Problems/Issues Encountered as an Director of Nursing

[Nascar nurse, ASN, RN]

First - you do realize that this is a DON subforum and you aren't likely to find many administrators here? Most, if not all of your responses will represent the nursing department and not necessarily the entire facility.

Now where in the heck to begin?????

1. Unrealistic expectations: From whom you ask?

- The families - No we really don't give 1:1 care here. No your Dr. will not be into see your loved one at the drop of a dime. No, your Mom is not necessarily the angel you think she is, she is manipulating you against the staff and you refuse to see it.

- The staff - I am a living person and can not make miracles happen. Yes staffing could be better but understand....I have a boss too. I have been very bluntly told "Here is your staffing budget. Keep it in line or I will find someone else who can". And there is also the constant staff bickering and I'm expected to be the referee and try and keep the peace. Somedays I just want to yell out my door "Grow the heck up people and just go take care of people instead of wasting time griping about what someone else didn't do...". My favorite (not) is when they finally bully someone into quitting then come crying because they are working short.

- The corporate aspect - Back to staffing budget. Would love to know what some of them make. Just where are all those profits going. (Along with their salaries, typically a good buildings profits are poured into the system to off set those sister facilities that are not doing well).

By the way...I had a great day at work today! I also want you to know that I love 90% of my residents, I love 90% of my nurses, I love about 75% of my aides and about 50% of the families. Heck, I even like those folks in the corporate office....they are just doing their jobs too. I love my job.

[Nascar nurse, ASN, RN]

Oops - forgot the unrealistic expectations of the surveyors/regulations.

Recently tagged on F309 due to a 2cm X 1cm bruise on the forearm of a resident who had an IV 3 days previous....tagged because the bruise was not identified on the most recent head to toe (I mean...who really cares in the big scheme of things. Little bruise, even the surveyors agreed this was from the IV, it wasn't any kind of suspected abuse issue, it was a perfectly normal little bruise with no odd complications, etc)

Tagged on infection control due to a GI outbreak back this summer. 3 units in the building. Only 2 units with vomiting/diarrhea. Staff working those 2 units also became ill over the course of the week. The 3rd unit remained healthy..both staff and residents (we mandated all staff stay consistent on units thru the entire hell week). We had a written plan in place immediately to identify when a resident started with symptoms, when symptoms resolved, reminders to staff on handwashing, all residents isolated to rooms, orders for zofran and immodium, reminders to watch for dehydration, pushing fluids...you get the point. Was able to pull this out and show the surveyors. Tagged because we didn't have a signed form on handwashing inservice in that time period and we didn't do stool samples to investigate the cause of the outbreak (they question food poisoning...I argued and argued til blue in the face that it wasn't simply because all residents served from same kitchen and only 2/3 units sick as well as staff DOES NOT eat from kitchen and same 2/3 units of staff sick). They insist I did not investigate the cause. Resident outcome failed to matter...within 6 days we had over 50% of the residents ill, within 10 days all symptoms resolved on everyone, not one resident was sent to the ER and not one resident even required an IV for signs of dehydration. Everyone of them were back at their prior level of function within 1-2 days of symptoms. I still think that was fantastic considering how many staff were effected at the same time.

[CapeCodMermaid, RN]

Nascar...we had the GI bug during survey. They said we didn't act quickly enough. I was told at 6:55 that 10 people in the building had vomiting and diarrhea. By 6:59 rehab was told to treat in the resident rooms, the main dini g room was closed,activitites wereunit specific and signs were up on all doors. Not fast enough? Less than 5 minutes?and, oh yeah, they saw someone walk past a sign...am I now responsible for every illiterate/stupid family member? I haven't gotten my SOD yet, but if they give us a tag on this, I'll be doing an IDR.

[MEMEBABY1]

LTC facilitys suck!...To much trouble

[cienurse]

Staffing cuts, budget cuts, more staffing cuts, more budget cuts.......forever being asked to do more with less resources........and keep a smile on your face and positive attitude while doing it and at the same time keep your staff happy and morale up! Good luck and let us know how things turn out!

[PankaD89]

\ said:

Staffing cuts budget cuts, more staffing cuts, more budget cuts.......forever being asked to do more with less resources........and keep a smile on your face and positive attitude while doing it and at the same time keep your staff happy and morale up! Good luck and let us know how things turn out!

I absolutely agree about the morale & keeping staff happy with their job. Obviously not everyone will be happy with their job or situation, you can't help that. But just prove you care, get out & help them, show that you're not afraid to get your hands dirty. Also make sure the residents know that they're your top priority...I've heard countless residents talk about administrators in the past with things like "coffee with the administrator, like he's gonna listen us or our needs"...truly sad when they're the whole reason we're there!!

[LTCRN4LIFE]

Nascar........LOL!!! OMG, I couldn't have said it BETTER!!!

and Meme....you had to have a bad experience somewhere......LTC's do not suck if the people running them and working them do a good job.....Hospitals suck...grocery stores....schools suck.....oh they all can suck......it is too bad you feel this way......why?

[fultzymom]

Budget cuts, budget cuts, and more budget cuts. Deciding what staff will be cut with the next budget cut.......also it's hard to keep good staff when there haven't been raises in 3 years due to the budget cuts. Oh BTW did I mention the budget???? Medicare/Medicaid expect the same excellent care year after year while cutting money to the nursing homes year after year

[NurseGuyBri]

YES Nascar, head on the nail! I'm right with you. I LOVE my job but there are some facets that would be so much better if people weren't so unrealistic in their demands. I do feel that survey gives unrealistic expectations- I wish it were more objective, but so does everyone else. I hear that they are going to do more observation and use documentation as supporting evidence. my experience (almost all of my tags) have been documentation issues. I also understand unfortunately that surveyors have to make a decision on how safe/secure/accurate a facility is in less that one week a year, so that has to be tough too.

[wyogypsy, RN]

Be careful what company you work for. I have worked for great companies, and recently worked for a company that makes it impossible for the administrative staff at individual facilities to be successful. If the surveys have been awful for a long time, then take a look at the company. Not 'every' administrator and DON they have had was bad, so the common denominator is the company.

[SuzieVN]

The DON is the first to get canned by corporate. You will have zero autonomy, even as a NHA- don't believe anything otherwise. You do what they say, and you get canned. If you don't you will get canned. If your survey blows, canned. If it's impeccable- you'll get for another reason. Good luck. Oh- and keep your calculator in hand- if you go 'off' the grid for staffing numbers on any shift? Yes- CANNED.

[Healthcaresolutions]

I am interested in a career involving administration in long term care. And, I wanted to hear first hand some of the biggest issues or problems that administrators have faced recently or over the course of their caree