Help am New DON FOR LTC

UM Review RN, ASN, RN · Jan 3, 2005

Could you define this a little better? I'm having serious images of you doing all the patient care while the CNAs sit back at the desk gabbing on cell phones.:uhoh21:

I have been working my hardest but have been pretty much doing it myself!!

Malt123 · Jan 3, 2005

Welcome to the world of LTC. Have you ever worked a unit before? What are you refering to when you say you are doing it alone? Is there no one else working there?

Are you passing all the meds, doing all the treatments, assessing all of the pts.,ansewring all the lights, calling the doctors,labs and pharmacy,pt. teaching,dealing with families and staff that refuse to work, feeding pts., bathing pts,admitting pts, discharging pts., dealing with state, starting IV's and monitoring them, doing the MDS, vital signs, charting etc........

virmm1, LPN · Jan 3, 2005

It sounds like you need to do some housecleaning. Can you start documenting the incidents of insobordination and then hire more aides before getting rid of the insobordinate ones? As a DON there's no sense in you putting up with this type of behavior.

alintanurse · Jan 3, 2005

Hi I am im great need of information regarding DON's how to deal with staff that wont listen and people who wont work as a team is there anything i can do to help improve our quality of patient care?? I have been working my hardest but have been pretty much doing it myself!!! Im pretty much tired of doing and am to the point i could just walk away with a different job!!! If anyone can help please let me know!!! THANKS SO MUCH

Oh boy--do I feel for you! About six months ago I accepted a position as a discharge planner/case manager of a unit in LTC. I was so overwhelmed with all of the work I was supposed to do along with the poor attitudes of the staff except for the physical therapy dept. The CNA's were downright lazy! I wasn't suppose to be doing any direct pt. care but inevitably I ended up answering callights too! I was handling all aspects of case mgmt. along with the plan for discharge and obtaining weekly auth from the HMO's,counseling families,fu on labs,calling MD"S for orders&filling out all the dc paperwork. I had so many meetings during the day that put me behind in my dc planning and eventhough I verbalized all this to the DON & administrator they weren't listening.I was so worn out--within 2 months I came down with pnuemonia and I am sure it was because I was so stressed. The patients were the only ones that would say anything about how hard I was working,the nursing staff would dump as much as they could possibly get away with. I lasted 3 months and I was thrilled to get the heck out of there-----my advice to you is run,run,run and don't look back. There is no way you are going to be able to change the culture there!

Malt123 · Jan 3, 2005

I agree. This sounds like the place where I was working not as DON but it was basically the same for the nurses, but I was the one getting the boot. These people did not want me there, they did not want me checking up on them, they did not care if the pts. weren't being taken care of. I was upsetting the apple cart. I am glad you wrote because I was blaming myself, but it wasn't me. You probably need to get out of there

renerian, BSN, RN · Jan 3, 2005

I feel for you I really do. As a supervisor I have sat down in what I call vent meetings. A time to get all the crap off your chest so we can move forward meeting. Bring food/munchies.They usually are long and I usually have to keep refocusing the group and you find out then and there who the leaders of the group are and focus in on their behavior and how they are leading the "herd" so to speak.

If that is not an option you need to delegate it back to your staff. If you have the ability to coach and council they try that and put a plan together. Copy for you, their file and you meet periodically to see how the plan is going. Oh course I have had to give people the discipline to termination process which I don't like/no one does I think.

Let us know how things go and if you try any of the things suggested.

renerian

Antikigirl, ASN, RN · Jan 3, 2005

Well...I have a few suggestions that may help with teamwork, but it will take time...your time.

When things got so bad with moral at my facility...no one did anything till I started taking up some slack in management. I had to be very careful, a combo of the 'give an inch they will take a mile" deal added with management perhaps getting upset with my endevors. But then again...I am not the DON so it should be a bit easier for you I hope!

What I did was I sent a letter of appreciation this Christmas (see the post "I get by with a little help from my friends" on general Discussion). That really made people feel good! Then, I got together with my DON and we are setting up a informal paper asking all staff for their advisements on how "they" feel their departments can improve on moral and efficiency! I feel it is nice to hear from the folks that do the work how to make it better! Yes, it could very well be more complaining than anything...so word things to prompt people to be realistic and for REAL change!

We also have many inservices...every two weeks infact. However, my caregivers hate these and it is basically the same old inservices they have had over and over again. I opened myself up for some new ideas, and will be teaching issues the caregivers wish to know along with a fresh new perspective on the old topics. Caregivers are rather excited about this, and lucky for my DON I was up for the challenge and am well liked and respected as being a real 'team' player with all staff!

Even though they are still in the begining stages moral is already improving, and it seems our staff has more hope then they had before...and even that is generating a sence of satisfaction you can feel! It is awesome :).

Good luck to you, maybe these suggestions will help.

bargainhound, RN · Jan 3, 2005

http://www.nadona.org

Malt123 · Jan 3, 2005

So where does this leave the nurse on the floor, stuck in with the aides,

chimama · Jan 3, 2005

Hi I am im great need of information regarding DON's how to deal with staff that wont listen and people who wont work as a team is there anything i can do to help improve our quality of patient care?? I have been working my hardest but have been pretty much doing it myself!!! Im pretty much tired of doing and am to the point i could just walk away with a different job!!! If anyone can help please let me know!!! THANKS SO MUCH

I have been DON in three LTC facilities. The only thing that is going to change the "culture" of where you work is for you to be able to pay your staff more and start over. That is not going to happen. LTC is a lose-lose situation.You will have no life as long as you are there and when the state comes in they will treat you like a criminal who only went into LTC to abuse and neglect the elderly. I advise people to never go to a Nursing Home. Go on welfare and keep your loved one at home.Do something, anything but a NH. And you should turn in your resignation today. You are in for a miserable time untill you do.

alintanurse · Jan 3, 2005

Hi I am im great need of information regarding DON's how to deal with staff that wont listen and people who wont work as a team is there anything i can do to help improve our quality of patient care?? I have been working my hardest but have been pretty much doing it myself!!! Im pretty much tired of doing and am to the point i could just walk away with a different job!!! If anyone can help please let me know!!! THANKS SO MUCH

I agree,I went to many meetings with management and the cna's-to try to correct their behaviors(not answering callights,being rude to pts. etc.) they were given monetary rewards and recognition,but I never saw these efforts affect the "core" group-who were very lazy and arrogant. After I left,one of the nurses I had worked with told me she was being "set up" by the cna's to get fired' They would tell her that pts. were requesting pain inj. so she would prepare the shots and go into the room and the pt. would tell her they had never asked for it. She would then have to waste the med( at the facilities expense)-and because LTC watches every dime-she was called in by Administration and told she would be fired if it continued to happen. She told me she then decided to have each cna state the request for pain inj. and sign their name in the pts. chart just so that she would have documentation supporting her case. She also was desperately looking for another job. LTC was a nightmare--get out of there!