Unbelievable

[CapeCodMermaid, RN]

This is part vent part question. I'm the DNS of a skilled facility. Most of the residents have psych issues...substance abuse issues and homelessness issues. We have been working diligently to change the communities perception of the building. YES we do short term rehab and YES we have very good clinical outcomes.

Census has been down as it has been in most of the facilities in the Northeast. Corporate wants new admissions and marketing people. Big mistake but I get it. So the Administrator tells me today he has found wonderful candidates and wants to hire them.

WAIT a minute I said. Were you going to hire them without anyone else meeting them? You want to meet them he asked. Jeez louise...I'm the DNS! I need to have at least some input into who gets hired.

Then he tells me that the new admissions person he wants to hire will be given the OKAY to admit any one SHE sees fit.

NOT ON YOUR LIFE I hollered. It's MY license on the wall, not hers and she darn well better clear any and all admissions with me. Then he tells me the marketing person he wants to hire is 'drop dead gorgeous'...stupid man. You can't say things like that...and yes, I told him that. He told me it's okay since he's gay. The man is as thick as a brick.

I told him if he gives the admissions person ( an LPN) the okay to admit anyone , he better start looking for a new DNS. When I interviewed I specifically asked who had the final say on admissions. Both he and the corporate clinical nurse said the DNS has the final say. They've lied to me about so many things I suppose I shouldn't be surprised.

Who has the final say in your buildings? I wouldn't mind if most of the residents were straight forward rehab with new knees and fractured hips, but we get referrals for people on multiple antipsychotics ...some are suicidal...some are homicidal.

Yikes.

[SuesquatchRN, BSN, RN]

I feel your pain. Corporate has been pushing us to accept anyone who shows up.

I would absolutely not accept the set-up he is dictating. And I would be smoked at being omitted from the hiring process.

My DNS and admin decide together. A nay from either nixes the admit.

[pielęgniarka, RN]

At our facility we try to get together DON, therapy, nursing, MDS nurse and admissions coordinator to review referrals and decide. Whenever it just our admit coordintor making the final decision it ends up being a disaster (happens sometimes). So we have IDT team meeting with whomever can attend before accepting. Our Director of nursing really has the final say though.

[Nascar nurse, ASN, RN]

Answer to your question... the administrator has the final say on admits with input from nursing, SS and business office. We are required to call corporate and justify all denials

Response to your vent - tsk, tsk...I feel your pain. I think the world's gone nuts

[CapeCodMermaid, RN]

It's bad enough that he wants someone else to decide who gets admitted.....it's worse that he was going to offer these 2 people jobs without any input from the DNS!!!

I suppose I shouldn't be surprised. We have a crazy woman whose child was abducted by the husband years ago. When I mentioned it the Administrator said :Yeah, it's like when you ask someone why they are sad and they tell you their cat died 5 years ago...time to get over it.

Honest to God I almost jumped over the desk to smack him. Surely, I said, you're not equating a cat with a child....he needs to go to the corn field.

[VivaLasViejas, ASN, RN]

Oh, sister, do I know what you're saying........that was the reason I left my last DNS job, only it was the marketing director who had the final say on all admissions! That's like putting the fox in charge of the henhouse! And believe me, she took everyone and everything that walked (or crawled) in the door, regardless of whether we had the proper staffing or even knew how to take care of someone with complex medical and/or psych issues.

I'm interviewing for a DNS position later this week, and believe me, my first question will be about who has veto power over a questionable admission........if it's not me---or at least, someone with a medical background---I'm outta there.

[Nascar nurse, ASN, RN]

Oh, sister, do I know what you're saying........that was the reason I left my last DNS job, only it was the marketing director who had the final say on all admissions! That's like putting the fox in charge of the henhouse! And believe me, she took everyone and everything that walked (or crawled) in the door, regardless of whether we had the proper staffing or even knew how to take care of someone with complex medical and/or psych issues.

I'm interviewing for a DNS position later this week, and believe me, my first question will be about who has veto power over a questionable admission........if it's not me---or at least, someone with a medical background---I'm outta there.

I love how the marketing director often is given a census bonus...just for getting someone in the door. But those of us left to care for the train wreck 24/7 is just given crap about why we don't have better time management to get staff off the clock on time.

[sls73]

For the most part Marketing reviews the admissions with the RNAC/Nurse Manager before bringing them in. They look at the clinical- she looks at the financial. When the census is low though, she will just try slipping them in without any input from nursing. I have to remind her then of the reasons why she can't do that, but most of the time the wheels have already turned on that particular admission so unless they have a vent, or TPN(no RN at night), or are seriously a risk- I take them. I just remind her that we had no input on this, especially if the admission has financial losses for us(most of the time that is what it is- have lots of wounds and are on M/C or something like that). Our Administrator has no input. I do have to admit our ED would hire that position and generally she gets input from other key staff. Final decision is hers, but she will at least run it by you and ask. I dont work for corporate though....

Our MD also is the only one to get a bonus- which I agree is not fair, but she doesn't get it on the H/C, just the IL and PC.

[Schmoo1022]

Oh Man! That is all I can say!

[CapeCodMermaid, RN]

Way back when I was the nurse manager for a busy subacute unit, the admissions people and the ADNS looked at the referrals. They sent one to my unit who was going through DTs and ripped things off the wall. They told me they had 'missed the ETOH' in the paperwork. From that day on, I invited myself to any admissions meeting for my unit. IF I was going to be held responsible for the care of the residents, I said, I will have some input.

I read every page of every referral. We almost took someone recently until I read the entire 49 pages of the referral..."aggressive, screaming, refusing meds, security called, put in 4 point restraints and given IV ativan." If I hadn't read all 49 pages they would have taken this person. Today, I looked at a referral. Looked good until the second to last page....on the Sex Offender Registry with the local PD and on probation.

The administrator tried to back pedal today by saying our referrals are too complex and of course I would get to see them before a decision was made. Then he tells me that it's only HIS license on the line if something happens. Do I look like I fell off the turnip truck yesterday?

I WILL, however, be interviewing any candidate for the admissions person.

And so it goes.

[caroladybelle, BSN, RN]

Ohhhhh, Heck no!

[debRN0417]

It's all about the $$ to them...sad. When I was DNS I reviewed every admission and even went to the hospital to see them if there was a concern. If I have to assume the responsibility for caring for them, then I will know exactly what I am getting and what their needs are. Stick to your guns...yeah he says it's his license, but it's yours too!