you had your survey yet? How did it go? Are you ok?"

    Well, I made it through...it was a Joint Comission Survey and it was probably the most stressful experience of my life. I don't ever want to have to go through something like that ever again! I had no one helping me besides a "consultant" who was never available. I had to prepare from scratch and I felt that the whole thing was like a nightmare!

    We happened to have done well with three conditions that we have to "fix" or put a plan in place to improve them. (I still don't even have the "lingo" for all of this down).

    Anyways, I really don't want this job and have put my notice in....now that I got them through survey they can find another DON, Administrator, Nursing Supervisor, Intake Coordinator, Field Nurse...as I was doing all of those things for 40 bucks an hour. Plus the fact that the PT who has started the company is interested only in the money and doesn't care a bit about the patients which became more evident once we passed the survey and he basically washed his hands of his patients. He hasn't called any of them or been back to see them. I can't work with someone like that. I referred all of my patients to another agency who can fully give them the care they deserve.

    I'm back to my old job as a contingent field nurse for a major HHA.
  6. by   henayneiCLNC
    Quote from amjbrick
    "Have you had your survey yet? How did it go? Are you ok?"

    Well, I made it through...it was a Joint Commission Survey and it was probably the most stressful experience of my life. I don't ever want to have to go through something like that ever again! I had no one helping me besides a "consultant" who was never available. I had to prepare from scratch and I felt that the whole thing was like a nightmare!

    We happened to have done well with three conditions that we have to "fix" or put a plan in place to improve them. (I still don't even have the "lingo" for all of this down).

    Anyways, I really don't want this job and have put my notice in....now that I got them through survey they can find another DON, Administrator, Nursing Supervisor, Intake Coordinator, Field Nurse...as I was doing all of those things for 40 bucks an hour. Plus the fact that the PT who has started the company is interested only in the money and doesn't care a bit about the patients which became more evident once we passed the survey and he basically washed his hands of his patients. He hasn't called any of them or been back to see them. I can't work with someone like that. I referred all of my patients to another agency who can fully give them the care they deserve.

    I'm back to my old job as a contingent field nurse for a major HHA.
    Don't beat yourself up - you did quite well!! JACHO is a practice in self-flagellation - you actually *invite* this masochism AND pay good money for it!! what a racket!!

    Dear, more good supervisors have gone back to the "field" over JACHO surveys..... and I'm one too!

    I was prompted to Nurse Manager (12+ hr a day 5+ days/week) of my HHA, from 10+ years in the field, and then was promoted to DON 6 months later when the current DON left - shortly after that corporate (headquartered some 2000 miles and a culture away) cut the position of Nur Mgr in our office and combined it with the DON position... so I was also doing most of what you outlined.

    We covered 3 large urban counties in Florida in which we handled skilled care insurance clients for numerous insurance companies, each with their own rules, requirements, authorization guidelines and reimbursement protocols (not to even mention the scheduling, orders, supplies, assessments, careplans and near daily communication required with many of the insurance case managers, and figuring out how to creatively get what the client needed in terms of skilled services, numbers of visits, equipment while staying within the confines of the insurance contract so that we'd get reimbursed!) AND 300 clients on an ElderCare county personal care contract (with it's unique and convoluted set of authorization protocols, checks and requirements) that netted over 2000 hours a week with all the necessary care plans, reassessments, HHA in-services etc, etc....

    I had a part time field nurse that I could only use for 6 hours a week in the office..... and I did it all for about $20/hr (but since I was on salary I was really paid only for 40hr/week - all the other hours were "just part of the job" which by then was nearly 60hr/week). This was 10 years ago. I was losing sleep, nauseated most of the time, felt like a total failure to my staff, my clients, my boss and my co-workers and had no family life. I had asked, no - begged, many times for more help, the Administrator had asked corporate repeatedly for a RFP to hire someone to help.

    We did quite well in all the Medicaid Surveys, the State Surveys and the Corporate Surveys, But when they decided to go JACHO I could not keep up, much less track and create all the graphs, time-lines and flow sheets for all things required by JACHO....

    Eventually, I resigned before the JACHO Survey. I helped interview and hire the nurse who replaced me. They fared moderately well in the survey and they were given extra time to work on the issues that were lacking because I had left.

    After that the office dropped the 300 client county Personal Care Contract, cut their territory to only one county and got the RFP to hire the nurse who had only been available to me for 6 hours a week for more than 20 hours a week. Sad to say, but sometimes it takes drastic action (like the DON resigning) to bring a need and issue into focus for higher ups so they can see, believe and act. The staff and the clients were the winners in the long run.

    Something I learned in those trials: Failure is not falling down, failure is not getting back up.

    b'Shalom
    Heaynei
  7. by   powernurse
    Quote from motorcycle mama
    I thought you had to have a CON to do HH and they were not only very expensive but you can't just buy a new one, you have to buy them from an existing HH agency who wants to sell one of theirs....it's so confusing.

    How much do one of those babies cost, anyway?
    if by CON you mean certificate of need.... that is only in certain states not all..... i am from connecticut originally and we had no CON....in the carolinas this is a strict requirement...... outside of expense, these agencies just arent giving up their territory....they realize the population is growing and yet the state is not opening this up for new businesses.... so much for freedom ...... no seriously though, the big monopolies are the ones who seem to be getting their foot in here..... no chance for startups

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