as DON/ADON ....do you help or hinder your staff?

Specialties LTC Directors

Published

I am an LPN in LTC. We got a new DON from out of state 2 yrs ago...who has since made tons of changes that originated from her home state. when she makes a change she says the same thing all the time "Its per corporate"....which half the time is bull. She made up an attendance policy that she herself doesnt adhere to or follow. She is an intelligent nurse...but she has this "i dont care" attitude about staff and residents. she takes it upon herself to cancel residents appointments if she thinks they dont need them....she changes meds and diets if she thinks they arent right. She never helps us with admissions or paperwork or with short staffing issues. She doesnt explain new things...she leaves notes and tells us to sign it. She has made families think that us other nurses are incompetent and that we dont know what we are talking about or doing....not good. She doesnt deal with staff issues such as : constant chronic call ins (its usually the same ones who call in or dont show at all...all the time and still have a job), the lack of teamwork in some nurses and cnas as well....the poor training that new nurses and aides get including sloppy orientation, she tells the day charge nurse to "get out of here" all the time and tells her to pass on her 4 to 5 hours of leftover orders, labs and consults to me (i do charge on 2nd...but i run a cart, tx's, charting, assessments etc) and i dont have time to dotheir work plus mine. The day nurse always gives it to me instead of splitting it...i think that if its going to be passed on...pass on whatever you have to the nurse in charge of that particular pt instead of me all the time. if we end up short on a shift..she or the adon dont help us...they tell us we have to stay over and expect us to be back the next day....the call ins never even get a word said to them...i had to fill out 5 med errors in one night d/t not having meds for 5 diff pts....the pharmacy didnt send them til after 3rd shift was there......she came to me and told me that they were just misplaced...i know they werent there..i checked 4 x before i ever filed a med error sheet on them....what she did was use that as a way to get out of reporting that to corporate in her wkly reports and not only was it a falsification....but it made me look like i overlooked something that absolutely wasnt there....my ? is this..as don / adon...how would you deal with each of these scenarios? do you help your nurses? or leave them hanging?

you know there is good and bad with LTC, when the residents say I am so glad your on today. It is not all a bed of roses. I have worked on both sides, nurse aide, then LVN, working currently on my RN, I teach the nurse aide class and do mds's/careplans with minimal help from IDT people. Our facility usually does not smell bad. We got a gal in the kitchen that can make a mean plate of enchiladas for $3.00 can beat MCDonald's anyday. I have seen good and bad adon's and good and bad DON's, I have a Don that is a bit on the lazy side, smoke breaks probably more than being actually inside the building. What I started doing is taking her to trainings with me putting out nice notes when I see her follow up on things. I know in a perfect world would not have to do this. But god forbid the last DON come back --- Telling all the family members that medicare pays the whole 100 days period lol. Yes good to vent about it. Yes you probably need more training but do you know her duties?? Has she been trained to train you?? Our RN consultant was stuck at a sister home with an IJ for a month before my boss was even shown our systems. Have to always look at the total picture. I really dont think most nurses get into the job just for a paycheck. The education part is the key. Like getting out there and turning folks to show them how to do it, proper body alignment. Show them how to make rounds, what to look for, teach them time management skills and encourage LESS TEXTING while on duty-- (drives me insane) I have worked in some big cities nursing homes an been afraid of the staff I worked with back when I was a young nurse, so I learned, "ok girls come on I will check these 3 rooms for you if you go get that light over there, then we will go turn them all together" I sure dont have all the answers but seems like more teamwork and less worrying about all the things the management or nurse is doing wrong would help a little. I teach my nurse aides when they come to work you dont have to like each other but while your in the building you have to work for the good of the resident. and some of that stuff like not getting your paycheck correct there are things you can do about that. If your DON is dogging you try to ask for a time to talk about how you can make things better for you and your residents? Conflicts dont get resolved if you dont talk about it. Sometimes if I have been so miserable working with unreasonable Don's, higher up's and could not get a resolution that worked for my own sanity and peace I did change jobs. But I always start a job hoping to stay there at least a year. I feel that is ample time to really see how things are going to be sometimes you have to get out sooner. NOt encouraging any of you to leave LTC-- we need nurses I never was upset with a nurse that came to me and said you know this is just too much I think I am going to work at home health, the hospital etc.. Everyone has a nitch. I want to motivate you to help someone you work with even if just bringing in some candy or fruit or special lotion for everyone to share. Or when they really need to get this guy off to PT but have to fill out meal intakes we go record a couple of intakes or answer a call bell. I am talking about DON's, Adon's Mds people , housekeepers offering to pick up your trash in your office those types of things for us all and you will see good things. We made a board and put thinks like WOW thank you ____ for completing your flow books, Thank you for cleaning out the fridge night shift, etc.. WE give movie tickets on pay day to the ones that are working extra. Kind people rule!!

