Help am New DON FOR LTC

Specialties LTC Directors

Published

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

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.

You hit the nail right on the head! Money talks, I don't care what anyone says. LTC pay is just not enough for the work you have to do. From the CNA's on up. YOu can offer all the incentives in the world, give compliments, etc. but increase in the paycheck would make all the difference.

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. :)

I totally agree! When I was a DON I always had two meetings. One at 7am and one at 1pm. Staff could attend either one.

One facility I worked for just could not get this in their heads they were basically waking people up in the middle of the night and continued to make the meetings mandatory for 2pm.

I suggested one month we have the meeting at 2pm and alternate the next month with 3am and see how many people got up, cleaned up and came in.

Needless to say, they didn't care for that idea.

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!!!

I am a big believer in lots of counseling and talking things through. Unless someone does something way, way out of line, I am not a believer in write ups. ( of course I am not going to stand by and let a resident be abused or something like that)

I don't see any positive outcomes from writing people up. It just breeds further attitude and discontent.

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

Hold the staff accountable. Give them the tools to do their work and let them know that you appreciate it when its done right. Praise freely and educate when instructing on correct method. When they have demonstrated that they are not willing to learn or do then counsel and let them go.

i, too have just become don for ltc. i have only been there 6 weeks and have been made to fire at least 10 people, i have actually lost count. i still have not had any time to learn the job as i am on the floor nearly all the time trying to hold it together. i work 10 -16 hour days without overtime i might add, while all other staff leaves at end of shift. my administrator is super but she is also up to her eyeballs in crap. i am so tired that i could die. the money is great but is this really worth it?

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!!
The thing that staff nurses would appreciate the MOST would be safer pt/staffing ratios, which unfortunaly the DON has no control over.It is the LTC corporations greed that breeds such contempt and unrest in LTC facilities. If staff nurses felt safe from retaliatory termination when reporting to management, things could improve ever so much. Staff nurses DO appreciate the pat on the back, the goodies, the meetings, BUT those wont solve the issues of overwork due to understaffing and retaliatory discharge or discipline. The REALITY of the LTC problems wont be solved with a bandaid.

hi there.. it is not easy to change old ways.. it takes alot of work and alot of reinforcement..i tell my staff to pick a good attitude!!.. i also tell them that they don't have to like me.. take me to lunch.. be my best buddy.. or socialize with me.. however.. they have to respect me and the position that i hold.. if they can't.. they don't need to work here.. also.. they are here to do a job.. not to socialize or gab.. and that they need to leave the problems at the door.. while this is hard.. family probs or g/f.. b/f problems.. must be left at the door!!!.. i am there to talk to and to help but.. not to do their jobs.. set your expectations high and it will follow but you have to be determined and committed to it!!!.. it takes lots and lots of time and perseverance.. won't happen over nite.. and as old staff leaves.. they always do.. you will hire new and that will also help.. show no favoritism and be consistant.. hope that some of this helps.. stick with it.. it is worth it!!!

most people go to work to do their job to support their family

there are always some who try and make a game of how much they can get away with..reward the first and get rid of the second

stand with your nurses if you think they are right..

listen to complaints, solving them will make for a happier work crew

Specializes in Executive, DON, CM, Utilization.

Good Morning!

If you have no system and no training "yet" then create a system as another writer announced that commands respect. The first time you walk into interview (whether they know or do not know who you are) is when it begins. Make rounds, and on interview dress like a corporate executive. Smile, meet everyone's gaze, reach out and shake their hand; give your first and last name. There is no need for them to know you are the new DON candidate; either the Administrator (if that is who is interviewing you) or "word of mouth" will see you through.

If you have not worked LTC do you know all about MDS, Medicare and Medicaid regulations; are you at least then going into a facility with a seasoned Administrator (for he or she can be your biggest variable in success), and another good variable is a consistent ADON (if he or she is in place) to help guide you through the hurdles.

Acute care facilities are beating a financial death trap, and LTC is the wave of the future; with new sub acute wings opening up, insurers are willing to pay the days for a post op to come recover, and still receive medical care. It is relevant and highly significant that you as a DON do have some say on admissions with the Administrators; you must have a broad background to enter LTC and put those feet down solid and be recognized.

