I'm the DON but the company is going to get me in trouble

[HonestyAlways]

I'm the DON in a LTC facility. Things have been going downhill for about a month as far as getting approval from corporate to order supplies, such as briefs, cups, pill crush pouches, gloves, etc. I didn't like it but we made do with less. I now find out that we are losing lab services because the corporate machine hasn't paid the bill. I learned about this from the lab, not my employer. This bothers me for so many reasons. My questions are 1. When do I have an obligation to report this to the regulatory agency? 2. What kind of trouble can I get into as the director if I have no control over bill payments and contracts?

I am terrified of what is potentially happening here. I feel an obligation to my patients and staff but have been told that I am basically referring my own license if I report them to the state. I just want to do the right thing. I don't want to abandon my staff or patients but I also have an obligation to myself and my family. I have never experienced anything like this and I feel a strong ethical and moral obligation to so many people here. Any advice would be greatly appreciated because I am scared, which is not a common thing for me. Do I just walk away? I won't lie for anyone and I will always try to do the right thing but this is a sticky situation and I need help. Thanks in advance!

[guest7/31/17]

You care about the patients. Cooperate or head administration cares about protecting their positions period.

[sallyrnrrt, ADN, RN]

What the company stands to loose.........

iJ, loss of Medicare money, paid at level of lowest rug level......? A fine, and administrator lis dinged.....this goes on till the IJ is corrected and state approves.......

Thankyou for doing what I would have done...

Best wishes

[Neats, BSN]

You state we are losing lab services. Blood draws have to continue... are you saying your facility is now making the resident go outside the facility? Maybe your corporate has a new vendor and they just lack the common courtesy to let you know. Maybe the bill was not paid but now it has, maybe they were haggling about a new contract...I am assuming the lab is straightening out and:

1. I would never allow an outside vendor say bad things about my company, I let them talk but you may not have the whole story. I just say I am sorry this happen and I will let my Administrator know you have concerns.

2. I would never ever let quality of care slide as an Administrator but maybe this is because I am also a Registered Nurse. I would start (at home) making a journal note about who you spoke to today i.e. administrator regarding the lack of supplies, a resident;s aunt brought in cookies for staff and had discussion of quality of care, real cryptic notes so your memory can be refreshed and no HIPAA violation has been made. I would also contact the corporate Chief Nurse and just let them know I know things are tight but.... Make sure you write down date times and names. I would give them 2 weeks to see if there is improvement then I would become more of an advocate and push harder with same people. If no change after 3-4 weeks, I would put my notice in and move on.

3. As long as no one has been hurt (resident or employee) then why report it. Sometimes things get tough and you have to tighten your belt. Reporting to the BON or the Department of Health what can they do? They only get involved if something happened and so far all I see is changes that make your nursing services more difficult to manage.

4. Be an advocate for nursing services do not apologize for this. Do not think you are going to hurt them in any way if you decide to leave, you more than likely live in a work at will state. I was an Administrator/DON for a big SNF company and traveled all over and if at any time I felt my corporation was not truthful or misleading or for that matter going down hill fast without a focus on resident care I would have left in a heart beat, it is my license a lot of staff are working under, and trust me they will replace a DON. I have been through some bumpy times in LTC but my threshold stops if the needs of the residents are neglected.

[HonestyAlways]

I left that facility during the summer because I was not getting responses from corporate and I refused to be a party to poor care practices and I saw warning signs everywhere of impending doom. I just heard today that the company has filed for bankruptcy and I'm heartbroken for the staff and residents. I do understand that often there are contract negotiations or payment delays that may require restructuring of bill payments but I have an expectation that disruption in services should be discussed with those that are having to be on the front lines to answer for it. I wish this company nothing but the best and that they are able to recover from this set back but at the end of the day, I had to walk away. I have to sleep at night with means that I have to be able to provide quality care to my patients and a safe working environment for my staff. It was the right thing for me and I have peace with my decision.