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one more thing to say, I was doing the supply ordering, I finally got someone else to take task off my back. But I am going to tell you I have a copy of everytime I sent a copy to main office and they would not approve gloves, bed alarms, face masks, things we needed to care for the residents. Usually they are pretty good if you give an explanation but they are feeling the squeeze with the medicare/medicaid cuts. So what we can all do to help the whole total pic is better charting. not grab 40 paper towels when we just need a few. It is getting crunch numbers time and I feel with the new rug rates coming up with MDS 3.0 we will really feel the bite. I have those copies ready for the state inspector next time they come in if they ask why we dont have this or that. So sick of that type of thing when fed regs say you have to provide quality care for residents how without supplies, people to care for them, will not approve for an extra restorative aide adn the list goes on and on..

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Reading your eloquent list of complaints against this DON makes me feel better about myself as a new DON. The only thing I could agree with or try to understand is making sure each shift gets out of the building on time to reduce overtime and for maybe understanding the floor staff point-of-view that they have a life outside of the job, unlike mgmt who are free to "live" at the facility. Expecting non-exempt employees to stay over routinely, because the DON does is discouraging to staff, being another reason for high attrition rates. That DON neds to get her scrubs on and help you.

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Specializes in geriatrics, pediatrics.

i am so soory that you do not feel support from your DON. As a New DON myself it particulary bothers me. I came to a facility that has had at least 7 DON's in 18 months. The staff here didn" t feel supported and rightly so. THeir boss was the DON of the week. I finally got all my manager positions filled and then told the managementthat our staff was just as important as our patients. The staff were really surprised to hear I would excuse unit managers from meetings if they needed them on the floor. THey tried it and found out I was telling the truth. Everyone need to be held accountable and the managment has to be consistent wiht everyone. i am starting to see the fruits of my labor and I have been there almost 4 months . Hope things get better for you soon-

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Specializes in geriatrics.
I have worked in LTC for most of my long career and am sick to death of people saying "LTC has historically been a mess." The facilities I have worked in have been clean, no smells, conscientious staff, wonderful care, great rehab, plenty of supplies. Please don't keep making broad generalizations about LTC. It's bad enough that most people out there think we do nothing all day...we shouldn't have to keep hearing it from people who work in the business. And about your paycheck...have YOU never made a mistake? Why do you act like the payroll people made the error to aggrevate you or cheat you?

AMEN SISTER!!!!!! I have worked in LTC for 17 years, started as CNA, LPN, MDS/Careplan Coordinator, and now DON. I have worked in some terrible places, and I have worked in some wonderful places. I think the same goes for all different areas of nursing. I love LTC, and will agree with you on this one. :yeah:

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Specializes in Geriatric.

I am an ADON, have been a nurse supervisor, floor nurse, med tech, and an aide. I agree that we are all not evil. I am the one people call when they need help, because they know I will help them, no matter what I'm doing. I don't get my work done, because I don't have time. My resident and my staff come first always. However my DON is the pits sometimes. She pawns things off on the floor nurses a lot, she is gone a lot without telling anyone. I love her as a person, but man she is hard to work with sometimes. I always say you have to lead by example or you will never be respected. Don't ever ask anyone to do anything you are not willing to do yourself, this includes your nurses, aides, housekeeping staff, and dietary staff.

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Specializes in Geriatrics, WCC.

I am a DON, and have also worked my way up from a CNA, floor nurse, shift supervisor, floor manager, etc. I am also the director over medical records, the MDS coor, Medicare nurse, and staffing dept. Currently, we just had survey through and am gearing up for the POC, just finished a year and a half grant on pain, am on a steering committee of 4 that wrote a new 3 year grant accepted from the state and have the training and education to start for 19 facilities in a collaborative and takes me out of the building at least a half day each week, am in charge of all depts getting their training for the MDS 3.0, have several meetings and classes in the next two months to change our software and need to train all dept on its use.

I get to work each morning by 5-5:30 and keep going until abot 4P. Even though all our positions in nursing are filled, there are still staffing issues due to staff taking vacations and extended LOA's back home (Africa). Don't forget those off on FMLA.

I also have two union grievances, several unemployment claims, and a discrimination suit I am working on.

I rotate on-call with some of my staff, and it is great that the nurse seldom call.

I have a problem with a nurse telling me she can't take her break or get her things done on her shift with no more than 18 -23 residents on a LTC floor. They do not do any of the assessments as their is a manager for that. They pass meds, chart, tx, etc. When I worked the floor, we had 30 40 residents each and did all the assessments. I believe a lot of the problems is time management skills. I do answer call lights, help feed and toiletr when i am on the floor.

BUT.... I can't be there all the time.

