ADON, Charge Nurse, Case Manager, MDS? What are these?

Jinxed13 · Jun 16, 2011

I am a RN with 17 years experience, including as a nursing supervisor in both freestanding private hospitals and public medical facilities. The questions you ask are fairly difficult to answer as there is really no set length of time one has to be a floor nurse to become a director of nursing or assistant director of nursing, but in my experience it is helpful if one does work as a floor nurse in the particular area they intend to become a DON or ADON in. Nursing is one of those fields where it is difficult to get real respect if you don't know what floor nurses go through or aren't familiar with the type of medical care your subordinates are trying to deliver. There is a statement, "nurses eat their young," which is unfortunately too often true. Having also worked as a floor nurse and "really knowing my stuff" I personally found it difficult if not impossible to have any real respect for those nurses who were in a supervisory position only because they obtained higher degrees and had no practical experience being nurses. It is true that nurses who obtain an ADN degree have had more clinical (direct patient care) time during their education than did nurses going for their BSN or MSN degreees. When I took my licensing exams, the proctors said that the nurses more likely to fail the test the first time were BSN's and above degrees due to the difference in direct patient care clinicals required in the different degree programs. I truly haven't seen that a BSN degree gets a nurse much more in salary than does an ADN and in some nursing jobs a BSN with no experience is at a disadvantage to an ADN with experience as experience can often be traded year for year in lieu of a higher degree. Currently to become a nurse practitioner (also called advanced practice nurse) one must have their MSN and then enter an advanced practice nursing program. In 2015, rumor has it that one will have to have a doctorate in nursing to become a NP. It is at the NP level that salaries really increase dramatically. Licensing and scope of practice varies state to state, however. Salary varies in all aspects of nursing depending on regional location; however, I have noticed that with the current economic climate and the spector of Obamacare looming, nursing pay has declined and while there is a nursing shortage, some healthcare facilities aren't hiring as they don't know what will happen when Obamacare kicks in and they don't want to have hired staff that they have to lay off with severance pay. Also, one other problem is that healthcare entities are unsure how to bill with the new reforms under Obamacare, and they are aware that they may have to ration services to patients as they won't be fully reimbursed for care that they are currently giving. As for education, some states require continuing education units (CEU's) to retain your license. CEU's are relatively easy to get and are available online for a nominal fee. Of course, CPR certification is required for most nursing jobs, with ACLS (advanced cardiac life support) required for some areas of nursing. Certifications required are entirely dependent upon the area of nursing one decides to specialize in. I specialized in behavioral health (psych) nursing as prior to becoming a nurse, I was a police officer. Being a behavioral health nurse I have also worked as a hospice nurse, detention center nurse, have been on hospital ethics panels, and was often called upon to work with families who were facing disconnecting life support for loved ones. I have never obtained any behavioral health certifications as they weren't required in any facility that I worked at. There is also SART (sexual assault response team) nursing certification, etc. I love nursing as it has so many areas where one can utilize their education and training and most previous degree programs transition well into nursing. Nurse educators often get certification in whatever subject they want to educate patients on, such as diabetes educator, etc. With the nursing shortage, I have found that the amount of time one has to actually instruct patients is limited, which is unfortunate. There are also nursing jobs through insurance agencies in areas such as Workmen's Comp or with health insurers working to teach patients how to manage certain diseases that they have (cardiac, asthma and COPD, diabetes, etc.). No direct hands on patient care is required, all being done over the telephone. My advice would be to talk with nurses in various disciplines about the duties and requirements of their specialty and also use the clinical time that is required in nursing school to help you evaluate what areas of nursing are of particular interest to you.