Not sure where this belongs..ALF

[SpookyRN764]

I am the Director of Health Services at an 80-ish bed building with 20 special care residents.

When I first started, we were 13 below budget. Now we are at budget. It took a long time but we are there. Mostly because we offer more services than a typical ALF in our region.

The main aim issue is this, I am a WORKING director. As in, I am the full time day nurse on our SCU. Plus, I do all the scheduling and day to day management stuff. Wasn't QUITE as hectic when we weren't at budget, but the types of residents we accepted to GET us there means more issues that need to be handled. (Care issues, staffing issues, family issues, med management issues) and since we are a new building, this is the FIRST time since opening that we've had this many residents. So there are logistical issues as well that we are trying to deal with.

I consider myself to be a great manager. However right now, everything is falling apart because I'm not able to be the manager I need to be. As the full time day nurse, I barely know anything about my SCU residents. Which is unacceptable. Basically, I run their meds out and handle emergencies but most of the day to day falls to my full time evening nurse. We have one full time wellness nurse on day shift and only that one full time evening nurse and no licensed staff overnight.

This is the first position I've had being the head, 2nd in charge, of a building. And I'm about to throw in the towel out of frustration. It is simply too much for one person to manage well. I'm a half-butted director and a half-butted floor nurse. My ED is wonderful and gives me great feedback but is reluctant to add another full time day nurse so I can focus 100% on my DHS duties. The reason is that we've "been in the red for so long it will take some time at or above budget to warrant more staff". The issues is, we will lose residents because of this and I will lose staff because of this. Running a building at nearly capacity with the same staff we had at half capacity is not possible. And it's showing.

Im the ONLY working director in our company.

What metrics or other evidence can I collect to bring to the table when I request another nurse that will justify the need? I am a steward of our company and wouldn't ask if it weren't impossible for me to do it alone, but it's impossible for me to do it alone. Ideas?

Thank you for reading and please redirect me if I'm in the wrong area.

[MrNurseJohn]

I feel your pain as I did your job for 8 years and then got promoted to executive director. Even as ED, I am a working manager. Sounds like your managers are in the wrong field. In ALFs, everyone has to wear many hats. If I were you, I'd get my Administrator license and be an ED if you like working in ALFs. The people you work with make the job and change comes from the top so if your ED isn't a worker, they probably won't ever realize what you go through. I'm glad I'm a nurse and have done that job. I always have helped my nurse with scheduling, taking call, nursing duties, etc...

[ponymom]

I'd just bring the post you wrote here, to the pigs in charge and call their bluff. Start informing families. Be ready to leave but in this case, it's probably a blessing anyway.

Good luck.