New LTC DON - need support!

[RRRNNN]

Tomorrow makes 2 months since I accepted DONship at a facility that had been let go for years. Before taking this position I had been risk manager there for about 7 months and that was my first long term care position. Before that I did 6 years of home health/case management and before that ICU, ER, and some rehab - for a total of 18 years RN experience.

I never got any sort of orientation into the risk manager position or into the DON position, the computer system, or any aspect of either job and I'm new to long term care. In fact, all the offices in the entire building had been completely ransacked and I didn't even have any of my predecessor's paperwork to use. This facility had been let go for years and had gone through several recent changes in ownership and bankruptcy. Everything had been allowed to run amock for years. Entire management teams just up and quit, repeatedly. They'd had a meth head for an administrator and a drug addict for DON. It was total anarchy. They inmates were running the asylum. We had drug addict charge nurses working there, narcotics diversions left and right, resident abuse....you name it, it was going on there. IJs left and right. The state was there every day. It's a miracle the place didn't get shut down.

The new administrator, former new DON and I did a lot to start getting things on the right track. We fired a lot of people and got some basic systems into place. The former DON ran screaming from the place after the 3rd narcotics diversion that happened under his watch. If he'd only stayed a few more weeks he would have realized that we'd taken care of the problem and the last nurse we fired before he left turned out to be the last one stealing narcotics. I think the former DON actually had a nervous breakdown, due to the attorney general investigation that was going on and the state being in the building so often etc. etc.

So - here I am. I would have preferred to stay in the risk manager position but I was terrified of who we might end up with as DON and the staff begged me to take the position because they were scared of the same thing. Things are most definitely on the right track and we've made huge improvements, but we're still very far behind where a nursing home should be. Most of our problems are just charting problems. Yes, when State comes I'm sure we'll get tons of charting tags but at least our residents are well cared-for. We're still just a one-star facility because the big tags haven't dropped off yet.

My problem is the non-stop stream of staff coming to me with complaint after complaint all day long. I can't get anything done. I'll start my day off with a long to-do list and get nothing accomplished. The other day it was 2:30 before I'd managed to complete one thing on my to-do list, just a simple infection report that should have taken 10 minutes. They just keep showing me all the stuff that still needs fixing and they think I can fix it immediately. They talk and talk, and I nod and agree and encourage and fix everything I can fix.....but my productivity is being affected very badly by the constant listening I have to do.

I got a risk manager who's a real crackerjack with lots of LTC experience. She just started two weeks ago. I told her very explicitly in our first interview that this place is in bad shape. It's a nearly sunk ship and full of many holes and needs a ton of work. I told her to go to the rest of her interviews and think things over and call me back if she was still interested. She called back and we did a second interview, and included the administrator in it. We even had a THIRD interview which included the corporate DON. In each interview we were very very clear with her about how bad the situation is and how much work it's going to take us to patch all the holes in this ship and just get it floating again. Not sailing. Floating.

She took the job KNOWING how bad things are, and I told her right off the bat that the staff had undergone many recent changes and we'd just done a big round of firings and hirings and that they needed a little time to rest and regroup before the next round of changes. These people went through a lot - including many times when the former owners made paycheck "mistakes" repeatedly.

She came into this job like a screaming hurricane, ready to "shake things up' and make big changes! Things finally seemed like they were improving and calming down and people were able to relax and breathe a little. Now the remaining staff are afraid they're all going to lose their jobs because she's telling them she's there to "clean things up" etc. etc.

She knows much more about the LTC industry than I know and she's pointing out problems that I didn't even know WERE problems. She's freaking everybody out and making everybody mad and taking up even more of my time with HER constant complaints about things I need to fix!

Yesterday, for the first time, I had to leave work early because I was blowing a gasket. I actually swore and threw some things.....lightweight things....... My to-do list is going NOWHERE because of the non-stop 8-hour-per-day interruptions and complaints. State is going to be here any day for our survey. I KNOW we're not going to do well but honest to God - I don't care if we get sixty documentation tags - if we don't get a K-tag or an IJ, the administrator and I will both be celebrating with champaigne as if we won the fricking lottery.

I hung up a sign on my door today saying I will only be taking complaints from 1:00 - 3:00 every day, along with a box full of complaint forms that people have to fill out completely before they come to talk to me. I guess that hurt some people's feelings.....the administrator told me I can't lose my cool and have to maintain a professional front at all costs.

OMG this is stressful. How can I calm the storm?!

[K+MgSO4, BSN]

Wow! I have no idea what to say....

Well done on limiting time for the complaining. 2 other ideas - draw up a table / chart and flag how many different people are complaining about the same thing. Put in a traffic light system or a numbering system and when something reaches a critical point you act now. E.g. the secure dementia wing needs a new nurses station. Not a major priority despite the whining. Refer people to the table and ask them which of the red items they think is worth delaying for a new desk. Also get a white board and divide it into 12 months. Put some of the non urgent issues into a month a few months ahead and when it gets there do it.

Another idea is as well as the complaints form also create an "I have an idea" or "I want to take the lead" form. Give the staff back the control and if they come to you with an idea sit down with them, discuss it and check in on how they are going with implementing it. One easy staff related win I had was buying forehead sats probes and putting it on the shelf in the store room rather than in my office.

As a manager one of my ethos is to provide my staff with the equipment they need to do the job and that the infrastructure is in good condition. Have someone (not you) audit all of you vital machines, assess all of the lifting machines, slings for same etc. Fix what can be fixed, replace the rest. Ensure you have enough of everything else that you need using the same traffic light system. Often a lot of staff complaining comes from a lack of tools to do the job right.

Then have someone go around with the infrastructure manager and point out all of the defects e.g. room 6 bathroom grab rail is damaged. Same deal, prioritise infection control, staff safety issues and patient safety isses.

The risk manager needs to have boundaries as well. Set up a regular meeting with her where she can bring up her concerns but other than the truely critical where she should be escalating ASAP then the rest is to wait until the weekly meeting. Remind her of the feelings of vulnerability of the staff and to take a pill with "clean this place up" act.

Next you..... make sure you are taking a lunch break away from your desk....go for a 10 min walk outside and just breath. You cannot reverse years of neglect in a short time frame. Take on the urgent issues but also some quick win projects to give you a feeling of accomplishment.

Good luck!

[heron, ASN, RN]

Oops! Wrong thread That's what i get for trying to respond while on my break:rolleyes:

Sorry.

[Orca, ADN, ASN, RN]

You are absolutely right in limiting the complaining. You might even consider having suggestions for facility changes submitted only in writing unless it is something that requires immediate attention. That way, you can review them when you have time.

People panic when too many things are thrown at them at once. Change, even if it is positive, can be stressful. I would tell the risk manager to tone down the rhetoric a bit. The terms that she is using are making people anxious, and you don't need that when you are trying to build your new team.

As for your facility being in danger of being shut down, I once worked for a LTC facility that was perhaps not quite as bad as the one you are describing, but they had significant issues. We once had four DONs in a 90-day period. A couple of years later, I was working for a rehabilitation facility. One of my patients one day was a facility inspector for the state health department. She was talking about some of the facilities that she had inspected, and she mentioned my former employer. She said "The only reason that we didn't shut them down is that the patients would have had nowhere to go."