Help am New DON FOR LTC

kathi yudin · Jan 9, 2005

when i first became don where i am.. all of my nurses decided to quit!!.. these were the same nurses that complained bitterly about the don i replaced... be fair.. and be equitable.. don't be afraid to show them that you are willing to do the work as well.. have staff meetings and listen to them..if they are not doing what you have asked them to do.. that is insubordination.. write them up if talking does not help..you also need the support of your staff developer and administrator.. that is so important.. i am very lucky... my administrator has guided me each step of the way.. go to conferences for don's.. if you are in california.. cahf(california association of health facilities) has one every year in vegas..it is on jan 25/26 this year and is at harrahs... on the 24th they are haing one on leadership.. they are well worth going.. join nadona.. national association of directors of nursing.. lots of good advice there as well.. the best advice.. be consistant.. fair... and remember you can't be their friend because it is hard to give orders to friends.. hope that some of this has helped...it has taken me almost 5 yrs.. and multiple staff changes to finally feel comfortable in my shoes.. persevere.. seek advice.. and you will survive!!!

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

kathi yudin · Jan 9, 2005

If you choose to stay as a DON in ltc, this is my advice: try to have a positive attitude (I know it's so hard at times with all the unrelenting pressures we face from all directions).. be willing to jump in there.. praise your staff.. give incentives... bring in goodies.. let them know that they are appreciated.. that is all that they want.. to feel appreciated.. i can tell you from my own experience that it is possible to succeed and have positve surveys.. no one likes surveys.. but.. they do serve a purpose.. to weed out the bad...!!!... openness.. honesty.. and positiveness all lead to good surveys.. my facility is proof of that.. whatever surveyors ask for.. including copies of incident reports which we don't have to hand over.. we hand over.. no one likes surveys.. but.. if your documentation is there... the residents look clean and well taken care of.. it is possible to have good surveys.. we do..!!.. they look and look but find only minor things...i say to you don't give up.. persevere.. meet with your staff.. be fair.. monitor the documentation.. and careplan documentation.. document everything.. give inservice upon inservice.. and you can succeed!!!.. good luck and keep us posted!!

I have been DON in three LTC facilities. The only thing that is going to change the "culture" of where you work is for you to be able to pay your staff more and start over. That is not going to happen. LTC is a lose-lose situation.You will have no life as long as you are there and when the state comes in they will treat you like a criminal who only went into LTC to abuse and neglect the elderly. I advise people to never go to a Nursing Home. Go on welfare and keep your loved one at home.Do something, anything but a NH. And you should turn in your resignation today. You are in for a miserable time untill you do.

kathi yudin · Jan 9, 2005

i stopped having mandatory meetings.. inservices are done any time staff is around.. if i have some one come in such as a drug rep or hospice.. i do it 2x during the day.. the first at 7 am for my noc and part of my am shift.. and at 2:30 for my 3-11 shift... i also post a sign a week before to give them notice so if they are off.. they may be able to come in.. they punch in/out to get pd for them as well...my door is open.. and i listen listen listen.. i have gotten to the point where when i am down a nurse on 3-11.. i give them the schedule and they fill it in...!!.. we have never used registry.. we started with bonus's and now i don't even do that.. no need to..it takes perseverence and patience..

If you want to be a well-liked DON don't have weekly mandatory meetings and don't expect your noc shift to ruin their sleep by having to attend meetings at 2pm. I wish you the best of luck. :)

kathi yudin · Jan 9, 2005

:balloons: :balloons:

great advice.. if you set high expectations.. you will receive them.. but first you must let your staff know what is expected of them.. also.. you must always be an example.. in otherwords.. if you want accurate and complete documentation.. you must do it yourself as well.. this is not a do as i say not as i do situation... do things in small steps... you can not expect to change things overnite and above all.. don't set yourself up for failure.. i have been don for almost 5 yrs.. i started as an mds coordinator which i knew nothing about either.. within 5 months i was officially the don.. my administrator saw something in me that i did not see in myself.. while i have been an rn for almost 30 yrs.. i took off 16 to raise my family.. i went to an associate degree program in ny.. moved to california 6 yrs ago.. worked ltc for 1 yr prior to arriving at my present facility.. i was a babe in the woods.. it took a lot of tears.. a lot of encouragement .. a lot of perseverance.. and lots of changes to staff.. but.. because of great management support.. i have been able to succeed.. you will too.. just stick to it!!.. and above all.. be fair..give kudos when needed.. give little notes as thank yous for support.. all your staff wants to know is that they are considered part of the team.. good luck.. you won't be able to fix it over nite but.. it will happen..

