Help am New DON FOR LTC

Malt123 · Jan 3, 2005

thanks that site really helped, wish I had this info before my problems got out of hand

Blackcat99 · Jan 3, 2005

I have been DON in three LTC facilities. The only thing that is going to change the "culture" of where you work is for you to be able to pay your staff more and start over. That is not going to happen. LTC is a lose-lose situation.You will have no life as long as you are there and when the state comes in they will treat you like a criminal who only went into LTC to abuse and neglect the elderly. I advise people to never go to a Nursing Home. Go on welfare and keep your loved one at home.Do something, anything but a NH. And you should turn in your resignation today. You are in for a miserable time untill you do.

:chuckle I've never been a DON but I agree with you 100%. Thanks for telling it like it is.

CoffeeRTC, BSN, RN · Jan 3, 2005

What I did was simple. Held a meet and greet. Laid down my expectations of the staff. Basically...do your job. And told them what they can expect from me. Leadership, team work, etc....This helped. Also an open door policy. Monthly meetings/vent sessions. Praise when its due. These things take time..but it can work!

CapeCodMermaid, RN · Jan 3, 2005

I agree,I went to many meetings with management and the cna's-to try to correct their behaviors(not answering callights,being rude to pts. etc.) they were given monetary rewards and recognition,but I never saw these efforts affect the "core" group-who were very lazy and arrogant. After I left,one of the nurses I had worked with told me she was being "set up" by the cna's to get fired' They would tell her that pts. were requesting pain inj. so she would prepare the shots and go into the room and the pt. would tell her they had never asked for it. She would then have to waste the med( at the facilities expense)-and because LTC watches every dime-she was called in by Administration and told she would be fired if it continued to happen. She told me she then decided to have each cna state the request for pain inj. and sign their name in the pts. chart just so that she would have documentation supporting her case. She also was desperately looking for another job. LTC was a nightmare--get out of there!

OK...first off...I really like most of the CNA's who work at my facility and I trust most of them, but why would a licensed person, RN or LPN, go get pain medicine without ASSESSING the patient herself??? Surely all y'all don't rely on your CNA's to do pain assessments.

Blackcat99 · Jan 4, 2005

If you want to be a well-liked DON don't have weekly mandatory meetings and don't expect your noc shift to ruin their sleep by having to attend meetings at 2pm. I wish you the best of luck. :)

Kandee Roses · Jan 4, 2005

I am a LPN in LTC. I ALWAYS do a pain assessment when one of my CNAs come to me about a resident in pain. When I do my documentation on the resident I gave the pain meds to, I always put the name of the CNA who reported the resident's pain, the findings of my assessment, which drug was given (even Tylenol), and if the pain med was effective. I also document if I did any other comfort measures, for example, repositioned resident( I ask my CNAs to help with that too), provide a back rub, or give a hot pack if its order. I am lucky to have CNAs that work as a team with me on taking care of our residents. I use to be one of those CNAs. Now, since I am a nurse, I have to trust those CNAs to help me "get the job done." If I feel that I can not, then I take aside the CNA and ask what the problem is and see if we can work it out. I love working in the LTC setting. I don't think I would want to work anywhere else. Oh by the way, did I mention that the LTC facility I work for is a small one? I feel sometimes that seems to help with the staffing when everyone who works together in a small facility seems to get along and wants to do a good job for our residents.

kesneysmom · Jan 4, 2005

I have been DON in three LTC facilities. The only thing that is going to change the "culture" of where you work is for you to be able to pay your staff more and start over. That is not going to happen. LTC is a lose-lose situation.You will have no life as long as you are there and when the state comes in they will treat you like a criminal who only went into LTC to abuse and neglect the elderly. I advise people to never go to a Nursing Home. Go on welfare and keep your loved one at home.Do something, anything but a NH. And you should turn in your resignation today. You are in for a miserable time untill you do.

What you have said has horrified me it is a good thing you left LTC. I love LTC yes there is obstacles and hardship but that comes with every nursing job I have ever been in. LTC has its ups and downs but I have been touched by patients and families in LTC that made all of the bull$#!& worth it. For me LTC is a win-win situation if you get the right mind set and dedication. I will agree some are bad but there are good LTC facilites out there.

kesneysmom · Jan 4, 2005

How long have you been a nurse? I just noticed your screen name had 02. Do you have a ADON to brainstorm with or even an HR person?

