Help am New DON FOR LTC - page 3

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... Read More

  1. by   ProfRN4
    Quote from nursemid02
    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
    i, personally, didn't see an attitude in her post. if your just venting, fine, just say your venting. if your looking for advice (as evidenced by the title of your thread), you should be prepared to explain and clarify what your situation is, and not get so offended. it is easy for readers to misinterpret what others are trying to say, especially when grammer and sentence structure are used incorrectly (some may be rushing to write, others may be trying to make a point by 'rambling'). i've posted many a time asking for specific questions, and people reply with things that have nothing to do with what i'm talking about. i think it's just human nature to add more to what is asked, to share their own experiences, and maybe giving some food for thought (as i did in my earlier reply). maybe it was helpful, maybe not. do what you want with the info.
    some (like the previous poster who 'interrogated (sp) you), actually have similar situations and experiences in the same field, and want to know more. so lay off, man. no doubt you are stressed over this. but as fellow nurses, we all share that stress (in whatever it is we do). we are not your co-workers (who are obviously stressing you out). we're just trying to help you, as you asked.

    also, i noticed that this was your first post here. you might want to check out the other forums (in your case, the nurse manager, lpn, or cna [if they have one]) to get a feel of the 'culture' of the website. maybe some other nms can give you the advice you are looking for. many have asked your level of experience, because yes it is relevant. personally, i have never known anyone to move their way up the ladder so quickly, with a diploma no less (i know every geographic area is different). if you did indeed graduate in '02, and you've worked your way up, more power to you. for all we know, you could have been working in this facility since you were 18 yrs old. or you could have been working as a school nurse (until now), and maybe you are in over your head. not too many people are 'out to get' total strangers on this bb. it is really like a support group. support we cannot get (or choose not to seek) from our co-workers. again, just trying to help you.
    Last edit by ProfRN4 on Jan 5, '05 : Reason: added content
  2. by   kesneysmom
    Quote from nursemid02
    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

    I don't know if you have a good administrator but at the facility I worked at they made some simple general rules that helped everyone.
    1) If a call light went off everyone was responsible to respond meaning if the administrator or the sectretary whoever was walking down the hall and there was a call light going off you could not walk past it or you were subject for a write up. That helped alot.

    2) The staff voted for employee of the month.

    3) We had an LPN do scheduling, if there was a problem she went to the ADON then on up the ladder if needed, also management had a float schedule for weekend house supervisory so you might do a weekend every 2 months. Also the RN'S had a schedule so they took turns during the week being house supervisor.

