my D.O.N. frightens me

yasmina · Aug 17, 2004

Well, the last year or so I feel like I'm walking on eggshells at my job! I have been an LPN there for over 30 years, I have taken on many different positions with lots of responsiblities.
People that are insecure put other people down. That me be the case in your situation. Perhaps you are doing too good a job.
I am also afraid of my boss, and am also working in a nursing home. I think a little fear of one's boss is natural. It comes with the respect thing, to a degree.
It is all about power. And, sometimes unfortunately, those who do great jobs are deemed a problem (they are too good). They make others feel insecure. Perhaps they are costly employees?
Everyone seems to need someone to pick on.
Maybe you need to more on. ????

Dixiedi1 · Aug 17, 2004

Now I am beginning to wonder about how much time lapsed between the diet change and the reprimand from the DON.

I had the impression it was a matter of between breakfast and lunch. In the LTC world this is not very much time. A whole day in a LTC facility would compare to mere minutes in an acute care facility (hospital).

Since the original post did not mention any other symptoms it would be safe to assume (yes, assuming is not a good thing but this is a discussion board, not a book) that there were none.

Just because a pt was on a "regular" diet in the hospital does not mean he successfully ate a full meal. He may have merely eaten the mashed potatos, ice cream and jello. Yep, he ate about 1/2 - 1/3 of the meal. Sounds pretty good for an elderly pt in the hospital. Let's just leave his diet right where it is, he seems to be doing just fine. Been there, seen it, it very surely happens.

Now, he's in a LTC facility, the admition orders have "house diet" on it and he can't eat it. So, the staff nurse decides an easier to chew and swallow diet is in order until he can be evaluated. If he can't tolerate that, well, I am sure (been there, done that) his Doc would have been contacted within those mere minutes so common in the hospital.

Docs don't want to know just "he can't eat the house diet" they want to know what he CAN eat, what other symptoms there are, etc BEFORE he is called. Yes, at breakfast he tolerated the pureed she brought in for him but I would have tried it a second time just to be sure, the big question here is will he be able to maintain adequate nutrition on the pureed. After all, there are so many possibilities and the Doc will want as much info as possible before he gives an order.

But, that's MHO after only 30 years.

nursemike, ASN, RN · Aug 17, 2004

I do a good job, and don't have anything to fear. But, when I see the D.O.N. walk in the building, I feel afraid. I wonder, What does she think I did wrong? Will I be fired today? Lately there has been a lot of people getting warnings for little things, and I suppose big things as well. I have tried always to do my best, but just the thought of her frightens me. It always feels like she is looking down her nose at me. I suppose she can sense my unease. Do any of you feel like I do?

Congratulations on deciding to continue your education. More choices are always good to have. But regarding your present problem with your D.O.N., have you considered addressing the matter directly? Perhaps you could schedule an appointment before or after work, or even on a day off to just sit down and discuss what s/he thinks of you, whether there are areas you might be able to improve, and what might be done if there are issues of concern to you. Assertiveness is not always easy, but it's usually helpful. Your anxiety could be completely misplaced, or valid, but more than is warranted.

Personally, I'd recommend not waiting for a scheduled evaluation, unless it's very soon. I'm assuming, here, that your D.O.N. isn't a jerk, in which case taking the initiative would probably be seen as a positive step.

If your D.O.N. is a jerk, my condoloences and please disregard everything after 'More choices are always good to have.'

debbiemig · Aug 17, 2004

wow! i'm sorry i mentioned anything on this site! you guys are brutal! you assumed that i did not assess the patient and didn't see what i was dealing with before i downgraded the mans diet. he had lung cancer.he had esophageal varicesis. he was an emaciated man who drank pepsi and ate cake. he said he couldn't swallow anything but that. he ate oatmeal, enjoyed it, had no problem with it.i did speak to my rcc when she arrived. i am offended by your comment that i am not a team player and took the ball and began to play without the team. have you ever worked in a long term facility with only yourself, a few aides and a supervisor? you don't know the decisions that have to be made " off the cuff". often times you go by nursing instincts. i know you will find fault with this, but i am a good nurse and i don;t like to " throw my weight around" but i am used to being the " only pilot on the plane" if you know what i mean.

i have quotes from the following earle58 and debbiemig in my reply
“to be specific, i had a resident that was admitted over the weekend i was off, who had difficulty swallowing. we spoke and he agreed to try a pureed diet. i ordered it, he ate it, did well and said to give it to him for lunch. i ordered it”
what i see here is a patient admit that came in over the weekend and that this nurse did not do the original h&pe.
the patient has difficulty swallowing and the nurse has not reported this…..”any one able to think possibility of cva or tia” but said nurse chose to change the diet. not once did this nurse mention that she attempted to let any one else know about this patient.
now to address the following from member earle58
“for crying out loud, the patient wanted the puree as evidenced by his request for lunch. he said it was much easier to swallow”
i have to disagree with that the patient wanted the puree, but i will admit that the patient was talked into the puree.
now i am glad that we can agree that this patient has a swallowing problem. but let’s not get all-emotional about it. in fact the question should be why does the patient have a swallowing problem and is it something that is new onset something that a doctor say an eent could fix. but as long as a doctor never evaluates this patient we may be missing some pathology that is killing the patient…hey i know as a doctor i am the biggest patient advocate in the patient receiving the best care.
i would also like to comment on the following statement by earle58
“next time, in spite of the pt's c/o dysphagia, we'll just keep him on a house diet and possibly choke.”
i never said that changing the diet was not the correct thing to do. heck it might have been more prudent to place the patient on npo and go back and review the chart and call the doctor to inform him if this was an acute change. but remember what the nurse in question (debbiemig) had written.
i hadn't had ime to speak with the dr as of that time. ( he would have agreed to anything i said, he trusts my judgement).
i am sure that depending on the facts and the dr’s h&pe, he might have agreed to the dietary change. but the simply fact is debbiemig had not contacted the doctor nor had debbiemig passed this information along.
hey it is a team effort and debbiemig just took the ball and started to play without the team.

