acute care nurse looking into ADON position

[chemo_nurse]

I am currently a four year acute care nurse in the state of Michigan. I have most of my experience in oncology/med surg nursing. After having to place a loved one in a LTC center I became very interested in the DON/ADON nursing role. What are your suggestions for making a possible transition?

[amoLucia]

Sorry this is going to sound like an epistle or short novella. But you asked...

To assume an administrative position and to do a good job doing it, you should have some LTC experience. (JMHO) I couldn't even fathom how one would try without the LTC experience. Believe it or not, LTC is more highly regulated than hospitals and our surveys are what legends are made of. And the chain of command within NHs usually follows the Administrator (licensed NH administrator), then the DON (so you'd have to be ready for that).

With good LTC experience within the nsg mgt team, the move up would be very feasible. But the top position is a 24/7/365 position. I don't think any DON ever turns off the job. You could be at a wedding reception when you receive a phone call that the Survey Team just walked in - so guess who's expected to go in.

My head is swimming with thinking about all the fine details of the various systems that the DON has to know. No kidding, but the longer I've been in LTC, the greater my desire is NOT to ever be a DON.

The ADON position is an odd-duck position. LTC experience is also highly recommended because in the absence of the DON, the ADON is IT. And all the myriad of things that the DON must have under control, the ADON must be able to pick up. The ADON position can be a jack-of-all-trades type of position. Some job position functions are assumed by the ADON or may be handled by nurses hired for Staff Development, Infection Control, MDS, with any of all the sub-projects of falls, restraints, psychoactive meds, weights, wounds, QA, employee health, etc. Evaluations, hiring, firing and disciplining is somewhere in there too.

It would be important that the DON would have a good supportive team within nsg (like unit managers and shift supervisors) as well as good relations with the Social Services, Activities, Dietary, Housekeeping and Maint Dept heads. There would also be a Medical Director and admitting attending physicians (they do contracts with the NH) as does the dietician, pharmacy, xray, lab, dental & vision services.

Sometimes, a corporate ownership chain will groom a prospective candidate as a DON-in-training. I don't know if working within a corp at the DON level is better or worse.

In my opinion, the response to your question, the obtaining of LTC experience at some nsg team mgt level would be desired. To be honest, I would think to move into the top positions without some LTC experience and some knowledge foundations would be masochistic, but that's just my opinion. I don't think you would want to move into a position only to be setting yourself up for failure. I'm sure there have been nurses that have done so, but I'd bet that they struggled. You do have some years of clinical nsg which is beneficial. I don't know where you are educationally.

If you really are interested give it a chance. But go in with your eyes wide open. Good luck.

The end to my novella.

[CapeCodMermaid, RN]

A DNS or ADNS needs EXPERIENCE in long term care. If you don't know the regs and the ins and outs of working in a skilled facility, you wouldn't be an effective leader. I've hired acute care nurses as supervisors or unit managers...they've struggled trying to make the transition.