Need advice: walking into a train-wreck?

[TiredRN-momto4]

I was recently offered a position as ADON in the LTC facility I've been working at for 2 months. Prior to coming to this facility, I had no LTC experience, as I had worked both in the home health field and in the hospital. I really want to take this position, but I have several reservations about it:

1) The DON is new to the facility as well, and has very little LTC experience. She does have 35 years experience as a nurse, and has been a nurse manager in the hospital, however. Both she and I feel that we will be able to work well together, but I'm concerned about her lack of knowledge about LTC regs. Could be a blind leading the blind situation if you KWIM.

2) The previous ADON left a mess of things due to being completely overwhelmed with responsibilities after the last DON left. The ADON was left with both her responsibilities, as well as those of the DON and as a result, there are many things that are behind and out of compliance.

3) My lack of LTC experience.

I think my biggest fear is that due to the window being open for state to come in, I will be held responsible (along with the DON) for the shape things are in right now. I plan to do a lot of research on all the LTC rules/regs, and I know I can help get everything back into compliance. We also have a good regional nurse that will provide plenty of training. I'm just worried that if I take this job tomorrow, and state walks in next week, I will be held responsible for anything that is still out of compliance at that point. Any suggestions, advice, anything?

I hope this is making sense. Stayed up too late last night watching Social Network with the hubby last night, got up early to get my 3 girls off to school, and now I'm trying to type this and entertain my 3 yr. old son at the same time :) Love my days off :heartbeat

[CapeCodMermaid, RN]

Certainly you can't be expect to fix things in a week or held responsible for things left undone before you got there.

Here's my question: Why would a facility want a DON & ADON who have no long term care experience? I'd think long and hard before I'd say yes to that job.

[TiredRN-momto4]

I've thought about that too, CapeCod. This facility is in a little town, where the applicant pool is pretty small. I think there were only 2 applicants for the DON position, and I don't think either applicant had LTC experience. There are 2 large hospitals and many other health facilities in the nearest city which is 30 miles away, so there aren't many people willing to drive from there to this town.

The most nagging worry I have is: what if the DON does something against regs (unknowingly due to her lack of experience)? That puts my license at risk too, right?

[CapeCodMermaid, RN]

No. We are all responsible for our own practice. Unless she does something illegal, she wouldn't lose her license either. The facility might get a citation, but your license wouldn't be in jeopardy.

[TiredRN-momto4]

Thank you so much for your response. This is what I assumed as well, but was told differently by the outgoing ADON. She told me that if I took this job, my license was immediately at risk due to the way things have been left. It doesn't make sense to me, but it did get me paranoid.

I know that the new DON does things by the book and is learning the regs. I would be the same way. I just wish she had more LTC experience. I'm a quick learner, have the ability to multitask, and handle stress relatively well. I realize that if I do accept this position, I'd have a long road ahead of me getting things back in order and into compliance. I'm willing to accept that challenge. I just didn't want to be worried about landing into trouble for something that the previous people did (or didn't) do, or did incorrectly.

Am I being too optimistic about this? Any other insight is much appreciated :)

[JenniferSews]

I can say our new DON walked into a train wreck. But she had the knowledge and experience and most of all the drive to carry us through. The facility has totally turned a corner and has gone from a 2 star to a 5 star rating. She had the systems down and knew what needed to be done and the state came within 3 months of her coming on board. It can be done, she is proof. However she came with years of experience in LTC and knew what the surveyors where looking at, what they expected, and what needed to be done.

She also devoted her life to the facility. For those months before survey and after she worked 10-12 hr days 6-7 days a week. Even now long after she works more hours than anyone. If they want you to take the jobs I would start with a good honest discussion about the expectations and goals. I know in some states the inspection by state is a joke. In CO it's a serious, panic inducing 10 day event where everyone involved is under extreme stress and they pick every little thing apart from HR to the dining room service. Get a clear idea so you can go in with your eyes open and not be surprised.

[TiredRN-momto4]

Thanks for the info :)

After talking to the regional nurse about the training I would receive, I decided to take the job and started today. Wouldn't you know it, state came in TODAY on a complaint...grrrr. It has actually gone OK, and the only thing we've been tagged on is the pureed meat at lunch today wasn't up to par on consistency. That was addressed immediately. The lady said that she is pleased with the changes that have been made since the new DON has come in. Hopefully things will go well. I'm encouraged by the fact that I've been told multiple times by other staff members, as well as residents, that this is the best management team the facility has had in years.