DON, Supervisor Medicare Certified Agency

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It seems that the only full time jobs around in Medicare Certified Home Health Agencies in my area are DON or Clinical Supervisor positions.

These jobs are like revolving doors in most of the agencies they just fire, hire or quit, hire over and over.

I'd like to hear some feedback on these positions.

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I could give you a description of the situation with a former DPCS from the viewpoint of the field staff, but it would be hard to do and not be identifiable. Well known to a lot of people in the area. Suffice it to say that the individual was used by the company. That about sums it up. Months after they left, it was still being talked about by those who remained with that office. I see it as the price one pays for taking an internal job with the employer. When they get what they want from you, then you are just as disposable as all of the external employees realize every day they go to work. Nobody forces nurses to take these jobs.

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I could give you a description of the situation with a former DPCS from the viewpoint of the field staff, but it would be hard to do and not be identifiable. Well known to a lot of people in the area. Suffice it to say that the individual was used by the company. That about sums it up. Months after they left, it was still being talked about by those who remained with that office. I see it as the price one pays for taking an internal job with the employer. When they get what they want from you, then you are just as disposable as all of the external employees realize every day they go to work. Nobody forces nurses to take these jobs.

DPCS stands for? (director of politics and crap for survey is the only thing that is coming to mind)

So, they disposed of the DPCS after they were used. How is the new DPCS? What did they use the DPCS for? Did the DPCS leave or was the DPCS fired?

I certainly know what you mean. I have been hired just weeks before survey, only to have my "job" eliminated a day or two after the surveyor walked out the door.

Most of these agencies are just on the edge of being shut down for something.

There are some good ones, but so hard fo find in this economy.

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The Director of Patient Care Services left on her own. The individual who took her place was shall we say, "challenged" in the job performance department? For one thing, even if you are the boss, to do the job, you have to spend some time at the job. Things were dicey in many ways. The first person chased the cats as long as she could to keep them corralled. Not tons of help from the company higher ups from what anyone could see. When the dust settled some, she left. The clinical supervisor left near the same time. Caused quite a bit of talk amongst the external employees. She was respected. Her replacement was nothing more than a warm body, drawing a paycheck.

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Thanks, caliotter3.

It seems that these are jobs to be avoided.

The agencies just don't change.

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Sounds like you guys are talking about a pretty big operation. The smaller agencies are mostly owned by another decipline other than RN or MD and don't know the first thing about whether the DON is doing her job until the surveyers march in. They have unqualified QA and most of them are incapable of qualifying their operations to the surveyer. They just do as they are told in order to keep the money flowing. Most of these agencies are folding like napkins.

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Sounds like you guys are talking about a pretty big operation. The smaller agencies are mostly owned by another decipline other than RN or MD and don't know the first thing about whether the DON is doing her job until the surveyers march in. They have unqualified QA and most of them are incapable of qualifying their operations to the surveyer. They just do as they are told in order to keep the money flowing. Most of these agencies are folding like napkins.

The agencies are folding and crumpling quickly and the larger ones that do not fold are facing financial reversals from medicare take backs after audits.

You are right, they hire people just to have a warm body in the chair and don't try to find qualified QA or Supervision. Then they fire the QA and the Supervisor and turn around and hire some more. By then the mess is too big to fix.

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Specializes in COS-C, Risk Management.

My experience has been that they usually hire someone without home health field experience, generally a former charge nurse or someone with some other kind of supervisory experience. Most field nurses wouldn't be caught dead in the director's chair (myself included at most of the agencies I've worked for).

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I guess I'm glutton. I love the QA part of getting a drowing agency out of the red. Yes, I have been termed and have also resigned d/t insubordination from clerical staff that the higher ups would not address. It is a very, very difficult position to hold, but somebody has to do it. I occassionally go out in the field when we are short just to relieve the schedulers. Being the Clinical Supervisor is very lonely!:uhoh3:

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I guess I'm glutton. I love the QA part of getting a drowing agency out of the red. Yes, I have been termed and have also resigned d/t insubordination from clerical staff that the higher ups would not address. It is a very, very difficult position to hold, but somebody has to do it. I occassionally go out in the field when we are short just to relieve the schedulers. Being the Clinical Supervisor is very lonely!:uhoh3:

QA - no one wants to hear what the QA has to say.

I have had agencies beg me to come work there and assure me that they want/need a QA only to find that they were not interested in tiny speck of the truth. Some of those agencies no longer exist.

You are a brave person. You must be very strong.

What is up with the office staff? I don't think I have ever worked in a home care office where there wasn't something ridiculous happening with the office staff. In fact, they are usually making a big mess and giving someone grief while playing computer games and/or watching TV!

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Specializes in Med/Tele, Home Health, Case Management.

SEEKING ADVICE ON ACCEPTING/DECLINING DON JOB OFFER:

Today I was offered the DON position of a small, privately owned (by non-medical people) agency with less than 15 employees and a current census of about 59 pts. I have only worked for this company for 4 months as a R.N. and have less than 1 year experience in home health and almost 2 years as a nurse. The previous HH agency I worked for was very large and, while I did get some orientation, there is a lot I don't know, mainly about Medicare rules/regs. One of the things that my preceptors told me was never to take a job as a DON for a HH agency because you are responsible for everyone's actions and your license is on the line. I did not express interest in this position and I do not feel that I am qualified. However, the owners told me they would send me to a state approved administrator training course (1 1/2 days) and that the job mainly involves employee management and communication with pts/families/doctors. The owners told me this would be a good career move for me. I'm not so sure.

After graduation 2 years ago, I went directly into Trauma ICU and only lasted 2 months due to poor training. So I moved to Med-Tele and was there for 7 months. Both of these positions were at a large 900-bed hospital and were bad experiences. Due to this, I sometimes feel insecure about my abilities to be a nurse at all. The thing I love about home health is getting to know the patients and having time to actually teach them about their disease processes, meds, etc. I am a former teacher, so that part comes naturally to me. During the interview today, I actually thought of a few things I would like to change/implement (inservices, staff mtgs, etc) if I decide to take the DON position.

My mind tells me that I am not qualified and I would like to know what you all think. Any advice is greatly appreciated.

Thank you!!!

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twin

I don't see how someone with your level of experience could be expected to handle that job even though it sounds like a small agency.

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