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Fellow DON's....I need some advice please...

by mtessmer2000 mtessmer2000 (New) New

Hello all,

I am new to this forum and found it by searching for hours...It seems to be filled with fellow leaders in nursing like myself and I am in need of some guidance, advice, or whatever you can offer a struggling DON.

I have been a nurse for nearly 20 years, and have worked in LTC, Acute Care, CCU, ICU, Disease Management, Travel Nursing, etc, and have now "settled down" with a job that I always wanted to do. I am the DON of a LTC Skilled Nursing Facility in WI, and within a non-traditional nursing management model. My facility is a 120-bed facility, and I have 3 MDS Coordinators who are to be unit managers as well. I have been in this role for 9 months now and have worked consistantly 60-70 hrs per week, and am on call 24/7. I have always been very efficient, a leader, have great organization skills, have managed and worked as charge RN in nearly every job I have had and this one, I have to say, is about killing me!

The responsibilities of our jobs are certainly broad and time consuming, but what I have been handling seems to be the job of more than one person. Here are a list of my responsibilities which I am sure will not be all inclusive.....

-Staff Development and Education (In-services monthly & Nursing meetings)

-Behavior Med Management and roundly with Psychiatrist Bi-monthly, TD screen management, etc.

-Hire, recruit and evaluate all nursing staff

-Infection Control (to which we just recieved an level L F-tag during our influenza outbreak), Epidemiology within my monitoring, ensuring adherence to McGeers criteria and CDC, etc.

-QA daily of behavior charting, Summaries, Incidents, Falls, MD Orders, New admits, Symptom Pursuits. QA weekly of Med rooms, passes, accurate charting, follow up with SO/MD's, etc., etc., etc.

-Daily MD rounds (we have MD's in our building for about 4 hours per day), and monitoring for accurate and compliant Mandated visits with each resident.

-Nutrition Risk Committee, Skin Committee, Behavior Committee, Medicare Committee, Falls committee...Chair of all of them..

-Required to staff (despite being salary) to improve PPD numbers one 12 hour shift per 2 week schedule

-PPD management with numbers that seem impossible to reach, in addition to staffing with the help of a scheduler (Thank you Jesus!)

-Employee Infection Control

-Immunization of Staff of TB, Hep B, FLU, etc, as well as Residents and keep current daily.

-Troubleshoot with staff and be available 24/7 for any nursing concerns, and resolution of conflicts

-Medication error investigations and re-educations

-Discipline and re-education of all nursing staff.

-Deal with and resolve resident and family as well as staffing complaints.

Now, I am sure I have forgotten something, but I feel like I am doing the job of at least three people, work everyday at home, and have now been written up 4 times since October by a brand new 23 year old new grad NHA with no medical background who needs to tell me everyday that she is my boss. I am undermined by one of my MDS Coordinators daily who was once the DON, and have a brand new nurse recently hired into one of the MDS roles (not by me mind you), and another who rarely checks her email or mailbox. I rarely get office time until after 6pm as I am out there on the floor with my staff, educating newer nurses, and attempting to understand the lack of professional accountability throughout my staff (especially seasoned and experienced nurses), and when I do get an hour or so in my office, it is to listen to a million messages and return phone calls.

I am now completely spent, sleep about 4-5 hours per day and one day a week on the weekends I sleep all day (literally), just from exhaustion. I had exactly 30 days of training from an interim DON who had never been a DON and truly have learned it all on my own.

Can anyone out there, tell me I am nutz, or tell me that this is the reality of a DON job?! Any advice would be helpful, or even just telling me to quit whining would be sufficient. I am paid fairly well, but at this rate making about $10 buck an hour, and my kids and husband (who I thank God for everyday), are surprised when I come home before 9pm....and I go in at 6 or 630 am!! Help, as I am at the end of my rope for sure.

Looking so forward to your responses.


Nascar nurse, ASN, RN

Specializes in LTC & Hospice. Has 35 years experience.

What/how many nursing supervisors do you have, ie: ADON, Staff Development Coordinator, Unit managers, etc? What are their jobs responsibilities - perhaps you need to delegate differently?

You should not be scheduled to work as a floor nurse with a census of 129. There may be a few days that you have to get pulled to the floor but you should not be part of the schedule. Somewhere in all those regs there is a regulation stating that a facility with over 60 residents is required to have a full time DON and this person is not to be scheduled as floor staff.

