How to Be a Successful ADON?

Specialties LTC Directors

Published

Specializes in LTC.

I recently accepted a position as ADON at a small facility. (Current census is 55). I want to be a good ADON, but seems I'm running into issues already. First of all, I have received no orientation. I was shown my desk, introduced to other staff and handed a job description. That was the extent of "orientation". I have asked for training from corporate, on more than 1 occasion but have yet to receive any or any promise of any. We naturally have "systems" that I am required to maintain. I have looked through them and am reading the clinical standards book, but there is no direction on how to accomplish the facility and corporate needs. My DON has been there a few months longer than I have and is in the same boat. She never received any kind of training or orientation either. This last week I feel like I've been riding the hell out of a stationary bike. Pedaling furiously and getting nowhere fast. I do not know what is expected of me other than to have reports done and sent to corporate by their deadline. I have tried to implement a couple of minor changes (i.e. attaching a pain assessment to the I&A report to ensure that they are being updated as required by state r/t falls, ST's, etc.) but was stopped from doing so by corporate because "it's management's job to make sure they are updated." ??? That's what I was trying to do!

Despite the above issues, (and there are many more) I want to be successful in this role. If any of you have any tips, tricks, general direction ideas that you think may help I am so very willing to listen. In fact, I'm all ears. Thank you.:)

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Specializes in retired LTC.

Not to scare you but, if your DON is really new and you're new too, you might plan on a survey team visit soon.

Check your old survey for any info to guide you.

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most places dont want you to make changes, they just want you to do what they tell you to do. I know that sounds harsh, but its usually the best way to handle situations like this, especially if they have been in the business for a while.

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Specializes in LTC.
most places dont want you to make changes, they just want you to do what they tell you to do. I know that sounds harsh, but its usually the best way to handle situations like this, especially if they have been in the business for a while.

I was afraid of that. Thank you for the advice.

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Specializes in LTC.
Not to scare you but, if your DON is really new and you're new too, you might plan on a survey team visit soon.

Check your old survey for any info to guide you.

I have looked at the old survey and 2 of the 3 systems I am responsible for was tagged on their last survey a couple of months ago (before I arrived). I am working hard to get those into compliance as quickly as possible for that reason. I hope I have a bit of a window to get them squared away. My luck, state will walk in Monday morning to have a look.

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Specializes in retired LTC.

To Op: - re your old survey - check to see how much the Plan of Correction is in place. That should be able to guide you and

give you a place to start.

Be careful you're not the new scapegoat.

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Specializes in LTC.
To Op: - re your old survey - check to see how much the Plan of Correction is in place. That should be able to guide you and

give you a place to start.

Be careful you're not the new scapegoat.

Ahh, scary thought. I will do that tomorrow. Thank you so much for the heads up.

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Specializes in Long Term Care.

That is exactly what happened to me. Here is your desk. You are right to continue the quality measures reports. I don't know how you have it divided up between you and the DON but monitor these closely:

Falls - interventions in place, documentation for at least 72 hours? Event notes complete

Decubs - measure weekly, document thoroughly.

Insulin Errors - biggie

Coumadin Errors -biggie

Restraints

Antipsychotics

Infection trends - enough equipment on hand in case isolation required. Ancillary staff knowledgeable regarding donning ppe

Hospital readmissions esp MI, Pneumonia and CHF

Medication errors

Recerts done in a timely manner - nightmare for me. Set up a spreadsheet for recert times.

Family issues

Employee issues

Inservices up-to-date?

TBs up-to-date

Licenses up-to-date

One I am having serious problems with is wound identification on admission with a TREATMENT IN PLACE from day 1. Mine think the "next shift can do it". Remember, if it is not found in 24 hours, it is YOUR WOUND.

Monitor the dining room. Are the residents actually being fed? Check their plates.

Be sure meal documentation is being entered. BAD, BAD, BAD if it is not recorded when there is weight-loss involved.

Are residents being turned. Heels floated?

Enough staff to cover shifts? Check for yourself. Many times the staffing coordinator thinks the shift is covered when in fact, it is not.

OMG and don't forget to make sure your QA meetings are up-to-date. Many times it is difficult to get the medical director in the bldg. Nag, nag, nag and document when you called if they are reluctant to come.

Sorry this is so long, but I tried to be somewhat thorough.

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Great!!! review!!

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Specializes in critical care, ER,ICU, CVSURG, CCU.

hey girl, are you still working for the same company we talked about in the past...if so i can help you be a supper ADON, really it would apply to any facility.

The "SYSTEMS" fall,accident,injury weight skin infections have to be maintained.........

find out how your DON wants you to help her maintain the above

you may be entering orders in computer, or the MDS nurse may be doing that, but check phone orders and new admits to make sure mars,tars, family notified, maybe check for daily charting on antibiotic or new med....... help with charting, make sure your nurses know who is skilled, who is just in their quarterly window for an mds assessment, and the required doccumentation is there.

be a laison with the Don! court residents and families........if they think you genuine care and concern, there will be less problems and complaints......everyone of my residents think they are "my favorite"........

one of you are going to be doing the schedule..........trust me, if your DON is doing it, she probably will appreciate you learning to do it......ask her.

for some reason i can not correct last two lines but help with orrientation...... :cat:

for some reason this post will

help irrient and train new nurses, help in inservices

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Specializes in critical care, ER,ICU, CVSURG, CCU.

actually geriatricRNBSN organized it best........

i can not over emphasise the positive outcomes for residents and families to think you genuinely care for them........

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Specializes in LTC.
actually geriatricRNBSN organized it best........

i can not over emphasise the positive outcomes for residents and families to think you genuinely care for them........

Thank you Miss Sally. Unfortunately, I felt compelled to quit that job. I posted about it a few weeks back. Things went from bad to worse. However, I will keep all of the good points in mind to be a good floor nurse. :D

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