Am I Overacting?

[NewTexasRN]

I want to make this short. Last week I started working at an assisted living facility. I have plenty of experience, just not in assisted living. So I was hired an assistant DON along with a new DON. The current DON is retiring at the end of the month.

So far I have been there for 4 days and I'm very concerned. Last Thursday the DON's had a potential admission. They left the building for about an 1 hr and didn't tell me they were leaving. So they left me with 105 patients with a LPN. That had me questioning their behavior. I found that odd since I'm still orienting and don't know enough yet.

The second thing they did that made me concerned was the fact that someone gave one of the residents alcohol. He was drunk and was threatening the other residents. The police was called and he was taken out of the facility via ambulance because that is the policy. Now, the DON's handled it without telling me what happened and what forms to fill out. Now, here's where I have a big problem. This happened on a Thursday. The DON's put me on call for 26 hrs this past weekend. Now what if the same thing happened, how would I know how to respond to a situation like that if they didn't even bother to tell me what they did?

The DON has me filling out practice MARS, getting rid of the patients old meds and brainless tasks. I might be paranoid, but I feel I'm being set up, which is why I'm here. If the DON doesn't trust me to handle things, then why am I being put on call?

The DON says I can ask her questions, but when I do, she is constantly criticizing my intelligence and making out whole staff nervous. So far I've kept my mouth shut, but I'm not going have someone play around with my license.

When I get to work this AM I am going to ask those exact questions and if they don't have a satisfactory answer for me. There's strong possibility that I will be walking out the door.

[Esme12, ASN, BSN, RN]

I would start looking for another position...she is not setting you up for success. As a new nurse you are at a huge disadvantage. Be sure you have malpractice insurance.

[HouTx, BSN, MSN, EdD]

If they don't have policies & procedures in place to cover specific situations, then I would encourage you to make this happen. Disruptive behavior by residents is not that uncommon - it should be covered by policy. I know how hard it is to try to acculturate to an ALF environment from a different type of setting. My state's governing agency (DADS) conducted a great workshop on nursing practice (legal and professional aspects) in different environments. I'm acute care all the way, and I found it very interesting. At any rate, your state agency (that approves ALFs) can offer guidance.

[Lev, MSN, RN, NP]

Just being paranoid, but it could be there may have been illegal activity going on, and they need a new DON to shift the blame to.

[jadelpn, LPN, EMT-B]

Here is my question--if there are 105 residents, and only one LPN--how the heck does THAT work? As DON and Assistant DON, you would not give meds, or otherwise engage a whole lot with the residents, no? So I am confused as to what the difference is with one LPN and 3 administrators, and just an LPN and one administrator. Still leaves the LPN "on the floor" with 105 patients. That is not safe in any scenario I wouldn't think.

I would familarize myself with policy. If there are no policies, I would ask about creating some. Assisted living doesn't usually have a lot of hands on nursing care--if there is, then I would question a resident's ability to stay in assisted living as opposed to long term or skilled care facilities. If it is a "dry" facility, then I could see an issue with the drunk resident. If it was the assault/behavior (which I am sure that was the issue) then the resident I would think would be charged with same--depending on circumstance. However, is there a reason that you don't suggest a "follow up" meeting to talk about how one handles resident behavior?

I get that assisted living is a whole different animal. I would take some time to look at policies. I would ask that you have a meeting even 2 times a week to discuss policy. It also would be nice to get report on a daily basis for anything that could become an issue. Your CNA's are instrumental in being in the know. You could be proactive in asking that the day LPN and yourself have meeting each morning with the CNA's to report off any issues. Then you can discuss how you will deal with it with the DON.

Get malpractice insurance. Be clear in that you would like to know exactly what your role is to be. Be clear that you would like open communication, as you do not want to walk into problems (especially when on call) and that you need to be sure of policy. I think your huge asset to doing the MARS is that you should know residents, what they take, how to reorder meds, and if they are taking what they are supposed to. If not, this needs to be dealt with.

I can not stress enough using your CNA's and LPN's to your advantage as far as resident care. It is a breakdown in this care that can lead to issues that you need to deal with, so to be proactive is a good thing.

Good luck, and let us know how it goes.