Help am New DON FOR LTC

[nursemid02]

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

[KarenGeorgeBSRN]

Wonderful commentary!

We must accept though that due to the shortages, nurses will come in with experience in other areas and depend upon those like us; who have done systems work, and know the innovative and creative changes to occur.

They are happening, and the specialty is open.

I still highly recommend that the new DON find a sister facility if she has had no formal training in order she not set the stage for staff taking advantage. If she continues to "hit the floor" they will remember every step she took doing so, and she will be exhausted, worn out, and ready to give up on LTC.

You must learn to be a generalist and wear many hats! To take a personal inventory at the end of the day to see all you did do, and prioritize the "tomorrow" after a good hot bath, shutting off the day, and a restful night's sleep.

Thanks!

:heartbeat:nurse:

Karen G.

I received no official training before I became a DNS. I think it was immensely beneficial to me and my facility that I was an aide, a staff nurse,a nurse manager for a subacute floor, a supervisor, a PPS MDS coordinator and an ADNS. I've worked for DNSs who have never done an MDS!

LTC will continue to be short staffed and will continue to have trouble recruiting nurses until WE change our image. Most people (nurses included) think it's a place where old people live and aren't sick and by inference, any nurse who works in LTC must not be able to get a job elsewhere where there are sick people.

I have said, and will continue to say, that LTC/SNF is the place where the BEST nurses are needed. We have no doctors standing at arms' length. We have to rely on OUR assessment skills and verbal skills to inform the doctors about their patients.

We can come here every day and say how smart we are and how hard we work but until the image of the LTC/SNF nurse changes, it'll be like preaching to the choir.

[gracenotes1]

Anyone that expects the state to come in a pat them on tha back IS in the wrong place in LTC. They are there for one thing and one thing only--to find out your problems and prove they are happening. If you have been DON for a year then yep it is your baby. So, if you have done your job all year all you have to do is shadow the surveryors and answer questions.

If your facility has been in a mess all year and no one is doing anything about it--then yep--you are in trouble.

Money is not the primary motivating factor. It helps but it isn't everything. I always said (while being a DON for 7 years) "happy staff, happy residents" and that is what we strived to do. There are things in your budget that you can do for your nurses that will make a difference. And finding out where they want to work and putting them there and leaving them there also helps. If a staff person is unhappy--find out why--it usually is not money--

Find out where their strengths lie, who they work well with and make those relationships grow into a team that works.

LTC is a huge industry and is getting bigger all the time. The level of care provided is getting higher as well. So be ready to grow with it.

Just my opinion.

[KarenGeorgeBSRN]

Dear Grace, and all!

You are absolutely correct; remember the survey situation is to find "negative" not encourage anyone for doing positive. Rarely will you hear a surveyor say "I really like the change in menu" but they will see if there are temperature issues in the "cooking and refrigeration" department.

Often nurses who are not documentors are fearful of LTC; this is just as simple if you put your mind to it, and your very excellent care, assessments, and independent interventions. Do not think you cannot do it; there are very specific formats in LTC, and sometimes an overload of residents and not enough staffing, but if you learn to delegate and prioritize there are options along the way. Be willing as a DON, ADON, and charge nurse to ask "staff" what they need help with, and or if there is a corporate takeover with new rules, policy, and paperwork "what can I help you with," you'll be surprised at how easy what you fear can be overcome!

I believe new graduates in particular can gain if they are strong in character from this very important experience. Yes, today I am an expert in several specialties, but feel deeply and powerfully that I am a specialist in being a "generalist" which means integration of all systems, and knowing gut instinct as a viable source of reference, action, and team compatibility. Taking our new graduates into the fastest growing part of health care is the best experience they will know. Shadowing nurses who have worked the trenches and know how to trust instinct and our professional actions is the greatest knowledge base you can have.

