Need Advice

[Tina**RN]

I am a new Director of Nursing in a small Non for Profit home that was opened in 1964. Most of the employees have been there 10-25years. I have never seen longjevity like this before! It is an exceptional place, I can see why people stay. The benefits and the staff budget is awesome!!! I am only the 5th DON ever and the current Administrator is only the second ever!! I love this job and am so thankful to have it.

I am having just one small problem, the ADON has been there forever as well and she does not take to change well at all!! And to top it off she has some really odd views on things and since this is the only nursing job she has ever had this is all she knows.

Example: There are no standing orders in this facility and she thinks its horrible for me to ask the medical director to look over some of our protocals and get some standing orders in place. She panics thinking about doing anything like that stating that would be against state regulations. I want standing orders for tylenol, mom, and skin tear protacol.. ect. She freaked out when a nurse put TAO on an abrasion without first getting a doctors order!!

Also she had major stress because I took all injectable meds off the TAR and put them on the nurses MAR. I felt all meds should be together, but they have been placing it on the TAR so she just could not handle this change.

She only wants moisture barrier cream (like calmoseptine) used IF there is excoriation or superficial open areas.. I say use it with incontince reguardless.. lets be proactive! Preventive care is important also .. but she says NO, state can give us tags for this, it will set us up for failure... WHAT!!??

I mean it's little things that should not be such a big deal and she goes on and on and on about them and it DRIVES ME CRAZY! She can not handle change well AT ALL and it makes trying to bring this place up to speed very difficult. And this is not a place that is a revolving door, these people have been here forever!! She is a fixture that is there to stay..

How should I handle her?

How can I help her see another way?

What should I do?

Thanks in advance!

[CapeCodMermaid, RN]

I've worked in places where many of the nurses say "That's not how/what we've always done". You know if we always do things the way we always did them, women would die in childbirth in alarming numbers, kids would get polio, and a broken hip would mean a death sentence...oh yeah, we'd be putting Maalox on pressure ulcers and baking them under a heat lamp.:eek:

Sometimes you can show these people why change is good...what the positive outcome is. But, sometimes, you have to say, It's because I am the DNS and this is how things are going to be done.

I think your ideas about being proactive are wonderful. As long as you follow standard practice of care, you can pretty much have your own policies. In one place I worked, they used $35 a tube ointment on everyone. I changed the house preventative to A&D ointment. You'd think I'd proposed running through the halls naked. We had no more skin breakdown than before and we save $$$$$.

YOU are the DNS. If you and your medical director want standing orders, go for it. Even in Massachusetts which has some of the toughest regulations, we are allowed to have standing orders.

Good luck. I'm sure you'll succeed.

[debRN0417]

I agree with CCM. You are the DNS. Standing orders are a good thing. They prevent unnecessary calls to physicians and delays in routine treatment. Keeping all the meds in one place is a good thing too, less chance of an error. Do what you need to do. Talk to her and explain your rationale. Try to get her to see the light, so to speak. It may come down to other "changes" if she is not willing to at least try to work with the changes you are proposing.

[Nascar nurse, ASN, RN]

We are not allowed to have official standing orders in my state so please check your particular regs before you proceed. (Key word here is "official"). There is a general understanding the the Docs would KILL us if we called them for a tylenol/MOM type order - haha

[caliotter3]

If standing orders are allowed in your state, then by all means, establish them. I don't see why the injectable meds were placed on the TAR unless it just suited someone. The only meds I have ever seen on a TAR were topicals and sometimes nebulizer meds because people were swayed by the term "breathing treatment". Is it or is it not a fact that these changes would result in tags? I do not believe this long serving person is operating on fact-based information. It is your responsibility to help her to come up to speed. Good luck finding a way to do this without ruffling her anxiety. You may have to resort to, "Because I'm the DNS". It might be easier that way.

[SuesquatchRN, BSN, RN]

[Pfiesty]

Kudos for your pro-active ways. You must be awesome at QA!

Your colleague goes on and on about her stance? Tell her you value her input, just ask her to put her rationales in writing instead of verbalizing so that you can study the details. Once she starts writing her rationales she may realize there are few or none. And you can show respect for her input while deflecting the verbal repetitions.

Good Luck. Sounds like you are doing a great job.