Don jobs

[nancythenurse]

Hello all. I work in a nursing home that is certified for 99 beds but census runs between 65-75 any given time. I came to this facility about 4 months ago.I have been an RN for just over a year and have worked in LTC since I graduated.

I am supposed to be the day shift charge/desk nurse although I often end up working the floor. Apparently there have been numerous DONs over the last several years most of whom left the area for personal reasons (I personally knew some of them and know that their leaving had little to do with the facility itself). The last DON walked out 2 months ago and the ADON is filling in on an interim basis. The ADON is very knowledgeable--she has been a state surveyor and a DON--but wants to work part time until she retires. Procedure wise she knows her stuff but practical wise sometimes things are left half done becuase she has trouble keeping up with it all (d/t age/health). When the facility hires a DON, she is planning to resume her parttime ADON/desk/charge nurse role. She and I are the only RNs in the building although we have an RN who will start on PMs shifts soon.

Nursing staff consists of several LPNs, the facility has been severely short staffed for a long time due to the rural area we live in.

I have talked to the Asst Adminstrator and let her know that I would be interested in the DON position. I am supposed to talk with her and the Administrator next week. I am pretty sure that the interim DON would be more than happy to act as a mentor to me and that other staff members, such as the MDS coordinator will be willing to help me. The floor nurses seem to like and respect me, especially the older ones who have seen me work the floor and do whatever is asked--from helping CNAs to pitching in for all of them when they have a hectic day in spite of the fact that I was not hired to work the floor. I have good communication skills and understand the "big picture" which I think will make me a good DON.

I was reluctant to apply for the DON sooner becuase surveryors were due in--which is the primary reason our ADON stepped into the role--surveryors were in and gone, we had a not too bad survey EXCEPT one major thing which was that Novolog insulin was on the MARS to be administered up to an hour before meals. Although most of us used our nursing sense and adminstered novolog within 15 minutes of meals, the state said the potential for harm was still there. The biggest problem in this facility has been the lack of consistency and stability in the DON position and I think that the administrator would be willing to forgo experience in favor of someone like me--who will stay with the facility and be a team leader instead of the my way or the highway attitude (which I can do too when needed, but there is a time and a place for it).

So, sorry to be so long winded, but what I want to ask is, what kind of salary range should I ask for?

[CapeCodMermaid, RN]

You shouldn't be offered the job as DON with only one year of experience. If they do offer you the job, they are desperate to get it filled. No offense but one year as an RN will NOT prepare you to be the clinical leader of the facility.

[debRN0417]

You sound like you are a very caring and knowledgeable nurse, but I have to agree with CapeCodMermaid- one year of experience is not enough. There are so many things that you need to experience first and learn. As a DON you are "it" the "buck stops here". Are you sure you're ready to accept that responsibility after only one year as an RN? Staffing. hiring, firing, discilpline, on call, meetings, reports, supervising, teaching, helping, ...the list goes on and on. When you are a nurse on the floor, at the end of your shift you clock out and go home. You are finished. When you are a DON- you NEVER clock out. You take it home, you live with it. I mean no disrespect to you, but I fear that you will soon regret it, and as CapeCodMermaid said if they offer you the job, they are desperate, and that is not a good thing either.....

[nancythenurse]

I do understand the monumental responsibility and time/dedication that this would take. And, yes, the facility is desperate because this is a town of 6,000 people with a state prison of 3300 inmates, most of the nurses in the area work for the prison because they make 90K plus a year with great benefits. That kind of money would be nice, but I dont want to work in the prison. The only nursing educational program within the nearest 150 mi is an lvn program that turns out a class of 20 every other year. The owner/administrator of this nursing home is on site and this is the only facility he owns. What I am thinking about asking is if I can start out in the capacity of assistant and gradually take more responsiblity, kind of shifting roles with interim don so she can act as a mentor to me.

