Director of Nursing seeks support from other D.O.N.'s

theleader · Jan 15, 2000

Hi! I too am a DON in a LTC. I took the position without any or very little orientation. Most of my changes came by trial and error. Some have worked and some have not. Staffing was my biggest problem. Overtime was at 1000 hours per month, morale was low, the CNA's ran the show and they had no accountability, nurses were frustrated, it was horrible. Now a year later, the LTC is a different place. Not all because of me but because of a joint effort on everyone's part. Attitudes have changed from an "I don't think it will work", to "Let's try it, we can make it work" I'm proud of my staff for the direction we're heading. I'd like to start a roundtable for my CNA's. Have you ever done anything like that? The meetings I attend are very helpful and I think if we did the same for our staff and incorporate othe facilities into our meetings it would be a tremendous help in boosting respect, morale, and job satisfaction and ownership. What do you think?

millee · Feb 20, 2000

Originally posted by theleader:
Hi! I too am a DON in a LTC. I took the position without any or very little orientation. Most of my changes came by trial and error. Some have worked and some have not. Staffing was my biggest problem. Overtime was at 1000 hours per month, morale was low, the CNA's ran the show and they had no accountability, nurses were frustrated, it was horrible. Now a year later, the LTC is a different place. Not all because of me but because of a joint effort on everyone's part. Attitudes have changed from an "I don't think it will work", to "Let's try it, we can make it work" I'm proud of my staff for the direction we're heading. I'd like to start a roundtable for my CNA's. Have you ever done anything like that? The meetings I attend are very helpful and I think if we did the same for our staff and incorporate othe facilities into our meetings it would be a tremendous help in boosting respect, morale, and job satisfaction and ownership. What do you think?

I would like to know how you did it, I am an RN and have worked in a facility for 10 yrs. started as a cna>lpn>rn, our DON is on med leave and we know is not coming back (cancer) the ADON is filling her shoes, I'm sorry to say she is in over her head and does not know what she is doing, we have all offered new ideas but all are rejected we have hardly any cna staff left, and on weekends often work w/ 2or 3 cna's, on a skilled unit w/50 pt. The last 2 weekends I worked I worked on the floor as a cna, as well as many times thru the week, I also am doing some of the ADON's paper work as well as my charge nurse duties. I am tottaly frustrated and have talked with the adm. more since Aug. than I have the entire 10 years I've been there, I could no longer take it and I have accepted a ADON position at a LTC faility close by. I have a lot of guilt and am scared to death to start a new job, but I feel as though I have to do this for my career and to keep ahold of the professionalism I have left. I hope I can last out the 2 weeks notice.one of the nurses who works this weekend called me yesterday to tell me they have 2 cna's and they called the acting DON she gave them a list of people to call, of course no one wants to work on their weekend off after working short all week, they called her back and her reply was oh well. is this right!!!! What in the world is going on she could have at least called these people herself, or offered to come in and help, how can you expect your staff to give 100% if you are not going to give????? Millee , e-mail [email protected]

MuldrowRN · May 20, 2000

I am a DON at a small nursing home. This is my 2nd year as such and I had no experice with LTC before this. As with all homes, STAFFING is my greatest problem. With employment up and pay for CNA's low, it is next to impossible to get aides or to keep them.

[This message has been edited by MuldrowRN (edited May 20, 2000).]

Nancy1 · May 20, 2000

I am an ADON in a not for profit LTC. It is true that staffing is getting to be a problem and we are all going to have to be creative to find ways to care for our residents. I have had the opportunity to discuss this subject with several different sets of nurses - from Vice President level to staff nurse. I know some facilities are taking a closer look at using Medicationa Assistants (A CNA who has been trained to pass PO meds.) And have the nurse do the assessing and charting and whatever. This will be only as good as your staff. Medication Assistants can be very good use of time, if you have enough CNAs to do the work. I have heard others talking about doing some advance training of CNAs enable them to do more of the vital signs and simple treatments. Again this works if there are enough. Where are we going to find staff to fill these positions. I hear from one part of the country that they have CNAs and no nurses, and others have nurses and no CNAs.