    I really believe as long as you stick with it, show the staff you really do care and that you are willing to work just as hard or harder then them then slowly it will get better. It just takes time.
  3. by   Malt123
    I would like to know what the size of the facility was. Some of the smaller ones just don't have the finances for an MDS cord. or ADON and yes you would be responsable for everything. I did case management along with the floor nursing. did the MDS,care plannig, aimes test ect. was given an extra dollar an hour for this. If you want to change things you first need to know where your staff is coming from. Maybe reading some of this will give you insight into what your staff is going through. I know my DON did not utilize me properly and ended up raking me over the coals because she didn't see what I had to offer, instead she wasted me. Try looking at everybody as if you were watching a movie, we are all movie critics then identify the problems and tackle one at a time. I wrote up an aide one time and I know she probably had adult ADD, she improved but retaliated doing all kinds of things to make me look bad. I am not a mental health nurse yet i am expected to know how to deal with this person and their were probably more. I guess I am rambling sorry. In nursing too long hehehe:chuckle
  4. by   bucksandra
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    Quote from nursemid02
    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
    hi nurse mid.. i was a don for 6 years. it sounds like you are putting out small fires and can't yet see what is causing the blaze. first things first..hold a mandatory staff meeting and let the staff know what is expected, what will and will not be tolerated. be very clear in your expectations. next, evaluate the results. you will know rather quickly who wants to be on the team and who doesn't. what was the last don like? perhaps she/he was very lax and didn't expect very much. it is also very important for the staff to see that you are buying into your own program. i have seen many don's with the attitude of "do as i say, not as i do". being an effective don takes a lot of time and hard work. to be an effective (and respected) don, you will spend very little time in your office and alot of time on the floor. how large is your facility? there are many things to think about, priortize what is most important and don't try to fix everything at once. i wish you all the best.
  5. by   doxima
    Quote from CapeCodMermaid
    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.
    Took the words right out of my mouth! Any nurse that will give a med without doing an assessment should have her job and license questioned!
  6. by   doxima
    Quote from chimama
    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.
    Here's hoping that you are no longer in LTC. Negatives need not apply! And thank goodness I have never had to work for a DON with your attitude.
  7. by   alintanurse
    Quote from doxima
    Took the words right out of my mouth! Any nurse that will give a med without doing an assessment should have her job and license questioned!
    You're right--she was waiting until after she prepared the injection and brought it to the patients room before doing her assessment. Although she wasn't giving the med,she was basing it the information she was given,---but don't you question the motive of the cna ?
  8. by   alintanurse
    Quote from chimama
    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.
    I still agree with this response,it may be negative but it is honest. I went to LTC with an open mind and heart,in fact I was excited about my new position but it didn't take long before I saw the realities, ie; dangerous care of pts., poor attitudes of staff etc. :uhoh21:
  9. by   knockandhello
    Been there , done that 2 years as charge nurse of small LTC.Left a bitter and twisted sister.No support from management, so the culture of the centre didn't change.I was constantly battling to introduce changes.Simple things that one would expect staff to do e.g continence care,base line observations on admission,charting, BPs, weights,just basic care.Dont even think about report writing..Left with high blood pressure and depression.The majority of the carers were relatives of the manager so I was repeatedly having to defend my nursing decisions to management.My suggestion is get out before you burn out. :angryfire :angryfire
  10. by   alintanurse
    Quote from knockandhello
    Been there , done that 2 years as charge nurse of small LTC.Left a bitter and twisted sister.No support from management, so the culture of the centre didn't change.I was constantly battling to introduce changes.Simple things that one would expect staff to do e.g continence care,base line observations on admission,charting, BPs, weights,just basic care.Dont even think about report writing..Left with high blood pressure and depression.The majority of the carers were relatives of the manager so I was repeatedly having to defend my nursing decisions to management.My suggestion is get out before you burn out. :angryfire :angryfire
    True!True!True! Thank god we got out!
  11. by   kathi yudin
    when i first became don where i am.. all of my nurses decided to quit!!.. these were the same nurses that complained bitterly about the don i replaced... be fair.. and be equitable.. don't be afraid to show them that you are willing to do the work as well.. have staff meetings and listen to them..if they are not doing what you have asked them to do.. that is insubordination.. write them up if talking does not help..you also need the support of your staff developer and administrator.. that is so important.. i am very lucky... my administrator has guided me each step of the way.. go to conferences for don's.. if you are in california.. cahf(california association of health facilities) has one every year in vegas..it is on jan 25/26 this year and is at harrahs... on the 24th they are haing one on leadership.. they are well worth going.. join nadona.. national association of directors of nursing.. lots of good advice there as well.. the best advice.. be consistant.. fair... and remember you can't be their friend because it is hard to give orders to friends.. hope that some of this has helped...it has taken me almost 5 yrs.. and multiple staff changes to finally feel comfortable in my shoes.. persevere.. seek advice.. and you will survive!!! :angel2:

    Quote from nursemid02
    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
  12. by   kathi yudin
    If you choose to stay as a DON in ltc, this is my advice: try to have a positive attitude (I know it's so hard at times with all the unrelenting pressures we face from all directions).. be willing to jump in there.. praise your staff.. give incentives... bring in goodies.. let them know that they are appreciated.. that is all that they want.. to feel appreciated.. i can tell you from my own experience that it is possible to succeed and have positve surveys.. no one likes surveys.. but.. they do serve a purpose.. to weed out the bad...!!!... openness.. honesty.. and positiveness all lead to good surveys.. my facility is proof of that.. whatever surveyors ask for.. including copies of incident reports which we don't have to hand over.. we hand over.. no one likes surveys.. but.. if your documentation is there... the residents look clean and well taken care of.. it is possible to have good surveys.. we do..!!.. they look and look but find only minor things...i say to you don't give up.. persevere.. meet with your staff.. be fair.. monitor the documentation.. and careplan documentation.. document everything.. give inservice upon inservice.. and you can succeed!!!.. good luck and keep us posted!!


    Quote from chimama
    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.
    Last edit by VickyRN on Jan 10, '05
  13. by   kathi yudin
    i stopped having mandatory meetings.. inservices are done any time staff is around.. if i have some one come in such as a drug rep or hospice.. i do it 2x during the day.. the first at 7 am for my noc and part of my am shift.. and at 2:30 for my 3-11 shift... i also post a sign a week before to give them notice so if they are off.. they may be able to come in.. they punch in/out to get pd for them as well...my door is open.. and i listen listen listen.. i have gotten to the point where when i am down a nurse on 3-11.. i give them the schedule and they fill it in...!!.. we have never used registry.. we started with bonus's and now i don't even do that.. no need to..it takes perseverence and patience..


    Quote from Blackcat99
    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.

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