Another rare and innate talent is "empathy" and those who truly blossom in LTC are those with loving hearts; who enjoy seeing their residents day in and day out, and build that extended family in the "home" that most will live in until the day they die. There is a beauty in knowing that LTC is growing; that we are picking up sub-acute wings due to the vision of large corporations seeing the destruction in acute care; many hospitals I believe will close down and become primary clinics, with small ICU units for 24 hour stays; next door maybe what your "granny" called that "old nursing home" shining with new paint, revised wings, licensed nurses training in all areas to be generalists, and proud of their efforts. The future is "next door" my friends and you can roll up your sleeves, expend some elbow grease, and be a part of the vision or apart from the "needs" of an economy that cannot support acute care for chronic issues. With the longevity of our last developmental stage (the elderly) there will be "chronic trajectories" that command our presence, care, and expertise in a setting where they might stay, and stabilize. No one can do so in acute care these days!!

What is needed is a true education of our profession, and a true revision so that educating our profession to the opportunity, the life within, and the new storefront on that worn old "nursing home door" is long gone. We are handling and integrating; systems knowledge and software guides us to consistency, and all it takes is the love, communication, and education of key players (DONs, Administrators, ADONs, charge and nurse managers) to encourage these "halls" be filled with appreciated and skilled nurses to lead the way in the years ahead.

IF you could transfer post CVA to a facility where you received medication, and nursing assistance and had a better recovery and insurance would pay would you go? IF you had back surgery and were panic stricken as to "how" you were to ambulate, get medication for pain, and even dinner 24 hours post op would you go?

IF you were post appendectomy, and could not obtain relief from per os medication for your post op pain and an IV could continue running a few days more, would you go?

The answer is "yes" and the LTC industry is addressing the needs of the community, the acute care facilities who are dying under the weight of noninsurability and in short the "vision" is brightening our lives, because today "healthcare is a business an industry" and we are all a small but integral part of the future.

Thanks one and all for your positive statements; LTC is not for the faint hearted but good LTC nurses appreciate new graduates, and acute care burn out nurses to their wings if you possess "empathy" and the insight to share the vision of this day, and the years beyond! Empathy by the way cannot be taught in classes; it is said we are "born with it or without it" but, I have seen nurses without it grow into it comfortably, with a heart of gold within the walls of LTC...

Have a wonderful day!

:redbeathe:nurse::redbeathe

Karen G.

Anyone that expects the state to come in a pat them on tha back IS in the wrong place in LTC. They are there for one thing and one thing only--to find out your problems and prove they are happening. If you have been DON for a year then yep it is your baby. So, if you have done your job all year all you have to do is shadow the surveryors and answer questions.

If your facility has been in a mess all year and no one is doing anything about it--then yep--you are in trouble.

Money is not the primary motivating factor. It helps but it isn't everything. I always said (while being a DON for 7 years) "happy staff, happy residents" and that is what we strived to do. There are things in your budget that you can do for your nurses that will make a difference. And finding out where they want to work and putting them there and leaving them there also helps. If a staff person is unhappy--find out why--it usually is not money--

Find out where their strengths lie, who they work well with and make those relationships grow into a team that works.

LTC is a huge industry and is getting bigger all the time. The level of care provided is getting higher as well. So be ready to grow with it.

Just my opinion.

[gracenotes1]

Ahhhh A nurse after my own heart.

You sound just like me!!! Care and compassion go hand in hand. You know it does not matter if you can insert a PICC in 5 second flat--if you are not skilled in compassion hen you have missed the entire reason for nursing to begin with. Don't you agree?

And we cannot eat our young!!! We have to help them. they come out of school with an idealistic attitude only to find that nothing they learned in school is actually the way things are. It is stressful and a culture shock.

It is up to the veteran nurses to help them not hinder them. Maybe their "bad attitude" is coming from an overwhelming fear of the real world.

The nursing homes of old are gone--gone!!! I know that if I were in need of skilled care I would rather go to a Skilled Facility any day.

Just here is my point--Three weeks ago I was hospitalized (long Story) but the short of it is this---They had computers that did not work, thermometers that did not work. It took one nurse over an hour to do a history and physical on me. Because of the inefficent computer that she had to deal with. It was aboslutely ridiculous.

I could write a very long story about the three days I spent at the local hospital---those nurse complained to me that they were over worked, under paid, and did not have time to do what they needed to do. I started to feel sorry for them--then I asked how many beds they had on their wing--40 beds. 20 patients per one RN, an RN super, a med nurse and an aide.