I find that some of the nurses I have recently hired do not have a lot of time management skills which throws everybody off. One of the nurses I correspond with in GA says the new grads that they have hired are not doing all that well either. Here in the Greater Milwaukee area, I have heard nurses talking about how many nurses are graduating but we do not know where they are going. Hospitals would be my guess. With all that I hear about Mandatory Overtime in hospitals I do not understand why.

I think those of us in LTC need to do something to promote ourselves. Nurse like to think that they have autonomy, I doubt that in a hospital. Think of the autonomy that our nurses in LTC have. they have to be good because that MD is not going to be there on a daily basis. It is the nurse who holds things together.

As you can read, I don't have answers, I only ask more questions. I help out my nurses to the best of my ability. I hope it is enough to keep them from leaving. We do not have mandatory overtime, and we have probably been at our minimum staffing 3 times in the past month. Which I do not think is too bad. I know they say they are short, I keep reminding them that the key word is minimum.

feel free to e-mail me maybe we can solve the problems....more likely we will continue to ask questions. NA

km rn · May 31, 2000

In our state we have an active association for DONs - NADONNA. It is also a national association.

This organization has regional meetings as well as 2 state wide meetings per year.

These meetings allow for members to network and provide support/information to each other. In addition, the State Health Department and ND Long Term Care Association use this group as a reference for quality of care issues, etc.

I am not a member, but my facility's DON and ADON are - we frequently share forms, and information with other DONs.

Look up NADONNA on the web to find out more information regarding your state's organization. Most administrators in our state are recognizing the benefit of this organization on retention, morale and information gathering.

er · Jun 23, 2000

I have been a DON for just shy of 7 years in a small 60 bed skilled facility. As much as I love the residents I'm sorry to say that I have reached burn out. I have practally lived at this facility due to staffing shortages. We are located in a very small town and the worker pool is extremely limited. I do have some very good and dedicated workers or I never would have lasted as long as I did. Anyway beit midlife crisis or whatever, I decided I needed "a life" and put in my notice, my last day is next Fri. I'm going to try hospice for a while. I have over the years implemented many programs for all kinds of problems, many worked a few didn't. That wasn't the problem. I just can't find decent help anymore. I, like I said before have a really good core group of workers that have been with me for years. I just can't find any new workers with the same dedication, or any kind of work ethtic. It doesn't seem to matter what I pay, how they are treated, what the benifits are, they simply don't want to work. Or more accuratately they only want to show up when they feel like it, ie) no parties going on, friends are busy, etc. They just don't care, they don't even care if they lose the job because they know they can get a job anywhere in town and we'll eventually get desparate enough to hire them back. It's either hire them back, or work all the extra shifts yourself (& I work for salary). So, alas--- I GIVE UP!!! I hope your situation is better. It can be a very rewarding and fulfilling job. Good luck!!

belinda · Jun 26, 2000

I also am a DON in LTC. I feel a lot of frustration at times, but I also love it. I work in a facility that is small--110 beds--and very home like. I would also like to taLK with other DON re: frustrations and other things. My email is [email protected].

susan827 · Jul 16, 2000

Originally posted by belinda:
I also am a DON in LTC. I feel a lot of frustration at times, but I also love it. I work in a facility that is small--110 beds--and very home like. I would also like to taLK with other DON re: frustrations and other things. My email is [email protected].

I'm a member of NADONA and this does help keep me current with the everchanging field in long term care. I have been a DON for the last 3 1/2 years of a private pay nursing home. I find the DON's of nursing homes in my area do not stay for longer than a year in most positions. I feel many nurses are not trained for the complexity or management skills for long term care and become easily burned out as a manager. I also feel they do not have the automomy to make the decisions to correct things in many facilities. Many of my colleagues work for facilities that are corporate owned with many other facilities and must get permission to change a simple form because they want all the facilities to use the same forms. I'm lucky that I work for a private pay facility and have the authority to change things and involve my staff in the changes. Staffing is the number one issue, and teaching management skills and teaching long time nurses to use their assessment skills were my main priorties. I agree with the statements that a LTC nurse must be a good nurse with good assessment skills and independant enough to make decisions. We recently were able to get addresses of nurses and cena's to send out letters to try to find qualified help. We now have 2 full time nurses for evening shift which we haven't for 2 years and a pool of nurses. Cena's have been difficult and we have increased hourly wages each year, now we are working on better inservicing. I would love to talk to other DON's about their challenges, and successes. Sometimes just a new way of looking at something, sparks an idea in our minds. We need to stick together because it can be lonely trying to accomplish all the things that need to be done. I love LTC and my job.\
Susan