Do you have a corporate nurse consultant? How often do they come? Maybe they could assist you with organization and delegation tasks. My first example would be that the unit manager or floor nurses should be doing rounds with the physicians. That should not be a DON task. Also, everywhere I've been, the social service director is in charge of behavior management meetings.

My biggest problem, if in your shoes, would be that 23 year old little snit that had to inform me she was my boss everyday! Written up FOUR times??? If someone had written me up FOUR times, I would already be fighting this person up the corporate chain or I would be out the door! Have you had a closed door, face to face with the little snit...I mean boss? If you want this position, you are going to have to deal with her to get her on your side.

Good luck - not sure this is a battle you are going to win.

CapeCodMermaid, RN

Specializes in Gerontology, Med surg, Home Health. Has 30 years experience.

You are being taken advantage of. It seems apparent by your post more staff need to be hired.

Ruas61, BSN, RN

Specializes in MDS/ UR. Has 39 years experience.

I think you are being taken to the cleaners. My mouth is on the floor with this work load. I think you need to consider your options and think about another job because this sounds like some toxic model for management.


Specializes in LTC, Education, Management, QAPI. Has 6 years experience.

I can unfortunately only say this - It sounds like my job description. I have an ADON, 2 UMs, and 1 MDSC. The MDSC has an assistant. I do everything you have listed in your post except that my ADON handles all staff development and PPD/FLU/Pneumo. I do have a scheduler. Those 2 alone take a huge chunk from me, but I still work 10-12hrs/day average as I'm working on developing some of our programs. I think you need some ancillary staff, stat!

I believe that you are really spreading yourself thin. I would try and delegating a little more to ADON. Also the LNHA is on a huge ego power trip. If you are at a corporate facility it's time to go over her head. It also sounds like she's using you as a scapegoat. If corp cant help you and you are passionate LTC then stay in this area of nursing but I would look into other facilities as well. Not all nursing homes work the same. I've been an LPN for nearly 9 years over half of that in LTC and I have 3 LNHA's in my immediate family alone. So all my $0.02 comes from personal experience :-). Good luck.

First off....Stop going in everyday at 6:30. You go in at 8:30 and tell your boss that you are working 10-15 hours more a week than you should be. It is hard to shave it off the other end but I would go in later. The former DON is undermining you because she doesn't want you to be sucessful....after all...she wasn't at the same job!

Yes, most of what you have on your plate I do too....I do not do any Physician rounds. I would delegate to the Nurses. I have someone tracking my Flu, Pneumo & TB. Employee immunizations are done by my Nurses but the paperwork all gets forwarded to me.

Give recruiting to HR.

That is way too much work and responsibility . You will end up at some point making a mistake due to overwork and stress . Then you will probably be fired My advice Run as fast as you can !!

Thanks so much for your insight and guidance! I actually have had several "talks" with the snit that is or should I say was my boss. I put in my notice today, and asked to go home for the afternoon. I asked directly if I was being terminated and the response was, "As I said, you will go home for the afternoon". I did so accordingly, and was called at 4pm and asked to bring my keys, security key, and my badge and that my belongings would be waiting for me. I asked again, if I was being terminated, and the response was, "I shared your letter of resignation with corporate, and we feel your resignation should be effective today." I came in, got my things, and did not leave quietly to say the least.

To answer your questions, there was only me as DON, and three MDS Coordinators/Managers with census of 120. No nurse consultant either...only the Corporate Ops Director who is not a nurse and has felt she has adequately trained me...

At any rate, I know that I am employable and have been actively looking none-the-less, have an interview tomorrow and next Tuesday. I left knowing I did the best I could do. I also filed a formal complaint with the DQA & DHS as well. Thanks again for your support!

Agreed! Well, they will now be down a DON as well. I pity the pour soul who thinks they may be able to do this job.

Thanks so much for the advice and insight. Unfortunately, no ADON to help and not one to be had within the management model there.

That is what I did today. Today was the last time they were going to abuse me and use me to the extreme! I have my notice today and later this afternoon was asked to turn in my badge, keys and security fab and that my belongings would be waiting for me. I came, collected my things, demanded to inspect my office (which I did and of course they forgot to include many things), and I left, unfortunately, not quietly.