Staff can be a nightmare and yet on the other hand they are endurance oriented. Just like residents stick around and do not go in and out the door (like acute care) staff can become inbred and dysfunctional, or they can become a healthy loving family. You see this can be your calling; do not show fear or exhaustion for all in all you are not there in the DON capacity to prove you can run rings as a floor nurse; many of us do not hit the floor but for rounds, a death, an intervention with family, a survey of course, and "pop ins" which I will make according to gut instinct to see how the night shift is really doing. You are a tower and yet you are the licensed RN at the top of the heap; make sure your heap is well cleaned and respectable for they will learn (all who are there) your personal style, and will want to be a part of, not apart from in the long run. Don't sprint you will burn out fast. Do not react, but ACT.

You deserve training but we all know what that means. So just as I'd tell a novice nurse to "ask if in doubt" you must ask. That means your Administrator might have to hold the fort for a week while you travel over to a sister facility who has a seasoned DON and you might find all the answers on this one trip. Then there is practice makes perfect.

Remember in LTC we have incredible demands in paperwork, and exhausted staff, much less finding good staff. We must inventory our day at the end of the day and make a list of all we did; not just what we did not do. Add to that an instinct to prioritize and that in many cases will always entail financial needs of the facility to provide nursing care. That breaks down to accurate MDS assessments, timely submission for payment, and even what I call psychologic bonuses when there are no financial incentives. A pizza party where nursing staff can hang out and be cherished goes many miles. Also an "open door" policy as a DON helps incredibly.

Thanks!

:redpinkhe

Karen G.

Specializes in Executive, DON, CM, Utilization.

Hi all,

I'd like to reply to this openly. LTC is the wave of the future despite historical horror stories, and negative experiences. An experienced nurse with good documentation skills, and management experience can be a "life saver" as a DON in a LTC facility owned perhaps by a larger company (or corporation) who has a "vision" as my original response shows.

Acute care is suffering as are the clients. Too many licensed nurses going into Utilization Review (and I wear many hats and have done it all), are denying cases without using critical thinking skills. If the statistics show a savings on an acute stay of one day but the client discharges and goes home and develops secondary infection and pain a readmission exists. It has gotten to the point that UR nurses are either learning to think and not just checking boxes of criteria, or we are still seeing less in cost-effective, and cost-extending care.

Larger companies are doing wonderful things in LTC. They are meeting the needs of acute care facilities and working hand in hand with new sub-acute wings. There a client still in need of medical care has "extended care" and he or she likely will cost less to the insurer and yet not be terrorized by a nasty wound or pain off the wall by early discharge from acute. This area of health care will grow, and take over the big gaps we have been seeing in recent years.

Are you a mover or shaker and creative? Even though LTC is traditionally conservative these new and exciting changes make you a part of a new system of extending care for all; not just the elderly or speciality (ventilator) et al. It is an important time for all of us, and let us not throw out the baby with the bath water.

I encourage all the LTC nurses who know of what I speak to share the positive for without this we LOSE out and not gain new nursing professionals who will allow this vision to prosper!

Again thanks!

:rolleyes::heartbeat:rolleyes:

Karen G.

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.
Specializes in Gerontology, Med surg, Home Health.

I received no official training before I became a DNS. I think it was immensely beneficial to me and my facility that I was an aide, a staff nurse,a nurse manager for a subacute floor, a supervisor, a PPS MDS coordinator and an ADNS. I've worked for DNSs who have never done an MDS!

LTC will continue to be short staffed and will continue to have trouble recruiting nurses until WE change our image. Most people (nurses included) think it's a place where old people live and aren't sick and by inference, any nurse who works in LTC must not be able to get a job elsewhere where there are sick people.

I have said, and will continue to say, that LTC/SNF is the place where the BEST nurses are needed. We have no doctors standing at arms' length. We have to rely on OUR assessment skills and verbal skills to inform the doctors about their patients.

We can come here every day and say how smart we are and how hard we work but until the image of the LTC/SNF nurse changes, it'll be like preaching to the choir.

cape cod mermaid!!.. couldn't agree with you more!!.. and that is exactly what i tell new nurses when they interview as well as the students that i teach..!!.. in ltc we are it.. we have to hone our assessment and critical thinking skills and go with our "gut" feelings because we don't have anyone else such as docs to rely on.. rather they rely on us!!.. ltc is actually the place to be as more and more the hospitals send the residents to us sicker and sicker to recuperate.. ltc is THE place to be especially for new nurses!!...cudos to you!!..

+ Add a Comment