Long Term Care / Nursing Home

[kmcasey0124]

My career goal is to be a DON in a Long-term care facility/Nursing Home. I have been an RN for 9 years. I have my BSN and am 5-courses from finishing my MSN (administration). I worked for about a year as a staff nurse in a nursing home immediately after graduating with my ADN. I have always known I want to work in LTC. However, I became frustrated by the lack of quality care provided to the residents and after speaking with the DON several times I decided I could no longer work for this particular nursing home. I could not make a difference as a staff nurse. I left and have worked in the hospital setting since then. I quickly worked my way up to middle management in the hospital. I am not unsatisfied with my current postition but I really want to work as a DON in Long-term care. I have read through the regs and different tags. I read LTC facility surveys in my area often to see what they are being tagged for. I am wondering if I should try to first obtain a postion as an MDS Coordinator or a Unit Manager to become more familiar with how the ins and out of a LTC facility work. What are you opinions? Can a DON with little LTC experience be successful in that postion and if so, what are the keys to this success?

[Lovanur]

Yes, you can be whatever you aspire to be. First, I would work as an ADON or RN supervisor. Positions open quickly, but he dedicated and let not circumstances dictate your actions.

[joanna73, BSN, RN]

Usually 3-5 years experience is required as a unit manager prior to successfully working as the DOC. You'll need to understand everything from basic care to performance management, MDS and all the quality indicators associated with the continuing care standards.

[tyvin, BSN, RN]

If you become an MDS coordinator you will get to know what care the residents are getting. You'll have to know everything about them, make the care plans, meet with the team and find out how much they care about their part in the residents life (SP, PT, Psych, activities, dietitian, etc...(they all contribute to the MDS). The MDS coordinator can make great change...I did.

When I did it the management let me make my own hours and I would go in on the eve and noc shift unannounced to check on how the residents were being treated; very enlightening. I had to show up every morning (Mon.-Fri) for the team meetings but had my own office and basically did my own thing. That was a great job.

The problem these days is they load the MDS nurse down with a huge amount of resident. The practical limit is 25 residents per MDS nurse, but sometimes they have the staff RNs fill out the MDS and load the person down with over 40 to 80 residents! I couldn't trust someone else interviewing the residents; I've seen RNs filling out the MDS via the chart alone and never talking to the resident let alone checking them out. I've seen them copying the previous MDS...so sad. How can the noc shift to a correct assessment?

I can't really blame them, it's not their job and they are already are over loaded.

Good luck to you :)

[joemomma35]

You need LTC experience to become a director in a LTC setting, it only makes sense. The MSN will look great on paper. You can be a supervisor, unit manager, ADON, etc. You need to be familiar with MDS. Acute care experience absolutely helps.

[Kpizzini]

Working in LTC is a new experience for me. I was hired because of my acute care experience and education. I find a lot of the job rewarding, and have become quite attached to certain residents, My facility has now remodeled itself into a sub acute center as well as a rehab and skilled facility. It was taken over by another company. This is a for profit hospital and there is a huge difference between for profit and not for profit. They want the nurses to be able to do everything. Supervise, take care of 15-20 people, do all documentation, attend care planning meetings with families and members of the multi-disciplinary team, pass all meds-including iv meds, care for picc lines, peripheral lines, do skin and wound assessments, communicate with md about labs and problems that arise, feed people, transport them to therapy, do all breathing treatments, woundcare, diabetic management, monitor labs, do chart checks, remove staples and stitches, tube feeds, catheterize and bladder scan as needed, and help toilet or change diapers or keep a voiding diary and track of who had a BM and when. Overwhelming! These elders have lived a life and contributed to society. They have raised kids and fought in wars. Why don't they get more value. The health system ad staffing laws are a joke. Noone cane do the job well with too many patients. Most of these people would be in acute care a decade ago. It is not fair.