I am new to this forum and found it by searching for hours...It seems to be filled with fellow leaders in nursing like myself and I am in need of some guidance, advice, or whatever you can offer a struggling DON.
I have been a nurse for nearly 20 years, and have worked in LTC, Acute Care, CCU, ICU, Disease Management, Travel Nursing, etc, and have now "settled down" with a job that I always wanted to do. I am the DON of a LTC Skilled Nursing Facility in WI, and within a non-traditional nursing management model. My facility is a 120-bed facility, and I have 3 MDS Coordinators who are to be unit managers as well. I have been in this role for 9 months now and have worked consistantly 60-70 hrs per week, and am on call 24/7. I have always been very efficient, a leader, have great organization skills, have managed and worked as charge RN in nearly every job I have had and this one, I have to say, is about killing me!
The responsibilities of our jobs are certainly broad and time consuming, but what I have been handling seems to be the job of more than one person. Here are a list of my responsibilities which I am sure will not be all inclusive.....
-Staff Development and Education (In-services monthly & Nursing meetings)
-Behavior Med Management and roundly with Psychiatrist Bi-monthly, TD screen management, etc.
-Hire, recruit and evaluate all nursing staff
-Infection Control (to which we just recieved an level L F-tag during our influenza outbreak), Epidemiology within my monitoring, ensuring adherence to McGeers criteria and CDC, etc.
-QA daily of behavior charting, Summaries, Incidents, Falls, MD Orders, New admits, Symptom Pursuits. QA weekly of Med rooms, passes, accurate charting, follow up with SO/MD's, etc., etc., etc.
-Daily MD rounds (we have MD's in our building for about 4 hours per day), and monitoring for accurate and compliant Mandated visits with each resident.
-Nutrition Risk Committee, Skin Committee, Behavior Committee, Medicare Committee, Falls committee...Chair of all of them..
-Required to staff (despite being salary) to improve PPD numbers one 12 hour shift per 2 week schedule
-PPD management with numbers that seem impossible to reach, in addition to staffing with the help of a scheduler (Thank you Jesus!)
-Employee Infection Control
-Immunization of Staff of TB, Hep B, FLU, etc, as well as Residents and keep current daily.
-Troubleshoot with staff and be available 24/7 for any nursing concerns, and resolution of conflicts
-Medication error investigations and re-educations
-Discipline and re-education of all nursing staff.
-Deal with and resolve resident and family as well as staffing complaints.
Now, I am sure I have forgotten something, but I feel like I am doing the job of at least three people, work everyday at home, and have now been written up 4 times since October by a brand new 23 year old new grad NHA with no medical background who needs to tell me everyday that she is my boss. I am undermined by one of my MDS Coordinators daily who was once the DON, and have a brand new nurse recently hired into one of the MDS roles (not by me mind you), and another who rarely checks her email or mailbox. I rarely get office time until after 6pm as I am out there on the floor with my staff, educating newer nurses, and attempting to understand the lack of professional accountability throughout my staff (especially seasoned and experienced nurses), and when I do get an hour or so in my office, it is to listen to a million messages and return phone calls.
I am now completely spent, sleep about 4-5 hours per day and one day a week on the weekends I sleep all day (literally), just from exhaustion. I had exactly 30 days of training from an interim DON who had never been a DON and truly have learned it all on my own.
Can anyone out there, tell me I am nutz, or tell me that this is the reality of a DON job?! Any advice would be helpful, or even just telling me to quit whining would be sufficient. I am paid fairly well, but at this rate making about $10 buck an hour, and my kids and husband (who I thank God for everyday), are surprised when I come home before 9pm....and I go in at 6 or 630 am!! Help, as I am at the end of my rope for sure.
Looking so forward to your responses.