Start up of a new facility - Did I get myself into a hot mess?

Specialties LTC Directors

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Specializes in LTC, Hospice, Case Management.

Looking for guidance from any DON's experienced in opening a new facility. Help me prioritize please!

I'm 4 days in. When I got there Monday there were 20 residents. This is a 100 bed facility that has been open about 2 months. (This is a beautiful place and the newest hot spot in my county. Everyone now wants to move in yesterday). I was absolutely thrilled to be offered this opportunity and hoping I don't regret leaving my nice cushy DON job where everything ran like clock work.

From what I can tell corporate has turned on the heat and they expect us to step it up on accepting admits. Also, it would appear that the facility has fallen behind on the hiring process and is not prepared to keep up with the pressure of 2-3 admits/day everyday! The team of staff I have have all come from different places, all have their own ideas (some with pretty bad ideas too) and everyone seems to think I'm going to make it all work...like yesterday. Heck I haven't even been trained on the computer system yet!

It has been an exhausting 4 days and I just want some input from someone who has been there, done that! I CAN do this and i WANT to do this but after 4 days I would like it if someone could tell me where to start and what is priority when everything seems to be priority. (maybe I'm just tired and whining :confused:)

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Specializes in Gerontology, Med surg, Home Health.

I haven't opened a building, but having read your posts in here for years, have no doubt whatsoever you'll rock your new job.Unless you only have one nurse, 2-3 admits a day should be doable.

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Specializes in Geriatrics, WCC.

I also have not opened a building (only closed one). Hiring of more staff of course is a priority. Try having daily huddles throughout the day to coordinate and better handle the admits. I hate to say but, sounds like you may need to be on the front lines with your staff to get the admits in the door and settled, at least for a while. laying down of guidelines with the staff right away to "discourage" their previous bad habits.

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Specializes in LTC, Hospice, Case Management.

Thanks to both of you. I'm up to day 8 and still hanging in. I will describe my 8 days to you with the same analogy I have told my family.... most times when starting a new job it's like a huge tread mill - the whole (or at least most of) staff is already going the same direction and pretty much going at the same pace. You simply step on and get with the flow of things. THIS has been like jumping into the bounce house and I'm doing my best to go with the ups/downs of the bounce house without getting bounced off! :***:

In my first 8 days I have managed to have 18 potential new hires started within the hiring process. This will help my existing shortage, weed out some of the problem people I already have on radar, the expected potential hires that back out at the last minute and still leave me enough to open the new unit. Fingers crossed I've estimated correctly.

We have had 12 admissions and I have reviewed at least another 10-15 referrals. I think my admissions department is a mess. I've got an internal admission director that is not a nurse and is already making it known that she has to have so many admissions a month or she won't get her bonus. My external hospital admit person is a nurse but is brand new to this position and doesn't seem to know what she can/can't accept. I've already heard numerous times from the internal gal "Well we HAVE to take residents". Yea, well we also HAVE to be able to take care of them when they get here and this nursing team is not ready for a brand new trach with multiple/complex wounds. We'll get there but not NOW! The good news is the administrator did back me up on it! :sarcastic:

The best news - At least for now, I'm still excited to get up every morning and get in there and start all over.

Thanks again for your input.

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Specializes in Geriatrics, WCC.

Best of luck to you.

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Specializes in LTC, Hospice, Case Management.

Just a note to self....next time just stay with the nice cushy job (but often boring job). Boring would be good about now!

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I've opened several new buildings in our state, as the DON and as the side by side corporate nurse overseeing and helping with it all!! You have described the norm, crazy as it is!!! On average it takes us 3-5 months to fill up! In that process you are in a constant state of change with constant new staff! Since your new no one and I mean no one knows how to do much, you're all learning as you go!! The systems you put in place have to keep being adjusted based on census and acuity. It's exhilarating, exhausting, overwhelming each and every time!! But the good part is, it's very very rewarding to see it all finally come together, see your nursing staff turn into loyal family and so much to be proud of!! So hang in there it does all work out if you have 2-3 months of 10-12 day to devote to it!!!!

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Specializes in LTC, Hospice, Case Management.

Thanks agingnurse! Your little pep talk has kept me from searching for plan B for another day.

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Please PM me if you have any questions I might be able to help with!! Good luck!!!

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Specializes in LTC, Hospice, Case Management.

Just thought I would go back and update on this thread now that I'm about 5 months in.

I'm not sure that I've ever had a job that I disliked so much. I'm so frustrated by the whole thing that I've spent more time in tears the past week than I have the past year. Friday I waved the white flag and informed the administrator my last day would be August 2nd. I can only hope to keep the last remaining piece of my sanity until then. Going to step back and take a break from this management business. I just need to go be a peon somewhere, keep my head down and be a worker bee - maybe even outside of long term care if I can find something.

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Wow, was THIS ending a letdown! I expected to hear you just still love the place,etc. It was like a bo*b dropped! Sorry to hear the place failed you. Stuff like this can make anyone feel impotent and incompetent, even if it's totally not so. Great learning curve for your future endeavors, though..

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Specializes in MDS/ UR.

My one year as DON was enough to put me off of it for all eternity. I would suggest MDS if you have a background in it, of course it could be enough to make you lcrazed too. You gave it a shot, hopefully you can find some peace/rest.

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