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Specializes in LTC, ER, ICU,.

op, your post is well taken.

i must say, all are not the same. moreover, the owner/coporate dictates a lot of the issues you mentioned. it does not mean the don/adon does not "fight" for "you", it means many times, she/he is limited in what she can do.

so many times the very people you think are "getting away" with. for example being late, beleive me, it is being taken care of. there are so many variables and it depends on keep paper trails and following policy and procedures, etc..

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Specializes in LPN.

I am a floor nurse at in a LTC facility. I believe the best thing you can do as management is encourge and compliment. People work harder for you, if they believe you see the good in them. My best and favorite supervisors, managers and DON's have made it a point to compliment staff.

I know there is a lot of poor performers around, but even they might improve with a bit of encourgement. When I work, I have 4 CNA's. I try to find something each one does well, and compliment them. They then usually make a point of showing me that they are doing this again. The compliments run the gamet from, "Wow, I am impressed at how well you handled that patient when he was verbally abusive" to "You always bring your vital signs to me within the first hour, it makes this place run so much smoother". I often see CNA making a point of showing others how good they are in this area, esp when they think I am watching. It's interesting and fun to watch. It also makes the times I have to give them a little talk about their slip ups and attitudes a little easier, ...and a little more distressing for them.

I had a Unit Manager who carried a book with every nurse and every CNA's name. Each month she would try to give everyone a geniune compliment about our work. Then you would see her pull out her book and check your name off for that month. It was not without it's humor, but I really looked forward to her feedback, and loved the compliments.

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Wow, your story seems quite similar to my LTC experience. It is sad but can be true at times, DONs not caring and letting others get away with things, that you would not be allowed to. I can only say work exactly by the book, in my experience I wish I would have tried harder to do this, because unfortunately I was fired but my DON still has the same job, in which she has had encouraged nurses to falisify documentation because state surveryors were coming in, did I say anything when I caught all the things she was doing, no I never did, because I was afraid for my job. Because they wanted me gone, I was fired along with two other nurses and two CNAs. Funny thing was my state board of nursing dismissed everything against my license and basically wanted to know who I had ticked off. In the past two years there has been close to probably ten firings at that facility, scary isn't it.

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Specializes in Geriatrics, WCC.

Only 10 firings in two yrs??? I let people go every month. In two months, my staffing dept hired 9 CNA's and I let 6 of them go. I will not tolerate any abuse, theft, lies, absentee problems, etc. we have a great facility and I plan on keeping it that way. I have nurses and CNA's that have been there since the 80's and newer ones also that just love it. I definitely appreciate my staff for the hard work they put in, and let them know every chance I get.

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You sound impressive as a boss, tough but fair. I can see that you are consistent and do not show favortisim between your CNAs and Nurses. Which is something I cannot stand, in my situation, the CNAs were always right and nursing staff was always wrong. I have witnessed nurses being extremely disrespectfull to the DON and even almost cursing her to her face and it was allowed. I will tell you my experience, I was employed six years, was working as a nursing supervisor, and was terminated for allowing a CNA to work out of scope. The aid was working on a day I was not even working and was caught drawing blood. Now after a full investigation myself and two other nurses were fired along with another aid. I was termed for teaching the aid to do it. Here was what I explained to the board I did not teach her anything I answered questions as HOw do you know what tubes to use? and this aid also helped to hold patients while drawing but I never stood over her and taught. She also helped me in putting in a foley catheter and I had to have her to insert the water in the balloon. 30cc, patient in side lying position, very combative. Now I completely explained this to the board and they fully understood that you do what you have to in the real world of nursing and said CNAs ask questions all the time that is how they become nurses, if the aide was dumb enough to try it then that was her problem not yours.

Now my problem I had with DON was she had a well liked nurse in our building to make a completely new TAR after we circled that a tx had not been done, because not all of the nurses had been instructed on how to do CPT, this was told to us that it is a nursing measure and should have been implemented, I could have done it myself because I had seven years experience as a Respiratory Therapist. Last time I checked CPT is not a nursing measure and cannot be done without a doctors order. So she destroyed the TAR and just made a new one, completely destroying part of residents medical record. Last time I checked to that would be considered illegal. I have been a nurse for fifteen years and this almost destroyed me, because I had married myself to my job and thought I was doing a good job, only to have it taken from me. I have lost my drive over the last sixteen months but have finally went back to work, after a seven month lay off from another job, and will be taking my RN boards in three months after being out of school for over a year, this also almost cost me furthering my career.

It is nice to see that you can run a tight ship, the DON I worked for has lost respect from many of her coworkers, and lacks professionalism, but I have let it be a humbling experience for me and have tried to rethink my strategy and really figure out to improve myself as a person and a nurse and all you can do is learn from your experience, and remember that you have to protect yourself and your license and hold an extremely high standard for yourself, and dont be afraid to speak up when those higher up are doing wrong.

Keep up your good work! :nurse:

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