Malt123 · Jan 4, 2005

what happened to the work ethics, respect for each other and doing your job? Why are CNA's allowed to refuse to do work? Why are the DON's always blaming the nurse? There isn't any one that doesn't know how hard LTC is, so why are we not more understanding of each other? I once did some calculations and proved to management that it was litterally impossible to do what they wanted in the specific time frame. Management can stay as long as they want but the staff has to leave in a certain amount of time. You can't put aside some ones tray or taking them to the bathroom or put off taking care of a crises. Every one has to do their jobs for it to work. If CNA's are refusing to do something or the DON is putting too much on the nurses or families are being too unreasonable than things fall apart. It starts from the top and works it's way down. If management has an attitude that only they matter then the staff starts to lose morale. Good people are needed in every aspect of LTC. Not just management. The nurses do not do the hiring and firing we have to work with what is given to us even if that means a whole unit full of CNA's that other floors don't want.

BeenThereDoneThat74, MSN, RN · Jan 4, 2005

I think the problem (at least in my facility) is that it is not as Long Term, or Sub-Acute as it once was. The peds LTC that I work at is classified by the DOH as a Nursing Home, and gets funding as such. Because of this the pay is low, and the nurse to pt ratios are high (but not nearly as high as an adult NH). We have chronic kids, yes. But we also have trached kids on O2, CPAP, Central IV's with TPN or antibiotic therapy. The kids are NOT stable. The acute care facilities (which we transport the kids to when they get 'sick') think we are a joke. We don't have the staff to support the clientele, nor can we attract the staff because the salary is not competitive with acute care. Therefore, morale among nurses who stay is low. I'm not saying the staff is incompetent, but their not adequately trained. Many of them do not have Acute Care experience, and many are LPNs, who cannot get jobs anywhere else (they are hard to come by where I am).

For those who are not lazy and useless, i think recognition goes a long way. So does $$ of course, but that's not always possible. Little things- a 'thank you', or 'good job guys', or even a free meal ticket may help boost morale. If that doesn't work, start giving out the pink slips :nono:

To the OP- what is your previous experience? I find that many NMs and DONs waltz in and out of our facility, and try to change everything. Much of our staff have been there for many years, and it's like they don't believe that the next one coming in is actually going to stay, much less make things better. They're kind of like orphaned children bouncing from one foster home to the next.

RE Agent · Jan 4, 2005

Hi I am im great need of information regarding DON's how to deal with staff that wont listen and people who wont work as a team is there anything i can do to help improve our quality of patient care?? I have been working my hardest but have been pretty much doing it myself!!! Im pretty much tired of doing and am to the point i could just walk away with a different job!!! If anyone can help please let me know!!! THANKS SO MUCH

This happened in a PACU before I was hired. The management got together, and hired new staff. The interview for the position was geared to hire only nurses who were interested in working together. It was a tough, but very good interview. In 4 months time the PACU staff was replaced, and it was a wonderful place to work.

nursemid02 · Jan 5, 2005

Welcome to the world of LTC. Have you ever worked a unit before? What are you refering to when you say you are doing it alone? Is there no one else working there?
Are you passing all the meds, doing all the treatments, assessing all of the pts.,ansewring all the lights, calling the doctors,labs and pharmacy,pt. teaching,dealing with families and staff that refuse to work, feeding pts., bathing pts,admitting pts, discharging pts., dealing with state, starting IV's and monitoring them, doing the MDS, vital signs, charting etc........

Yes as a matter a fact i was because there was no MDS coordinator your talking to her yes i was calling the doctors making sure everyone was taking care of and yes I was dealing with family and staff that refused to work and dealing with call lights pharmacies and STATE along with taking care of IV starts being the RN 7 days a week so whats with the attitude It wasnt always like that there used to be a time where people worked And yes i did do alll the treatments I wasnt asking for your sympathy all i was asking for was a suggestion from you So thanks but no thanks i dont need your attitude i get enough of that at work