[nyteshade, BSN]

A DON should know how to do everyone's job, and yes the buck stops with you. It's more than just staff/resident issues. I strongly believe a DON should have a MDS background. Are you ready to answer to a surveyor about RAPS/MDS assessments/careplans? I can assure you that will be a topic of interest year-round. A DON should understand the MDS language. Just my two cents...

[CapeCodMermaid, RN]

There are Administrator in Training programs in which the person in training has to spend time doing everyone else's job...CNA, diet aide, housekeeping etc to understand what the whole job is like. I think DNS candidates would benefit from that. I've worked with some who NEVER passed meds, NEVER did an MDS or anything else. They looked good and could boss people around but they had no clue about the importance of the other jobs.

At least when my MDS coordinator complains about 10 Med A patients and tells me "you don't know how much work it is" I can tell her "Yah...I do..I was an MDS coordinator at a facility that averaged 25 Med A a week plus managed care". If you've done their job you learn how to help them organize their time or how to help them (maybe) do it better. At the end of the day, it's ALL on you. How can you properly supervise people and have expectations for them if you have no idea about the job they do????

[nancythenurse]

I sure appreciate everyones responses and I agree wholeheartedly--in order to understand the process and make decisions one has to know what is involved for the person doing that job. Funny you should bring that up, because our MDS coordinator is going to be gone in July I have been cross training for MDS the last several weeks so I can fill in for him. Our MDS person is an LVN who does MDS under the DONs supervision and I understand how important MDS so I would not accept a DON position unless I know how to do it. We have a nurse who handles the RAPS and careplans who I have been filling in for the last couple of weeks, so I have been doing those too. I have learned more about LTC since I have been in this facility than ever. Even though I do not have the title ADON, I have pretty much been the ADON since April. And, guess who was the only nurse in the building who passed meds and was on the floor all 4 days that the state was in. You guessed it, it was me. ( I have been a CNA and I also worked as a dietary aide sometime back.) Seeing how state operates and the kinds of things they are looking for taught me a lot--I was also tasked with going through our survey results and pulling charts to make sure evidence that we were following up on our plan of correction was supported by documentation in the charts. The thing is, I am not starry eyed about what this kind of a position will involve, but I am wondering how much mistakes or negligence by the nurses on the floor can effect the DONs license?

[debRN0417]

If the facility is cited for substandard quality of care, the DON and Administrator are reported to the DHP and yes, it goes against your license.

[Moogie]

A DON should know how to do everyone's job, and yes the buck stops with you. It's more than just staff/resident issues. I strongly believe a DON should have a MDS background. Are you ready to answer to a surveyor about RAPS/MDS assessments/careplans? I can assure you that will be a topic of interest year-round. A DON should understand the MDS language. Just my two cents...

I once worked with a DON who didn't seem to understand or value MDS. The CNAs were supposed to do the worksheets (which I don't understand at all...but I digress) and they were lax about getting them done. One time I stayed late to finish the worksheets and got yelled at by The DON for "doing the CNA's work". I don't know how the RNACs survived with that DON.

[sayitgirl]

You need to get a job on a med surg floor in a medical hospital and work for at least a year. Then go back and work on a unit in a nursing home as a staff nurse, preferably a subacute unit, for at least a year. Then progress to being a manager of a unit, then maybe, then I would suggest that you attempt to be a DON.

[noc4senuf]

Do you know the regs, both state and federal? Have you written a POC or know what is involved with that? Have you worked with a budget and able to stay within one of let's say $1M and above? Do you know what the benefits are of medicare and how payments work? THere are many more things to being a DON then being able to "fill-in" for the MDS coordinator.

[nancythenurse]

Thanks for all your replies/advice. But, I ended up with a job offer for a United Indian Health Services clinic as triage nurse, which I am really excited about. I have been on the job for about a week and I think I will have the opportunity to develop more skills and knowledge about disease processes etc. The interim DON and the LTC center was not happy to see me go and gave me an excellent review, stating that if I didnt like UIHS to come back and shed teach me the DON ropes. (she is ready to retire and stepped in just to help the facility but she knows her stuff.) I think it ended up working out for the best. Thanks again.