Hi Nurse Mid.. I was a DON for 6 years. It sounds like you are putting out small fires and can't yet see what is causing the blaze. First things first..hold a mandatory staff meeting and let the staff know what is expected, what will and will not be tolerated. Be very clear in your expectations. Next, evaluate the results. You will know rather quickly who wants to be on the team and who doesn't. What was the last DON like? Perhaps she/he was very lax and didn't expect very much. It is also very important for the staff to see that you are buying into your own program. I have seen many DON's with the attitude of "do as I say, not as I do". Being an effective DON takes a lot of time and hard work. To be an effective (and respected) DON, you will spend very little time in your office and alot of time on the floor. How large is your facility? There are many things to think about, priortize what is most important and don't try to fix everything at once. I wish you all the best.

nightingale, RN · Jan 9, 2005

---------------- Let's remember, this is a supportive website for Nurses ---------------

With that said, I am glad to see the later discussions took a better turn and thank you to those posters.

nursemid02: I wish you were my DON; I would love to team up with you. I am struggling to maintain my role as an MDS Coordinator and keep my personal life full and predictable.

I hope things are fairing better for you. Please let us know how your responsibilities are progressing and how we can help.

Malt123 · Jan 10, 2005

I always thought the DON was like the captain of a team, here it sounds like she is the only player and everyone else has to be bribed to care about the pts. I am sorry but the other nurses also care about what's going on I personally am insulted if a DON tries that on me, I also feel as DON she should be able to pick out the people that are good and go from there. When a DON is in it for themselves she can be spotted a mile away and there is nothing that she can do to change that exept hire people like herself. then all she has to do is worry about them taking her job. but, if she is evil enough that won't happen.

sorry if this sounds negative, I am just tired of the games, I am an adult and an RN and expect to be treated with respect along with the management crew. an RN is an RN no matter what title she carries and if I don't get something done you better believe there is a reason for it. Being treated as if I am back in kindergaten doesn't work with me. nothing works when you try to manipulate me.

javanurse2000, BSN, RN · Jan 10, 2005

QUOTE: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!!! END QUOTE> Ok...read above...she feels like she has done her best to improve patient care but is the only one trying....worded kind of weird. Even though I feel this way sometimes, its usually just b/c I am overworked....there are in fact many other people who care about residents quality of life where I'm working. Unfortunately, there are people who stir up trouble and have a poor work attitude. As far as doing it all yourselves gang...funny story about this past weekend: I was 'walking at a brisk pace' past the nurses station with some neb tubing and noticed the outside door alarm was going off. Also, the oncoming nurse had just set her stuff on the desk. I knew she had just past by and didn't bother to check for eloping residents or to silence the alarm so as I am walking past with the tubing in an obvious rush to go help somebody I said "Gee, I hope thats not a resident getting out"...She responded "Its Mr.X and Mr.Y, somebody needs to go and get them". I said, "You're Somebody!!!" :angryfire -- Ok, maybe I yelled it. Not to worry, this doesn't phase her at all + the residents are fine. To address the new DON, While you are there, YOU are one more who does care. Hang in there but don't kill yourself....remember we're all an hour glass full or two from getting our beds

CHATSDALE · Jan 10, 2005

those who scorn ltc are overlooking a need...these people need care...some families cannot care for their relatives and some have no one...we have had residents who have died and there was no one to notify..

there is a need for hard working, compassionate care givers...get rid of those who don't do the work or who call in or worse just don't show up when they feel like it.

the idea of bonuses are good but too many times this just becomes extra pay for the same old work...everyone believes that they are 'entitled' to a bonus

if you provide a good work enviorment and give respect to your workers they will provide you with respect and good work in return..

after some of the ring leaders are gone the rest will decide to shape up or leave...either way you are a winner...you will always have some problems and you will have to maintain a firm code of conduct with the best interests of the residents the primary concern but there is a way of providing care for those who need it...

