My Spidey Senses Say 'be careful'

[RN Dani SM A]

I work for a small hospice agency that has about 13 patients. I first started 7 months ago as a visiting RN and shortly after, they asked me to be their DON. Now, I do have some management experience, but am a brand new nurse. I knew I had no business being a DON, but there were no other choices since I was the only one with a BSN,

I know I really like Hospice nursing. I have very much enjoyed my patients

People managing is certainly less warm fuzzy, but is OK

The management team scares me, They have a desperate smell to them and I feel nervous.

My questions are this

What does a DON do, exactly? I read the job description, but it is kind of vague. what are the nitty gritty things that you do or your DON does?

How do you protect your license when you have people under you? Sometimes management puts people in the field before they have been back grounded or oriented, I have thus far been able to dodge shady documentation but sometimes I am pressured to do it.

Any thoughts?

[tewdles, RN]

As DON you should have a say over which nurses are making visits in the field...it should be your call.

No person without an adequate background check or appropriate orientation should be completing field visits unsupervised...period.

Are the management people you are referring to above or below you in the pecking order? Either way, you should probably discuss with them your concerns and the supporting rationale.

I am concerned about the "shady documentation" part. I, fortunately, work for an agency with very high expectations and integrity, managers DO NOT "fix" documentation to make it look correct. You are correct to be very cautious about this type of activity...it is, afterall, your professional liability that will be in question should there be some sort of incident or investigation. In my estimation, a company which asks their professional staff to cut corners or to "fudge" documentation in order to create a pretty picture are the very companies that have little reservation about terminating the staff that comply with those requests, should there be a problem.

Good luck!

[RN Dani SM A]

Thanks. I work really hard to do everything by the book. The pressure comes from above. I have been stubborn about this and I think its starting to cause problems, so the whole thing may be out of my hands soon. I really just want to be a hospice nurse and be out in the field anyway and it would be so much nicer to be in an ethical company.

[Whispera, MSN, RN]

You just said you work for an unethical company, didn't you?? Do you really want to work for such a place, when their slop can roll over you? Who do you think would get the blame if something hits the fan?

[AtlantaRN, RN]

Madea says "if it walks like a duck and it quacks like a duck.......AFLAC!!!!!!"

Turn in your notice and move on....

Your license is toooo toooo precious to risk it for an unethical company.....

BTW-are you required to wear TEAL uniforms??? just wondering----

[AtlantaRN, RN]

When you apply at other companies, i wouldn't go into real detail WHy you left this one---I would just say "an ethical conflict....." My current employer understood when she saw who i worked for last.....

Good luck to you, move on and don't look back.

[Bubbles]

I think you should listen to your gut. One can make the mistake of joining a flaky company, but your RN license is to important to risk where you are. You recognize you are not experienced enought to be their DON and it sounds like you are not being treated as such. Only 13 patients! No wonder they are desperate!

[rngolfer53]

Thirteen patients seems too small to be a viable, independent organization, given the Medicare hospice per diem. Corners will have to be cut somewhere.

Sounds to me like "desperate times call for desperate measures" describes the management team, and therefor the entire outfit.

I think your spidey sense is on the scent of a mess in the making.

Given the situation you describe, the only way I would even consider the DON job is after setting down, in writing and in detail exactly what my duties and authority will be, on what exact parameters I'll be evaluated, and then having the agency execute the contract.

They'd also have to pay me a lot of money for the position, a lot of money. You'll need some savings when you're looking for your next job, or hiring a lawyer.

[Felixrnlnc]

As a DON for a 140 patient Hospice I can tell you alot of what is expected of you. But first is INTEGRITY!!!!!! and you sound like you have it. A small hospice can be just as hard to run as a large one. Maybe harder! First and formost I would recommend that if you decide to take this on get onto the Medicare website. You can determine alot from here as to the rules etc. There are guidelines for all disease processes. If your patient does not meet 1/2 or greater of these guidelines then discharge the patient. Never, never, never change documentation. If a nurse remembers something she forgot to write (or if her documentation does not describe the VERBAL picture she gives to you) have her write a "Late Entry". Then enter it on her bi-weekly plan of care. This will be sufficient for Medicare review and it will not be fraud. Also give a copy of the Medicare General Guidelines and the Guideline for each disease process. I have each of my Nurses take these with them. If they see their patient repeatedly and the patient is not meeting the guidelines then we begin to plan for discharge. They also discuss this with our NP and MD and as a group we plan their care.

You already know the management team SMELLS. So you have 2 choices 1. Leave and find a Hospice that agrees with your ethics. 2. Stand your ground and build an amazing Hospice that will service your community and bring dignity, comfort and proper care to patients and families facing the end of life. Neither answer is wrong. But if you plan to stay remember Winston Churchills words "If you are going through Hell.... Keep going".