Help With New DON Position

Specialties LTC Directors

Published

Specializes in Critical Care/LTC.

20+ years experience mostly in med surg and critical care. Tired of the floor nursing stress and low pay, I took advantage of a DON opportunity I came across at a smaller family owned nursing home. The administrator and I hit it off immediately- personality wise and both being male helped as well (not meant to offend but to give a better picture). He gave me everything I asked for as far as salary requirements and flexible hours. The facility has gone through 2 DONs during the first year of Covid due to not wanting to be exposed and for having to work tons of overtime during the initial crisis. When I arrived, they had a temporary interim DON covering until a new DON was hired...which was me. The only issue I am having is there wasnt really an orientation so to speak on the DON duties and expectations. The adm is very supportive and encouraging which helps a ton. I initially had some staff issues being the 3rd DON in the last 15 months but have seem to reassure staff that I was here for the long haul and wanted to improve on staff morale and teamwork. So basically I am wanting to make sure I am doing everything the DON of a nursing home needs to do to stay compliant with CMS. Short of memorizing all 275+ F-tags can any of you seasoned DONs break down what you do on a daily or weekly basis. A routine you found works best and is efficient. Also What are all the items you track. I am currently tracking:

  • ATB/Infections
  • Wounds
  • Hospital/ER Visits
  • Falls/Incidents
  • TB/Covid Vaccine
  • Alarm Device Use
  • Psychotropics
  • NOMNC Notifications

I also am taking the Infection Preventionist module from the CDC so I can be the Infection Preventionist for the facility. And also am required to be in charge of the QAPI program and the usual staff development training stuff.

So with that said, is there anything else you think I may be missing? Any suggestions or time management ideas would help as well. I am trying not to get too overwhelmed but our annual survey will be any day now. BTW I purchased The DON's Handbook for Long Term Care which has helped some and Searched Google for Anything related to DON duties and daily tasks and nothing of substance was found. 

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Specializes in retired LTC.

Sounds like you have a full plate.  Might there be anything you could delegate to another nurse supervisor or head nurse/manager?

Make sure your last survey Plan of Correction has been met and is still in effect. DOHs like to pop in when there's a changeover of a new LNHA or DON.

Two things to add to your list - compliance with licensing and certifications of nsg staff (ie no expirations and certs up-to-date). Also add INFLUENZA vax to your immunization record monitoring.

Rely on  your Social Worker, Activity Director and Pharm Consultant as key support. If they're good, they're INVALUABLE.

Good luck to you and welcome to our world of LTC.

And welcome to AN.

 

2 Votes
Specializes in Critical Care/LTC.
On 4/21/2021 at 3:48 PM, amoLucia said:

Sounds like you have a full plate.  Might there be anything you could delegate to another nurse supervisor or head nurse/manager?

Make sure your last survey Plan of Correction has been met and is still in effect. DOHs like to pop in when there's a changeover of a new LNHA or DON.

Two things to add to your list - compliance with licensing and certifications of nsg staff (ie no expirations and certs up-to-date). Also add INFLUENZA vax to your immunization record monitoring.

Rely on  your Social Worker, Activity Director and Pharm Consultant as key support. If they're good, they're INVALUABLE.

Good luck to you and welcome to our world of LTC.

And welcome to AN.

 

Yes Plate is full but when you work for a small facility, you have less supporting staff and you have to do the jobs of about three people...LOL But I enjoy a challenge and want to do my best and not let adm/owners down. Thanks for the info! Much appreciated. My administrator's response to me was "You have only been here three months. Don't be so critical of yourself, take day to day." Support like that is priceless...

1 Votes
Specializes in retired LTC.

Sounded so understanding.

Am guessing someone else is doing your MDS//RNAC/care planning duties.

And tracking 'care days and that DOH/CMS roster.

If you've got good ancillary support, you are blessed. There are ways to delegate tasks so that you only have to review & collate & process. It can serve for those others to improve their own resume skills section, so that's a win-win. 

1 Votes
Specializes in Gerontology, Med surg, Home Health.

From what I’ve heard, the focus for survey this year is everything infection control and immunizations. 
Make yourself a schedule knowing it will change depending on what goes on. Monday weights and skins, Tuesday Falls, Wednesday psychotropics review. Whatever will keep your mind focused. You’re lucky to have a supportive administrator.

Feel free to PM me if you have questions. I’ve been in the business forever- tiny buildings, huge buildings. At the end of the day you have to go home knowing your residents got the best care possible 

2 Votes
Specializes in Critical Care/LTC.

Yes CapeCodMermaid, we are expecting our survey anytime now and other facilities that just had their survey agree. Mostly infection control and immunizations mostly due to the poor performance of nursing homes during the pandemic. One good thing that came out of the pandemic is bringing LTC to the forefront of the news and policy makers.

2 Votes
Specializes in retired LTC.
2 hours ago, DONJuanOhio said:

Yes CapeCodMermaid, we are expecting our survey anytime now and other facilities that just had their survey agree. Mostly infection control and immunizations mostly due to the poor performance of nursing homes during the pandemic. One good thing that came out of the pandemic is bringing LTC to the forefront of the news and policy makers.

This is true, but I fear much of the attn will remain negative and unassistive.

2 Votes

Might there be anything you could delegate to another nurse supervisor or head nurse/manager?

At my facility, the DON and ADON have both served as unit managers on my unit. Now they are delegating numerous tasks to unit managers without regard to their experience on my unit when they were unable to complete the tasks/audits, 672/802, education of staff, IDT notes, care plan updating and other clinical concerns. We have RNAC, house supervisors, and educators on staff. Not sure what those staff members are being tasked to complete. We have had numerous DON, ADON and administrators in the short time I have been employed at this facility.

 

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