i hope that you will decide to stay ... good leaders are needed

nursemid02 · Jan 26, 2005

i, personally, didn't see an attitude in her post. if your just venting, fine, just say your venting. if your looking for advice (as evidenced by the title of your thread), you should be prepared to explain and clarify what your situation is, and not get so offended. it is easy for readers to misinterpret what others are trying to say, especially when grammer and sentence structure are used incorrectly (some may be rushing to write, others may be trying to make a point by 'rambling'). i've posted many a time asking for specific questions, and people reply with things that have nothing to do with what i'm talking about. i think it's just human nature to add more to what is asked, to share their own experiences, and maybe giving some food for thought (as i did in my earlier reply). maybe it was helpful, maybe not. do what you want with the info.
some (like the previous poster who 'interrogated (sp) you), actually have similar situations and experiences in the same field, and want to know more. so lay off, man. no doubt you are stressed over this. but as fellow nurses, we all share that stress (in whatever it is we do). we are not your co-workers (who are obviously stressing you out). we're just trying to help you, as you asked. :)
also, i noticed that this was your first post here. you might want to check out the other forums (in your case, the nurse manager, lpn, or cna [if they have one]) to get a feel of the 'culture' of the website. maybe some other nms can give you the advice you are looking for. many have asked your level of experience, because yes it is relevant. personally, i have never known anyone to move their way up the ladder so quickly, with a diploma no less (i know every geographic area is different). if you did indeed graduate in '02, and you've worked your way up, more power to you. for all we know, you could have been working in this facility since you were 18 yrs old. or you could have been working as a school nurse (until now), and maybe you are in over your head. not too many people are 'out to get' total strangers on this bb. it is really like a support group. support we cannot get (or choose not to seek) from our co-workers. again, just trying to help you. :)

i appreciate all the help yes i do to think it is relevant about when i graduated i graduated from nursing school may 2001 have worked in numerous fields ltc/home health/hospice in that time i have meet many obstacles. the 02 is for the number of children i have !! you cant imagine how long i worked late trying to get things straightened out so that the next day would be half way decent. i guess the reason for the attitude was due to the fact that i am stressed due to the fall of quality of care in the facility i feel like im in a constant tornado no one wants to work and take care of the ones who gave the there job the elderly!! every day i get out and see my patients and take care of them as a nurse should do!! i was a cna long before i became a nurse did 2 years as cna and 1 year as cma im only 30!!! believe me i appreciate all the help i can get but i do think people can choose words a little better!!! thanks for bringing it to my attention for my poor attitude and poor choice of words!!! i really do appreciate all the help i can get!! thanks for your support

nursemid02 · Jan 26, 2005

those who scorn ltc are overlooking a need...these people need care...some families cannot care for their relatives and some have no one...we have had residents who have died and there was no one to notify..
there is a need for hard working, compassionate care givers...get rid of those who don't do the work or who call in or worse just don't show up when they feel like it.
the idea of bonuses are good but too many times this just becomes extra pay for the same old work...everyone believes that they are 'entitled' to a bonus
if you provide a good work enviorment and give respect to your workers they will provide you with respect and good work in return..
after some of the ring leaders are gone the rest will decide to shape up or leave...either way you are a winner...you will always have some problems and you will have to maintain a firm code of conduct with the best interests of the residents the primary concern but there is a way of providing care for those who need it...
i hope that you will decide to stay ... good leaders are needed

Thanks for all your words of encouragement I really appreciate all your help!!! By the way I feel for you I have nurses that act that same way when it comes to a patient choking or in your case eloping! Thanks for your help!!!

Hollyhock · Jan 28, 2005

you can't do everything at once, or even by yourself. delegate. turn it back to those under you, in a nice way. "I need to have you..." "Would you please..." " Mrs x needs a dressing change could you get Jane to help you to do it now, Please." "I know it is not mr joneses day for a shower, but he smells and I want him to have one now. Let me know when it is done." Give complements when they do it. Donuts once in a while bring smiles, or a pizza when they are short of help and having a hard time getting out to eat. If you show the staff you care about them as individuals they are more willing to meet your expectations. My supervisor says " what I need to have you do is... You can do this, this is in your scope of practice"

Pick the worst thing to work on first. Notice who is doing it and complement them, encourage the others. I have had some awasome supervisors! They taught me a lot in the way they treated me and in the words they used to direct me. It is helpful to know the DON's expectation, Tell everyone together in a staff meeting. The last DON I had did not tell every one and expected the word to be passed, which it wasent. She never had a staff meeting. That's some advice from the bottom of the totum ploe.

Town & Country · Jan 28, 2005

I think that the fact that the OP is here asking for tips is refreshing in and of itself - she actually CARES what goes on, which IMO is half the battle!

My tips:

* do away with "mandatory" staff meetings. If you HAVE to have a meeting, make sure the night shift doesn't have to come in during their sleep time.

* form relationships with ALL the nurses - not just your "pets"

Those are just two things that occurred to me, I hope your job gets easier. BTW I agree that you should have a facility-wide meeting to announce your expectations.

That way, there can be no confusion.

Let people know from day one where you stand.

I personally would be on the lookout for some great CNAs to have on standby if needed, although I hear they're at a premium these days!