I am a new grad and got a job as ALF director position!

Long Term Care Columnist / Guide · May 23, 2011

I'm the Director of Health Services (otherwise known as the DNS/DON) of a 95-bed ALF, and I'm here to tell you that this is one tough job! I've been in and out of ALF nursing for over 10 years, and even as a seasoned director, this job challenges me creatively, intellectually, emotionally, spiritually, psychologically, and even physically every single day. I can't even begin to imagine doing this as a new grad........there's simply too much of EVERYTHING going on for a nurse who doesn't really even know how to be a nurse yet. Here's but a few of the things I handle every day:

Admission assessments. SIgnificant change assessments. Checking out wounds. Responding to resident emergencies (and believe me, with as many nursing-home-eligible residents as I have, these occur on a regular basis!). Tracking and logging incident reports. Investigating falls and other incidents. Faxing/calling doctors. Creating interim service plans for residents whose needs have changed. Dealing with families. Dealing with staff conflicts. Daily meetings. Writing progress notes. Monitoring weights and vital signs for residents on alert charting. Ordering medical equipment. Interacting with outside therapy and hospice providers. Auditing the med room. Delegating and re-delegating staff on nursing care tasks. Keeping track of TB/Hep B for both staff and residents. Infection control. In-services (both giving and receiving). Employee discipline. Following up on labs/tests. Monitoring diabetic records. Thinking up new interventions for the resident who's just fallen for the 50th time in the past six months. Reviewing prospective admissions. Running the building when the administrator is on vacation or at a corporate convention. Assisting with 2-person transfers. Passing meds when the med aide has to leave in the middle of a shift. Busing the dining room after a big shindig for the residents and families. Listening to employees, residents, family members etc. when they ask for my help and trying to come up with solutions that are both wise and practicable.

Oh, and did I mention actually using my nursing skills, such as knowing what edema and wet lungs mean in someone with a history of CHF and patching together a wicked skin tear on someone who's been on prednisone for 25 years?

I've been at this for a long time. I love it. I'm never bored with it, and there's nothing like the satisfaction of finally pinpointing why we can't keep a particular resident off the floor and fixing the cause. But frankly, I wouldn't work for a company that would have hired me for the DON position fresh out of nursing school; that proves to me that they are concerned more with their profits than the quality of resident care. With all due respect to the OP, NO new grad is ready for this sort of responsibility......heck, there are some days when I'm not sure I'M competent, and I'm one of those anal-retentives who takes her copy of the P & P manual on long car rides, to bed, and when she goes to the bathroom. :)

Home Health Columnist / Guide · May 23, 2011

best wishes with your new position. seasoned nurses concerns about facility hiring new graduate rn are justified as we've seen too many corporations throw staff under the bus to "clean house"...very high turnover; most directors last 1-2yrs at same facility. my advice:

a. obtain individual malpractice insurance to protect your rights and any calls to appear before board of nursing.

b. know your state regulations regarding alf inside and out. state will be out to visit you, especially after complaint made. pennsylvania assisted living residences permit lpn with 1 year experience to be alf administrator.

list by state:assisted living regulations and licensing

c. check your states dept of health website re facility inspection reports to see if any skeletons in the closet so you'll be prepared. ask to see your facility reports and corrective actions taken as part of training.

d. learn regulatory requirements for elder abuse, hiring standards based on obra regulations within state and reporting requirements for patient deaths and incidents.

institute on aging - older adults - elder abuse/neglect

pa criminal background :prohibitive offenses no hiring most healthcare facility

reportable incidents and conditions.

e. understand about the business side of alf: operational excellence strategies

f. join alf directors groups in your area. network for support.

g. participate in our ltc: directors nursing and assistant (don/adon) forum.

h. understand role of long-term care ombudsman

good luck on this journey.

Chin up · May 23, 2011

I have my LPN. That is my pay scale at this moment until I finish 4 months training. I will take my board in a few months so yes if I fail my board HECK! LOL ok it is not funny. They already told me after 4 months of training if I don't like it, I have a choice to step out - wish me luck! And again. Thank you ya'all

Which may change things...have you been a LPN long and worked in management? Or the least, years of clinical experience? Any unit manager experience, or even supervisory? I am just curious, I don't know you or your skills. I am a LPN in administration and know we are capable of anything. I will say, I was prepared for all my management roles, though a slow and steady progress and much acute and LTC experience. Peace!

eve5483 · May 23, 2011

best wishes with your new position. seasoned nurses concerns about facility hiring new graduate rn are justified as we've seen too many corporations throw staff under the bus to "clean house"...very high turnover; most directors last 1-2yrs at same facility. my advice:
a. obtain individual malpractice insurance to protect your rights and any calls to appear before board of nursing.
b. know your state regulations regarding alf inside and out. state will be out to visit you, especially after complaint made. pennsylvania assisted living residences permit lpn with 1 year experience to be alf administrator.
list by state:assisted living regulations and licensing
c. check your states dept of health website re facility inspection reports to see if any skeletons in the closet so you'll be prepared. ask to see your facility reports and corrective actions taken as part of training.
d. learn regulatory requirements for elder abuse, hiring standards based on obra regulations within state and reporting requirements for patient deaths and incidents.
institute on aging - older adults - elder abuse/neglect
pa criminal background :prohibitive offenses no hiring most healthcare facility
reportable incidents and conditions.
e. understand about the business side of alf: operational excellence strategies
f. join alf directors groups in your area. network for support.
g. participate in our ltc: directors nursing and assistant (don/adon) forum.
h. understand role of long-term care ombudsman
good luck on this journey.

