LTC DON claims she cannot work the floor due to regulation

[KSinMT]

Hi, I've worked in LTC for the past 15 years in 3 different facilities. The most recent facility I work in, the DON claims it is a state regulation that she cannot work the floor if census is above a certain number. I have never heard of any such regulation, and I know it is not a company policy because this particular facility was recently bought out by a different company. I suspect this "regulation" was made up by the former DON and is being carried on. Has anyone ever heard of this before? I would think in a crisis or emergency situation it would be the DON's responsibility to cover the floor if needed but she will not due to this supposed "regulation". We have a new administrator and I'd like to ask him about it but I don't want to be "that person" and cause any trouble!

[LauraF, RN, ASN, CNA, LPN, RN]

It looks like depending on census it could be legit.  LICENSED STAFF (RN, LPN/LVN) For 1-59 licensed beds: 1 RN/LVN 24 hours/day For 60-99 licensed beds: 1 DON RN Day Full Time (may not be charge nurse) and 1 RN/LVN 24 hours/day For 100+ beds: 1 DON RN (may not be charge nurse) and 1 RN 24 hours/day DIRECT CARE STAFF 3.2 hprd Do not double hours of RNs/LPNs and exclude hours of DON.  I found this at :  https://www.justice.gov/sites/default/files/nursing_home_staffing_standards_in_state_statutes_and_regulations.pdf

 

[Jedrnurse, BSN, RN]

10 hours ago, LauraF, RN said:

It looks like depending on census it could be legit.  LICENSED STAFF (RN, LPN/LVN) For 1-59 licensed beds: 1 RN/LVN 24 hours/day For 60-99 licensed beds: 1 DON RN Day Full Time (may not be charge nurse) and 1 RN/LVN 24 hours/day For 100+ beds: 1 DON RN (may not be charge nurse) and 1 RN 24 hours/day DIRECT CARE STAFF 3.2 hprd Do not double hours of RNs/LPNs and exclude hours of DON.  I found this at :  https://www.justice.gov/sites/default/files/nursing_home_staffing_standards_in_state_statutes_and_regulations.pdf

 

I'm going to step out on a limb and say that the DON can ALWAYS work on the floor but they can't be counted in the ratios, at least per this citation.

That would be a big difference from "cannot work on the floor".

[VivaLasViejas, ASN, RN]

I’ve always thought it would be beneficial for management to work the floor at least one time per month. That keeps it real and they’d have “skin in the game”, so they know what can actually be accomplished during the course of a shift. I also think everyone should have to work a night shift once in a while. That might quash some of the eternal shift wars. Nursing is 24/7 and neither days nor nights have it easier. 

[Jedrnurse, BSN, RN]

7 hours ago, VivaLasViejas said:

I’ve always thought it would be beneficial for management to work the floor at least one time per month. That keeps it real and they’d have “skin in the game”, so they know what can actually be accomplished during the course of a shift.

Thank you! I wholeheartedly agree and have been saying this for years...

[PoodleBreath]

I've been in facilities where management had to pick up the cart, usually they just fuffled around with paperwork, rearranged the cart, told us how inefficient we were, and walked off the shift with a ton of meds, wounds and orders not done. I still remember the supervisor who proudly told me in report that she had spent the shift rearranging the eyedrop drawer.

I also worked in a facility where the DON was not allowed to work the cart because of some issue with her license where she wasn't allowed to do direct patient care. The facility failed her up the chain of command until she became DON.

[KbLPN13]

My DON just worked the floor today. We're in the middle of pandemic and many LTC staff would rather make more money traveling than care for the elderly. 

[amoLucia]

Agreeing with Jedrnurse!

[summertx]

On 10/5/2021 at 10:21 PM, KSinMT said:

Hi, I've worked in LTC for the past 15 years in 3 different facilities. The most recent facility I work in, the DON claims it is a state regulation that she cannot work the floor

LOL. We had a DON like that, she just  enjoyed  sitting in that office and watching all the nurses do 2 admissions each. She just enjoyed  sitting and make every excuse not to get up and help. 

[JKL33]

On 10/8/2021 at 7:34 PM, KbLPN13 said:

We're in the middle of pandemic and many LTC staff would rather make more money traveling than care for the elderly. 

You mean many LTC staff would rather take the opportunity to get ahead just a little tiny bit in life, which is an opportunity that their employer is never in a million years going to remotely try to offer them. Make sure you understand that the idea of wanting to gain a little room to breathe isn't directly related to traveling or the elderly.

[jljrdhd]

There is a regulation that states that if a LTC building has a census greater than 60 residents, the DON cannot act as charge nurse.  However, that does not mean that a DON can't give meds, do treatments, admissions, or other direct patient care duties.  It only means that the facility can't apply a "dual role" to a DON if the building has a capacity greater than 60.

I was a DON for years and did my share of hands on resident care, especially during emergencies or when we were short staffed...in fact, those were my favorite days! 

[JBMmom, MSN, NP]

I did a brief stint in case management in a hospital. I helped a patient to the bathroom and was very quickly approached by a manager and reminded (really informed- because I missed that part in orientation) that because of my non-clinical position, the hospital's insurance did not allow me to provide any direct patient care. Aside from almost immediately putting in my notice because that was the most ridiculous thing I had ever heard, it made me more aware of just how different nursing roles can be. As others have already pointed out with the regulations that the DON can't be charge, is it possible that your organization has non-clinical positions or less coverage for management? I know my DON NEVER touched a patient when I was in LTC, but she was also a particularly poor manager.