[This message has been edited by susan827 (edited July 16, 2000).]

oramar · Jul 20, 2000

Originally posted by readnour:
Hi, everyone!!
I am D.O.N. at a Long Term Care Facility in Iowa. I am interested in making acquaintances with other D.O.N.'s in similar positions. I have a variety of issues I'd like to share and converse with you about. I have many good ideas - some tried and worked, others tried and not worked - and would love to hear some of your ideas. The LTC industry is changing rapidly, and nurses in our positions are growing evermore accountable and responsible for just about everything entailed in the LTC arena nowadays. Furthermore, I find the Quality Indicators Reports very useful and beneficial in providing more direct focus to our Quality Assurance team/activities.

If anyone is interested in sharing thoughts and/or ideas, please respond. My email address: [email protected]

Thanks!!

I am not a DON but I hope you will not mind if I tell you this story. My sister-in-law has been a CRNA for the last ten years. She is a hard worker and a very concise worker. She was a joy to anyone who was on duty with her. She was just hired by the post office. The money is better, the hours are better, the shift is daylight only and if she eventually gets hired full time the benefits will be excellent. Hospitals and LTC facilities are being forced to increase the workloads and cut the benefits and even sometimes the pay of employees who can easily go elsewhere. My sister-in-law has of course reported back to her former co-workers about her delight in her new position, she especially likes the 15 min. break every two hours, all the other CRNAs are buzzing about that. About half of them have put in applications to the post office. What a nightmare you DONs and other managment people have looming, I actually feel sorry for you. I think it is going to get worse.

oramar · Jul 20, 2000

Originally posted by oramar:

Originally posted by readnour:
Hi, everyone!!
I am D.O.N. at a Long Term Care Facility in Iowa. I am interested in making acquaintances with other D.O.N.'s in similar positions. I have a variety of issues I'd like to share and converse with you about. I have many good ideas - some tried and worked, others tried and not worked - and would love to hear some of your ideas. The LTC industry is changing rapidly, and nurses in our positions are growing evermore accountable and responsible for just about everything entailed in the LTC arena nowadays. Furthermore, I find the Quality Indicators Reports very useful and beneficial in providing more direct focus to our Quality Assurance team/activities.

If anyone is interested in sharing thoughts and/or ideas, please respond. My email address: [email protected]

Thanks!!

I am not a DON but I hope you will not mind if I tell you this story. My sister-in-law has been a CRNA for the last ten years. She is a hard worker and a very concise worker. She was a joy to anyone who was on duty with her. She was just hired by the post office. The money is better, the hours are better, the shift is daylight only and if she eventually gets hired full time the benefits will be excellent. Hospitals and LTC facilities are being forced to increase the workloads and cut the benefits and even sometimes the pay of employees who can easily go elsewhere. My sister-in-law has of course reported back to her former co-workers about her delight in her new position, she especially likes the 15 min. break every two hours, all the other CRNAs are buzzing about that. About half of them have put in applications to the post office. What a nightmare you DONs and other managment people have looming, I actually feel sorry for you. I think it is going to get worse.

PLEASE EXCUSE me for typing CRNA when I mean to type CNA, I am NOT talking about Certified Registered Nurse Anesthetist, I am talking about Certified Nurses Aids. Sorry if I confused anyone.

belinda · Jul 25, 2000

ORAMAR--

I am not sure how to respond to your post. Please tell me, are you making fun of DONs? Are you trying to prove a point? I will admit that your post made me a little angry.

I am a DOBN and I work very hard to help and be there for my staff. I think that you must understand that budget cuts and low pay are not the DONs fault. I think that you need to look at the government. Look at what your government reimburses for a person to stay in a nursing home. At times we are forced to care for residents that we recieve lower reimbursment than it takes to care for them. At times, our resdients cost us money to care for...because of your goverment. As a DON, I do have to follow a budget, however I do not set the budget..I am just responsible for sticking to it.

I am a DON because I love LTC. I love taking care of the people at the facility. Sometimes it is a very difficult job with absolutely no thank you's. But still there are nurses out there willing to do it. I think that we should thank these people for being a DON.