Can a DON make a real Difference?

When our DON walked off the job after a to do with the administrator most of the nurses talked about her as if they respected what she had done. She stood up to the administrator when he was trying to force her to take an admission that we were not prepared to care for. However, it is unfortunate that she did not come back and fight the administrator tooth and nail about a lot of things. I had never heard anyone talking about her good or bad prior to her dramatic exit. And of course, when she left, the place became more chaotic than it was already. She didn't do us any favors by standing up to the man and leaving over the issue.

There have only been two other DONs that I have really thought were worth their paychecks. Both were obviously involved with caring about the patients and about the nurses and CNAs doing a good job taking care of patients. To some extent, all of my other bosses have been paper pushers or desk jockettes. One of them was just collecting a check from the company while drawing disability and coming and going when she pleased. Never saw her even produce any worthwhile paper. Don't know how she did it. I would feel ashamed of myself to come to work at 10 in the am and be gone before 1 pm.

Can a DON make a real difference? YES.

But here's the thing. . .and this is what I learned when I became a head nurse and unit supervisor. . .as a DON you will have a lot of job responsibilities that you will have to fulfill that as a staff nurse you were not aware of. In fact, most of the staff are not aware of the DON job responsibilities that you will have, nor will they understand them. When you come up from the ranks of the staff you tend to have the situation of what is going on with the staff in your heart. It's naturally because that is what you know and you know it well. You won't know the job of DON as well, so it will be very enticing to regress back to doing staff nurse things. Being a DON will give you the authority to influence the attitudes of the nursing staff. It won't be easy. In fact, I'll venture to say that in most cases it is going to require that the ones who viewed the residents as so many animals, to be fed, watered, and put away will need to finally quit and leave. To some extent you can influence that by putting some pressure on them. It will be through your efforts in hiring and delivering a serious speech to new hirees about your philosophy on how you want the residents treated that these changes will come about. Addressing behavior and making workers change their attitudes is a very difficult thing because you can't really put any disciplinary action on it. You can call people into your office and have one-on-one talks with them, but they are only going to go back out and talk about it with the staff who have their sympathy (attitudes! you gotta love it). You can write them up and address it on their yearly evaluations, but it won't really affect their employment though it may affect their job satisfaction and influence their decision to finally move on. Only through attrition of the old staff and your hiring of new staff will you finally see things start to change. And, that may take some time. So, the question is how much patience do you have to see this out. The homes where there is great attitude are usually led by a DON who has been there a while and has had a chance to have their influence make a difference.

If you have never interviewed and hired anyone, that is a new experience in itself. People can be very deceptive during the interview process. And, the time to get rid of a bad worker is during their probationary period. If you do not have charge nurses who are going to help in writing up or calling indiscretions to your attention you could get stuck with a real problem employee. One of the first CNAs I hired who I thought was good in her interview turned out to be a big liar and ended up getting fired for falsifying charts and got involved in a big incident where she accused one of the nurses of some wrong doing. You don't know how relieved I was to be rid of her and how much I learned about job interviewing.

The fact is that most of your administrative responsibilities are going to consume your time. You have no clue what they are, but your boss will make them very clear to you. You may find that your communication with the staff will become much harder to maintain or accomplish. I think the DONs who care are the ones you see working longer hours in order to get out onto the nursing units and interact with the staff. It also takes a good knowledge of how to successfully delegate and supervise. As a head nurse I was constantly having to go to meetings or deal with budget problems and staffing and had very little time to actually see what was going on with the day to day problems of the patients and staff on my unit. I found it very frustrating.

I say, give it a try. It's the only way for you to find out what the job is like. But, I would also caution you that you may find yourself unprepared for some of the tasks you'll have to do as a DON. Nursing school really doesn't prepare anyone for being a manager and supervisor. It is something you'll have to learn through seminars offered by business professionals. If you're reticent to go for a DON position at first, go for a supervision or Assistant DON position to begin with.

If a DON is seen actually getting her hands dirty, toileting someone, changing a soiled brief, *gasp* doing rounds with the aides should someone call out (I know, time is an issue, but...) do the employees catch the caring fever?