Oh they just seemed to be worked to death,. At 4:00 pm my husband went to the nurses desk and came back and told me that there were 7 nurses--every one of them--sitting at the desk and ON the desk, eating and drinking. He was so angry and I was too. As a DON my nurses never behaved that way. They worked. They got breaks, and they got their work done. It didn't happen over night--because they were not like that when I started--but they were like that when i finished.

I don't feel sorry for them when they spend their time and the patients time trying to get out of work. I realise that this varies from facility to facility but leadership is what makes the difference.

As a DON you set the standard!!! Get out of your office---see what they are doing--sneak up on them. Do med pass every now and then. And set up a Nursing Admin team that is loyal to you and to your committment to having the best quality of care!! It can be done. I did it--or rather WE did it. And I know it can be done.

I am a journalist--always have been. I have always kept a journal. When I was taken out of nursing by a terrible wreck---I went back to my journals and wrote a book.

[KarenGeorgeBSRN]

Dear Grace,

I wish you all the best with your book, and yes we can learn a task or intervention; anyone can it is a matter of being taught, followed, and re-integrated. Anyone but anyone can learn an intervention.

Compassion and empathy come with life experience. When you experience your first death; as the person passes and God enters the room you are initiated into the truth that we have one true physician, one employer, one BEING greater than all medical knowledge, my higher power is God.

If you go to your job with faith, if you become a member of the team, if you seek self appraisal daily you become a nurse. Yes, nursing school is degrading for so many but the responsibility of many lives comes under your hands. Inability is far easier than ability.

I am sorry for your recent acute care experience. I have seen nurses in acute care told by managers "don't waste your time on that client he is Medicaid or Medicare and they are sitting here for free." Yes healthcare is a money making endeavor but where are we taught to judge a monetary state when we are entrusted with a life in our hands daily. Nowhere!

If one cannot see that the patient or resident could be their father, mother, sister, or spouse there is no reason to be in this profession.

Thanks!

Karen G.

Ahhhh A nurse after my own heart.

You sound just like me!!! Care and compassion go hand in hand. You know it does not matter if you can insert a PICC in 5 second flat--if you are not skilled in compassion hen you have missed the entire reason for nursing to begin with. Don't you agree?

And we cannot eat our young!!! We have to help them. they come out of school with an idealistic attitude only to find that nothing they learned in school is actually the way things are. It is stressful and a culture shock.

It is up to the veteran nurses to help them not hinder them. Maybe their "bad attitude" is coming from an overwhelming fear of the real world.

The nursing homes of old are gone--gone!!! I know that if I were in need of skilled care I would rather go to a Skilled Facility any day.

Just here is my point--Three weeks ago I was hospitalized (long Story) but the short of it is this---They had computers that did not work, thermometers that did not work. It took one nurse over an hour to do a history and physical on me. Because of the inefficent computer that she had to deal with. It was aboslutely ridiculous.

I could write a very long story about the three days I spent at the local hospital---those nurse complained to me that they were over worked, under paid, and did not have time to do what they needed to do. I started to feel sorry for them--then I asked how many beds they had on their wing--40 beds. 20 patients per one RN, an RN super, a med nurse and an aide.

Oh they just seemed to be worked to death,. At 4:00 pm my husband went to the nurses desk and came back and told me that there were 7 nurses--every one of them--sitting at the desk and ON the desk, eating and drinking. He was so angry and I was too. As a DON my nurses never behaved that way. They worked. They got breaks, and they got their work done. It didn't happen over night--because they were not like that when I started--but they were like that when i finished.

I don't feel sorry for them when they spend their time and the patients time trying to get out of work. I realise that this varies from facility to facility but leadership is what makes the difference.

As a DON you set the standard!!! Get out of your office---see what they are doing--sneak up on them. Do med pass every now and then. And set up a Nursing Admin team that is loyal to you and to your committment to having the best quality of care!! It can be done. I did it--or rather WE did it. And I know it can be done.

I am a journalist--always have been. I have always kept a journal. When I was taken out of nursing by a terrible wreck---I went back to my journals and wrote a book.