Our facility that I current work at is a dual certified facility - meaning that there is not a rehab or short term side. The rehab/ MCR pts are dispersed (somewhat evenly) throughout the building. This also means that both nursing managers on the unit are responsible for some long term and some short term residents. It is a 120 bed facility and I am the ADON. The structure during a typical 7-3 shift is: Administrator, 1 DON, 1 ADON, 2 Unit Managers, 4 Charge Nurses, a MDS coordinator, a MDS Assistant, 2 Restorative Nurse Aides, 12 Nurse Aides.
First, the responsibility at my facility for answering call lights goes to EVERY SINGLE EMPLOYEE IN THE BUILDING. This goes for dietary, rehab, maintenace, housekeeping - everyone!!!! Now, of course, they cant fix the problem, but they respond and alert the nurses. The ultimate responsibility for the call light lies on the CNA and the LPN/ Charge nurse on that floor. That being said, again - If I have light ringing, as the ADON, I will ask what they need but leave the light on. If it is not an emegency, I will time how long it takes a CNA/LPN/Nurse to answer. If no one answers within 2 minutes, I go to the desk and then, of course, they will answer. 2 minutes is too long, of course, but as long as it's not an emergency, I want to see who responds. Once they see me on the floor, they answer quickly.
Our facility is very specific in the fact that NO ONE has the right to say, "It's not my job." Our managers are responsible for ensuring that the LPNs and CNAs are not sitting around (which I must say, they work VERY hard).
As for a job description, there's just WAY too much to list. Our UM's are way overworked as is the whole building. Our patient to nurse ratio is too high for a skilled unit (30:1) and everyone is overwhelmed, but we do it.
The key, as far as I can tell, is to have the right people on the floor and to nix the ones that are not right. This accounts for attitude, my biggest pet peeve.