leslie :-D · Aug 17, 2004

i thought the patient requested puree for his lunch....didn't he?

usually i go to the md with my findings and suggest a speech/swallow eval; and will tell the md that i've downgraded until swallow eval is done.

of course the md is always supportive as they don't want any risks of their patient aspirating either.

and yes, we shouldn't assume and i would certainly hope that all pertinent data was relayed to this patient's doctor....

leslie

debbiemig · Aug 17, 2004

This DON is miserable! We have gone through 10 ADON's in the past 18 mos.That must say something. Her worth is in her ability to second guess the state .She is mean!Mean! Mean! I have a problem with authority figures, they make me very nervous! You are right though. I will be moving on!

Well, the last year or so I feel like I'm walking on eggshells at my job! I have been an LPN there for over 30 years, I have taken on many different positions with lots of responsiblities.
People that are insecure put other people down. That me be the case in your situation. Perhaps you are doing too good a job.
I am also afraid of my boss, and am also working in a nursing home. I think a little fear of one's boss is natural. It comes with the respect thing, to a degree.
It is all about power. And, sometimes unfortunately, those who do great jobs are deemed a problem (they are too good). They make others feel insecure. Perhaps they are costly employees?
Everyone seems to need someone to pick on.
Maybe you need to more on. ????

debbiemig · Aug 17, 2004

The reprimand was before lunch of the same day!

Now I am beginning to wonder about how much time lapsed between the diet change and the reprimand from the DON.
I had the impression it was a matter of between breakfast and lunch. In the LTC world this is not very much time. A whole day in a LTC facility would compare to mere minutes in an acute care facility (hospital).
Since the original post did not mention any other symptoms it would be safe to assume (yes, assuming is not a good thing but this is a discussion board, not a book) that there were none.
Just because a pt was on a "regular" diet in the hospital does not mean he successfully ate a full meal. He may have merely eaten the mashed potatos, ice cream and jello. Yep, he ate about 1/2 - 1/3 of the meal. Sounds pretty good for an elderly pt in the hospital. Let's just leave his diet right where it is, he seems to be doing just fine. Been there, seen it, it very surely happens.
Now, he's in a LTC facility, the admition orders have "house diet" on it and he can't eat it. So, the staff nurse decides an easier to chew and swallow diet is in order until he can be evaluated. If he can't tolerate that, well, I am sure (been there, done that) his Doc would have been contacted within those mere minutes so common in the hospital.
Docs don't want to know just "he can't eat the house diet" they want to know what he CAN eat, what other symptoms there are, etc BEFORE he is called. Yes, at breakfast he tolerated the pureed she brought in for him but I would have tried it a second time just to be sure, the big question here is will he be able to maintain adequate nutrition on the pureed. After all, there are so many possibilities and the Doc will want as much info as possible before he gives an order.
But, that's MHO after only 30 years.

UM Review RN, ASN, RN · Aug 17, 2004

This DON is miserable! We have gone through 10 ADON's in the past 18 mos.That must say something. Her worth is in her ability to second guess the state .She is mean!Mean! Mean! I have a problem with authority figures, they make me very nervous! You are right though. I will be moving on!

Good grief! She sounds horrible! Well, I don't blame ya, hon. There's millions of places out there who'd be thrilled to have you.

The reprimand was before lunch of the same day!

I'd probably have walked out shortly after. :chuckle

leslie :-D · Aug 17, 2004

i agree with angie o., debbie.

you sound like an excellent nurse and are clearly wasting your talents there.

you deserve much better.

wishing you all things good.

leslie

Tentorio2002 · Aug 17, 2004

sounds like a bad place to be

i think sometimes nurses forget why they got into it in the first place

glad you didn't

best of luck

debbiemig · Aug 17, 2004

:) Thank you for your kind words! Debbie

sounds like a bad place to be
i think sometimes nurses forget why they got into it in the first place
glad you didn't
best of luck

yasmina · Aug 17, 2004

Good grief! She sounds horrible! Well, I don't blame ya, hon. There's millions of places out there who'd be thrilled to have you.
I'd probably have walked out shortly after. :chuckle

When people we work with are difficult,accusatory and hard to please (if not impossible),the people pointing their little fingers and gossiping need to evaluate why they decided to go into Nursing in the first place.

Yes, there are plenty of places to move on to. However, I wouldn't leave if the ONLY thing you would leave for is the DON> Perhaps she will move on herself.

I was an auditor myself. I wasn't very good, as I gave 'everything away.' So, if the DON is good with the State, perhaps she would be a good state surveyor rather than a team player.

My DON would not get wrapped up in such stuff. He totally respects his nurses. If they are caring about the residents, and trying to do the right thing, that is what matters. Blatant incompetence of course wouldn't be tolerated. Doesn't sound like that is your situation.

Only jump ship if you really want to. How long has she been there?