Hi. I'm an RN with 17 years of experience in ICU, ER, rehab, and home health case management. I just finished my first week in my new position of Risk Manager at a 90-bed nursing home that is failing. Less than five years ago it was a 5-star facility and now it's a 1-star. They have had problems that have led to what seems to be an endless spiral of nurses quitting, DONs putting in overtime on the floor to cover, DONs quitting....they have a group of mean girls who seem to take pride in making new nurses quit. As their reputation has plummeted, they're now only being sent the patients nobody else will take. Right now most of the patients are medicaid patients, and they're the only agency in the area that takes medicare pending patients. They have a very high # of patients with severe behavioral issues, and don't have the staff to handle such high acuity patients. It seems to be a runaway train.
I can see the writing on the wall already. It won't be long until I'm expected to start filling in for absentee nurses. The current DON, who has only been there about 6 weeks, is losing his mind already. The ADON is a tremendous trouble maker and the leader of the mean girls. And by mean - I mean MEAN. They sabotage things so badly I can't even describe it. They set new nurses up for failure and keep themselves from being fired by calling the failures into the state all the time so they're covered as "whistleblowers." The state is LITERALLY there every week.
They NEED a full-time risk manager. The "gang" keeps the management (AKA the DON, corporate nurse and new administrator) so busy chasing their tails with covering shifts and interviewing and hiring and doing investigations, that there's nobody to run the ship and make sure things are being done safely I NEED to do risk management, and only risk management at this point. They don't even have an MDS coordinator and I need to learn a little bit about MDS so that I can make sure the care plans
are in compliance etc. Hopefully MDS is similar enough to OASIS that I can do at least some good.
I feel terrible about all of the night shifts the DON is working, and his lack of sleep. He is trying so hard not to let the ship sink. I'm not willing to do what he's doing, though. I'm willing to work as hard as I possibly can full time and even overtime doing risk management and MDS if I can learn it but I'm not going out on the floor to be a target for those wicked women. They would eat me alive, and I would quit and the facility would be as short staffed as ever and still not have anybody doing risk management.
I think I need to tell the DON, administrator, and corporate nurse where the line is before it's crossed. I'm terrible at setting boundaries. I hate saying "no" so bad that it's hard for me to avoid crying when I have to. But they're going to have to choose between me doing a great job of full time risk management or leaving. They've been advertising for this position and for an MDS coordinator for months and offering very generous bonuses. They have an awful time getting people to work there.
Any advice on how to set the boundaries professionally without seeming mean and selfish? I'm also concerned that I might be accused of patient abandonment if I leave the facility when they're short staffed.