Frustrated Need Input

[rockchalk_jayhawk]

Good morning all. I am in need of some major input. My full time job is working in an ICU at a rural hospital. That job is excellent. For some extra spending cash I work part time in a small nursing home. It is going thru some major changes. And as most people will say..."No one likes change." We are in absence of a DON and have a ADON who is an LPN in RN school who will be acting DON upon passing her boards. There is only one other RN who works in the facility which makes 8 hours a day, seven days a week RN coverage a problem. Administration states "We are not concerned with that issue." That and not having another experienced RN to bounce things off of has the 2 of us wondering about our liability. We realy do not have a superior to consult with. It just seems like the ADON (which is new to the facility) is drowning. She is trying to please everyone and pleasing no one. She is letting go of the GOOD help and keeping people who frequently call in. She will not accept help in any form. She will graduate in May, who knows when she will take boards and its a big question whether she will pass on her first try. WHere do we go for RN advise. Any comments will be taken with appreciation.

[RNPATL, DNP, RN]

You are in a tough situation. However, as one of the few RN's in your facility, you are playing a supervisory role. The residents in your facility need oversight of their care by an RN. Most states have minimum RN staffing requirements and your administration is probably not concerned because they have coverage 7 days a week by an RN. However, they are somewhat near sighted in that the LPN they have "acting" as DON can not serve in this role. Regardless of whether she is in school or not. She is NOT an RN and can not serve in this role. What this means is that the RN's working in the facility are truly the ones responsible to ensure that the residents are getting the care they deserve and need. I am afraid that if the State where to come in on a complaint, the administrator would have to produce an Director of Nursing or another Registered Nurse that was appointed into a leadership role. If the facility is unable to do this, they would be in be trouble.

I have run several facilities where I have placed an LPN in an ADON role. However, in the absence of the Director of Nursing, I always had another RN in charge and appointed as such. The other issue is that RN's can not, under most State's Nursing Practice Acts, take clinical direction from an LPN.

In relationship to the drowning "acting" DON, I would certainly set up sometime to review this issue with the administrator and her at the same time. This way all involved can discuss the issues and the amount of responsibility that has fallen on the shoulders of the RN's in the facility. Regardless if you know it or not, as one of the 2 RN's in the facility, the responsibility of care oversight is on your shoulders as well as the other RN. Good luck.