ADON recruited for DON position

[cherbRN]

I am currently in the ADON position for a LTC with a maximum bed number around 108. I have been in this position for 10 months. I started as the night RN in charge in January and was offered the position in May. Previously I was a staff RN for a level 1 trauma center / ER for almost 2 years. This has been my career thus far as a registered nurse. Not very much experience as far as a time line, but have obtained many skills and experience, by experiences alone.

My life as ADON. I feel that I am missing out on the picture. I am a task/errand girl. I have been delegated the recurring paperwork that is generated and must be maintained on a daily basis such as, fall prevention, uploading incident reports and tracking, verification of investigation/investigation of incidents, post occurrence IDT, CII destruction logs, daily census and staffing, admissions, checking all orders in house against MAR, TAR, POS and making sure POA's have been made aware, entering labs into the computer for lab days, gathering all reports from nurses in the AM for the DON to have for AM meeting, hiring/disciplining/firing of CNA/LPN/RN ("I want her wrote up!"), infection control, infection control log, observing CNA performing skills (ie: peri care, cath care, transfers...), observing LPN/RN performing skills (ie: trach care, cath insertion, Gtube, treatments...), psychotropic monitoring (disclosures, side effect monitoring sheets, antipsychotic drug SE monitoring (AIMS), resident change of condition monitoring (see to it that the MD/POA have been notified and correct plan of action is in place), designated "hall" to monitor for cleanliness, answering call lights in timely manner, seems that I am forever dealing with CNA drama. I do all the CNA scheduling and manage call offs/replacements. I also take "phone" call every other week, which "I" had to set in place because otherwise I was getting at least 15 phonecalls from the facility any given day. "We would much rather call you." And because I am more "in the vicinity" of the facility I may have to go in and start an IV or run an IV ABT because the LPN isnt IV certified or hasnt "done it in years." I am currently working on a presentation and informational about IV's for the nurses so they are comfortable in their craft. And several other things I feel that I am forgetting. Are these the normal delegations to ADON?

I get along with all of my staff. My DON has been angry because most of the nurses will come to me with questions instead of her. Unfortunately my DON has a selective memory and only remembers things convenient for her at the time. The rule is good for at least a day because chances are the rule will be different the next time you ask. If you are in a situation with your back against the wall she will throw you to the wolves. Every man for themselves type of deal. And a rule by tyrany or "my way or the highway" attitude that everyone is tired of hearing. Not only by the DON but she and the EDON are "friends" so they buddy up together.

Sometimes it feels like I am on a "need to know basis" and am not "privy" to the information that would help me at "my" new craft as ADON. I asked to be trained on MDS/RAPS and was told that the coorperation would send me to the class, then they decided that I didnt need to go. I have been through several "random" surveys and have yet to be incorporated on the plan of corrections. Medicare A/B billing and certs/recerts I have "minimal/moderate" knowledge.

Case and Point. I have been recruited to interview for a DON position at another facility. Skilled 65 bed facility. So much smaller. What are your thoughts? Thanks in advance.

[caliotter3]

Sounds like you have had a pretty good introduction to the paperwork aspect of the job. You can learn the other stuff that you have missed out on at the new job because there will be no impediments to your progress. I say go for it. Good luck.

[Nascar nurse, ASN, RN]

I have known many DON's that did not know anything about MDS and medicare billing and they seemed to survive just fine.

Have to admit, it always irked me tho. Some seemed to not want to know or learn too.

[noc4senuf]

Besides knowing how the MDS, RAPS, etc works, how about surveys and plan of correction writing? Budgets? Etc?

[susanthomas1954]

Questions:

1) When was their last survey, and what were the results

2) How many DON's have they been through since the last survey

3) What is the corporatation that owns the facility promising you as far as training and education? (They are likely to deliver on about half of what they promise, in my experience)

4) Do they have a strong ADON/MDS person who has been on board since before the last survey?

Ask those questions, and you will have a clearer picture of what you are in for.

Good luck,

ST

[cherbRN]

Thanks so far for the responses. My official interview is now set up for next Thursday. Can anyone else think of any more good questions to ask?

As a reply to an earlier response, I do not feel that I am at all knowledgeable in the plan of corrections brought on by state surveys, I have worked with state surveyors, but no more than helping them locate things and being witness to an observation of a procedure.

Like I had mentioned I am not privy to a whole lot of information the DON and Administrator like to keep most things to themselves.

I do have some knowledge of state reportable incidents (24hr) and 7 day updates.

I dont know guys. Everyone I work with currently believes that I am more than capable of handling this job and its requirements, I still have reservations. When do you know when it is ok to "take the plunge?"

[cherbRN]

Besides knowing how the MDS, RAPS, etc works, how about surveys and plan of correction writing? Budgets? Etc?

OH! and by being witness i pretty much know how to "NOT" budget effectively. LOL....sorry burn. I think in the position I have been in, I have learned a lot of "what not to do's" my DON is not very informative and does not own up to any mistakes, but she is quick to place blame. But as far as planning budgets, no, i unfortunately do not have that skill yet.

Do you think these are things that are acquired/learned through training or something I should be very familiar with before even thinking about this position.

Thanks again!

[noc4senuf]

When I did my first budget, it was 2 weeks after I took my current position. The NHA handed me the info and said... here you go. I asked plenty of questions and got some formulas from her to figure out vacations, sick time, raises, operating expenses and such. As for the Capital budget, I went around the building and looked at what was needed and started my "wish" list.

[Havin' A Party!, ASN, RN]

Your boss sounds like my old one. Get out of there now!

Learn as much as you can about your potential new bosses.

[SE_BSN_RN, BSN]

Some of that stuff I did as the SDC. Is there not one in your facility? If not, there should be.