thank you so so so much!!!!! :redbeathe:nurse: :yeah:

eve5483 · May 23, 2011

Which may change things...have you been a LPN long and worked in management? Or the least, years of clinical experience? Any unit manager experience, or even supervisory? I am just curious, I don't know you or your skills. I am a LPN in administration and know we are capable of anything. I will say, I was prepared for all my management roles, though a slow and steady progress and much acute and LTC experience. Peace!

No I have never worked as a nurse!!!! Only 840 hours of clinical hours from my nursing school!

Nccity2002, MSN, RN · May 23, 2011

Since when have LPN's NOT done nursing assessments? They ARE nurses too. I dont understand why some RN's consider themselves so much more qualified to do anything above an LPN. They are very much qualified to do an assessment as the RN. How else are they suppose to know whats going on with their patients and what to watch for? Yes I know an RN has more education but either way, both nurses, so both do nursing assessments. CNA, well maybe not so much.
To the OP-Good Luck to you in your new position, I think I'd be a tad bit nervous as a new grad but hopefully it goes well for you. :)

...I think the OP was referring to initial assessment. At least in my state (CA), the BRN requires it to be done by a Registered nurse.

kgh31386, BSN, MSN, RN · May 23, 2011

I will take my board in a few months so yes if I fail my board HECK!

Nothing against the OP...but you're potentially going to be a director on your own BEFORE you even have a license. Now you may be one amazing new grad who can run an entire hospital..but on paper this just doesn't look good.

lckrn2pa · May 23, 2011

If you have a nursing instructor you respect, think about running it by them and getting some outside and ongoing support/advice.

I think this is the BEST advice anybody on this board has given the OP. The people that know you and know the community will be best at offering advice and guidance. Good luck in your new position and congrats.

NurseLoveJoy88, ASN, RN · May 23, 2011

Me too.

Me three !

BabyLady, BSN, RN · May 23, 2011

congrats! I had only a year experience when I was hired by a company to be Director of Nursing... I stayed their for sometime and I did an EXCELLENT job because I felt I had something to prove and because I was just so grateful that they hired me! Now I am working as a Healthcare Administrator for another company..... congrats!
I think the other posters are jealous....

I am a newer nurse as well, however, grew up in a large medical family.

While I work with people with 20+ years that I wouldn't put in charge of taking care of a guppy, when it comes to things I like putting your head on the chopping block for a job that you are 100% unqualified to do, you need to heed the warnings of those that are more experienced.

When you see a whole paragraph of experienced nurses posting "Kudos" to tell you that you have made a bad decision...chances are you have made one.

Trust me, I don't always agree with some of the advice that some of my more senior co-workers give me...but you can bet your bottom dollar that no matter how much I THINK they are wrong on some occasions (not a lot, but some)...if I have one telling me I am getting ready to make a major mistake, you can take it to the bank that I am going to listen and err on the side of caution and follow their advice.

Moogie · May 26, 2011

No I have never worked as a nurse!!!! Only 840 hours of clinical hours from my nursing school!

I don't mean to sound harsh, but someone with no experience as a nurse other than nursing school clinicals has no business being the director of anything. You will have enough on your plate learning how to be a nurse, much less learning how to be a manager. Four months of orientation sounds great but in reality, many places will promise as much orientation as one needs before you're hired. Once they've got you, the orientation period mysteriously vanishes and you end up with little or nothing.

The more education I have, the more I realize what all I don't know. Of course, as a new grad I thought I could handle anything. I ventured forth into situations that would have made experienced nurses pause and some of the lessons I learned were painful.

When an experienced nurse like VivaLasViejas says that the job of an ALF director can be overwhelming, please listen. She knows her stuff! You don't have to put your own hand on a hot stove when someone else warns you that you'll get burned.

I wish you the best in whatever you decide but I sincerely hope you will listen to some of the opinions posted here.

Calixan · May 27, 2011

Speaking as former LPN, 9 Years in fact, and now a RN for the last 13 , I can say that LPNs are not as qualified as RNs to do an assessment. LPNs are trained for lack of a bettet term to be task oriented. Disease process, critical thinking are not major teaching points in most LPNs programs. I am NOT saying that RNs are better than LPNs just that the education is different and that both have their areas of more intense training. And in most states LPNs are not legally allowed to do an assessment without an RN cosigning it.

But they are still assessing whether the RN is cosigning or not. They have to know whats going on with their patients. Or maybe they don't. Maybe thats why us nurses that work in the ER can rarely get any information about the patients that come from the nursing home. HA! Now its all coming together. smh

Anyways, LVNs and RNs here are allowed to do patient assessments.