Problems/Issues encountered as an director of nursing

First - you do realize that this is a DON subforum and you aren't likely to find many administrators here? Most, if not all of your responses will represent the nursing department and not necessarily the entire facility.

Now where in the heck to begin?????

1. Unrealistic expectations: From whom you ask?
- The families - No we really don't give 1:1 care here. No your Dr. will not be into see your loved one at the drop of a dime. No, your Mom is not necessarily the angel you think she is, she is manipulating you against the staff and you refuse to see it.
- The staff - I am a living person and can not make miracles happen. Yes staffing could be better but understand....I have a boss too. I have been very bluntly told "Here is your staffing budget. Keep it in line or I will find someone else who can". And there is also the constant staff bickering and I'm expected to be the referee and try and keep the peace. Somedays I just want to yell out my door "Grow the heck up people and just go take care of people instead of wasting time griping about what someone else didn't do...". My favorite (not) is when they finally bully someone into quitting then come crying because they are working short.
- The corporate aspect - Back to staffing budget. Would love to know what some of them make. Just where are all those profits going. (Along with their salaries, typically a good buildings profits are poured into the system to off set those sister facilities that are not doing well).


By the way...I had a great day at work today! I also want you to know that I love 90% of my residents, I love 90% of my nurses, I love about 75% of my aides and about 50% of the families. Heck, I even like those folks in the corporate office....they are just doing their jobs too. I love my job.

Oops - forgot the unrealistic expectations of the surveyors/regulations.

Recently tagged on F309 due to a 2cm X 1cm bruise on the forearm of a resident who had an IV 3 days previous....tagged because the bruise was not identified on the most recent head to toe (I mean...who really cares in the big scheme of things. Little bruise, even the surveyors agreed this was from the IV, it wasn't any kind of suspected abuse issue, it was a perfectly normal little bruise with no odd complications, etc)

Tagged on infection control due to a GI outbreak back this summer. 3 units in the building. Only 2 units with vomiting/diarrhea. Staff working those 2 units also became ill over the course of the week. The 3rd unit remained healthy..both staff and residents (we mandated all staff stay consistent on units thru the entire hell week). We had a written plan in place immediately to identify when a resident started with symptoms, when symptoms resolved, reminders to staff on handwashing, all residents isolated to rooms, orders for zofran and immodium, reminders to watch for dehydration, pushing fluids...you get the point. Was able to pull this out and show the surveyors. Tagged because we didn't have a signed form on handwashing inservice in that time period and we didn't do stool samples to investigate the cause of the outbreak (they question food poisoning...I argued and argued til blue in the face that it wasn't simply because all residents served from same kitchen and only 2/3 units sick as well as staff DOES NOT eat from kitchen and same 2/3 units of staff sick). They insist I did not investigate the cause. Resident outcome failed to matter...within 6 days we had over 50% of the residents ill, within 10 days all symptoms resolved on everyone, not one resident was sent to the ER and not one resident even required an IV for signs of dehydration. Everyone of them were back at their prior level of function within 1-2 days of symptoms. I still think that was fantastic considering how many staff were effected at the same time.

Nascar...we had the GI bug during survey. They said we didn't act quickly enough. I was told at 6:55 that 10 people in the building had vomiting and diarrhea. By 6:59 rehab was told to treat in the resident rooms, the main dini g room was closed,activitites wereunit specific and signs were up on all doors. Not fast enough? Less than 5 minutes?and, oh yeah, they saw someone walk past a sign...am I now responsible for every illiterate/stupid family member? I haven't gotten my SOD yet, but if they give us a tag on this, I'll be doing an IDR.

LTC facilitys suck!...To much trouble

Nascar........LOL!!! OMG, I couldn't have said it BETTER!!!

and Meme....you had to have a bad experience somewhere......LTC's do not suck if the people running them and working them do a good job.....Hospitals suck...grocery stores....schools suck.....oh they all can suck......it is too bad you feel this way......why?