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This is a discussion on Any advice and help is greatly appreciated!!! in LTC: Directors Nursing / Assistant (DON/ADON), part of Nursing Specialties ... I am a recent RN graduate. I took my 1st nursing job at a LTC/SNF as a floor RN. Within a couple...by cad3 Sep 16, '12I am a recent RN graduate. I took my 1st nursing job at a LTC/SNF as a floor RN. Within a couple months, I am now the active D.O.N. I am having a hard time with staff regarding a multitude of problems. How can I change the work culture? I am meeting resistance every day. I have tried to implement different tools to make their jobs easier. I have modified the medication administration times, and really tried to bring a positive attitude to them. I cannot get the idea of time management into their heads, nor the fact that basic care is all I am asking. I feel like every day I get farther and farther behind because I have to direct staff of every minute of the day on things they should already know.
If anyone has outlines for monthly and/or quarterly reports such as Medical Director Meetings, Infection control, IDT, Quality Assurance, anything you can offer is appreciated.
Any advice, tips, or heavy drink concoctions I will use!
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- Sep 17, '12 by Nascar nurseFrom new grad to LTC floor to DON in just a couple months! Yikes and double yikes! Someone has set you up for failure!
I'm not sure worrying about quarterly or monthly reports is really your biggest priority at the moment. I would be much more focused on making sure you know your facility policies and procedures inside out. Concentrate on: 1. Pressure ulcers (tx orders in place, interventions in place, nutritional supplements in place, does the staff, both aides & nurses know who has pressure ulcers, does the careplan match all those items that are in place). 2. Falls (who are your fall risk residents, who are the repeaters, are interventions in place and appropriate, is staff actually implementing the interventions/not just paper compliance, has family/Dr been notified of falls, does the careplan match all the interventions).
As far as meeting resistance from staff, you may need to be more specific with what you mean. I'm concerned they may not be taking you seriously due to your lack of experience and it could be that you really are making some judgement errors because you don't have a good knowledge base to build on.
- Do you work with a corporation or a private facility?
- Is there corporate support available to you?
- Do they already have reports and forms that they require to be done on a monthly/quarterly basis...don't waste time re-inventing a wheel.
- Does your facility have a traditional survey process or a QIS process?
I'll start here but there is so much more. Answer some questions and I'll come back to help with some more answers (and so will others)
- Sep 20, '12 by amoLuciaMust have missed this thread earlier. Nascar, you said a mouthful!!!
One thing for OP ... go easy with new things. Too much, too soon! People are very resistant to change. You perceive your changes as beneficial, but the staff pretty much like things 'the way they always did it'. Go slow.
Secondly, all your changes seem to be one-directional. Did you make any effort to include your staff for their input/recommendations? I betcha they might be more receptive if things weren't just dished down to them. You noticed I said 'dished DOWN' - seems that way to me. They probably have an wealth of knowledge that you need to tap into as you seem to be hitting a wall of 'passive resistance'.
Thirdly, Nascar priortorizes wounds & falls. I would add to check med errors & psychoactive meds, and also weights. Just a couple of other high-risk areas.
Fourthly, is your staffing OK?
I am hoping that you have a strong nsg support team of ADON or supervisors, MDS/RNAC, SD/IC nurses. Use their skills and knowledge!!!
And just to give you a heads up - plan on a State survey soon!!!!! They usually come in when there's a new change of DON. So I would suggest you familiarize yourself with your last survey, esp that your Plan of Correction is being followed (assuming that there were citations). And lots & lots of good luck!
- Sep 20, '12 by CapeCodMermaidIf I were working in your building, I would have a hard time believing you knew what you were talking about. Sorry but from new grad to DON in 3 months is scary. All I can say is good luck and pay attention to the nurses who have experience.
- Sep 20, '12 by itsmejuliI'm an LPN with 3 years experience in nursing and 30 years of working experience. I've never worked in a supervisory role but I have a whole lot of experience being supervised.
A few months ago I landed a new job supervising HCAs performing homecare in a lodge for 165 geriatric clients. When I took this job I decided that I was going to use the management skills I liked from the supervisors I'd had over the years whom I liked and respected.
I go in to work every day with a smile on my face, I don't scowl and say nothing negative. No matter what's going on, I do my best to be pleasant.
For probably the first 6 weeks I just watched what was going on and listened. I listen to everyone and take opinions from everyone, everyone includes all the aids and the clients. I allow input from everyone and then decide what is best for everyone. If there is an issue I take the aid aside in private to talk, I finish the conversation with something positive in their performance.
I show them respect, I thank them, and sometimes I bring treats.
I have a terrific team of aids, they do their jobs well and complain very little. They thank me often for having their backs and listening to them. I have very few call offs and my team picks up extra shifts when I ask.
And then there's the other half of my job...
- Sep 20, '12 by amoLuciaKudos to you, itsmejuli.