Problems in LTC- Texas

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I am a fairly new DON at a 118 bed facility in East Texas. We have a new administrator who I thought I liked, but things are not so wonderful right now. A couple of weeks ago, we had a new resident with psychiatric issues in her history. She had been living alone, but was sent to a hospital and subsequently placed in our facility by Adult Protective Services. One evening, she had an episode and got very angry. During this time, she began yelling, felt that she was being held against her will and began calling the police every few minutes. There were no medications ordered, so I called the physician on call for the nurse since I was still in the building. She refused the injection and I called the administrator. She told me to tell the nurses to hold her down and forcibly give her the medication. We did not feel that was a prudent plan of action and I called my regional nurse consultant. She was not available, so I called the lead nurse consultant for our corporation, who told me not to do what the administrator instructed. My beliefs that this was battery and chemical restraint were confirmed by her.

Yesterday, I was reprimanded by the administrator for calling the corporate nurse. She said that I should not question her directives and should have done what she told me to do.

Also, when I was hired, I was told that I was on call 24 hrs a day. The ADONs (I have 3) are on a call schedule. This administrator told me in a meeting that I would be in the call rotation from that point forward. I asked if that meant that I would not be on 24 hour call and she said "No, you are on call all the time, you will just take a call rotation, too." Last week, she announced to the ADON on call that I would be taking 2 shifts that Friday (16 hours) as charge nurse. I have not worked a floor in 13 years. I have an MSN with an emphasis in nursing administration and have been an occupational health nurse for the last 13 years doing case management and managing a clinic for a healthcare system.

I feel I should look elsewhere and now. Suggestions? I really do want to stay in long term care. Am I crazy - is this normal behavior in LTC?

Specializes in ICU, CM, Geriatrics, Management.

Jackie -- You sound like a terrific nurse. It's time to bail out of there!

Curious... not clear from the post. Was the NHA approached about the potential liability of her directive before contacting the consultant?

Yes. I told her that we could not do what she was asking. She was adamant that it was perfectly legal and appropriate. "We did it [at the last place] all the time." The directive was for me to tell my nurses to hold the resident down and give her the Haldol. I called the corporate nurse to make sure I was correct. Of course, she told me that I was right and that we should not do what the admin said to do.

The others are correct. A DON cannot be a charge nurse if your bed count is over 60.

Besides that. Why stick around and have to deal with this administrator's rantings. I can guarantee you that things will not get better and this person may cause you to get into trouble and lose your license, possibly.

I would not be able to trust her after this episode.

Personally, I would find me another job and leave.

Specializes in acute care and geriatric.
...Personally, I would find me another job and leave.

She already posted that she did just that,

Specializes in LTC, Pedi LTC, EMS.

I am an ADON in LTC. My DON is on call 24/7....for the administrative nurse on-call to contact her if needed...or the floor nurse is to notify of a discharge or death in the facility. She NEVER is to work the floor....she does not take on-call rotation. When she has a question about protocol, she IS TO CALL he corporate nurse Consultant....that is what the nurse consultant is there for! The DON is the head of the nursing department. Have the nurse Consultant meet with you and your administrator together and get this worked out. Going to your Nurse Consultant is NOT going over the Admin's head. If you had followed the admin's direction, you AND the admin could have lost your licenses.....the admin is, after all, responsible for what happens in the building.

Specializes in Sub-Acute, SNF,ICU,AL,Triage, Cardiac.

is your new administrator new to the facility, or a true newbie?

how do you like the facility not counting the administrator?

how familiar are you with the company, their ethics, and their upper level support for your position?

some of these things weigh heavily on how i think you should process where to go from here. administrator was way out of line - this behavior can actually cause her to lose her license. she is held to a stricter standard for implementing and upholding the regulations, especially with the treatment of residents.

since it sounds like you cannot just jump ship, here is what i would suggest. you already opened up this can of worms with the nurse consultant, so request a private meeting with her or him either in person or phone, and review the incident together. verbalize exactly how you felt about the situation. then proceed to review what the corporation expects you to do in this type of situation moving forward. then review your job description and the regulatory standards. since it is the administrator who imposed them, then you go up that next level. review with the next level person your understanding of what your responsibilities are, what you were told as being your primary focus when you were brought in and hired as the don, and how you are going to go about to accomplish those tasks or meet those goals given the right set-up - feel free to state how you think it can be better set up for everyone's success.

start a journal (i did this early in the beginning of my career) - write date/time notes as you see fit. in the meantime, keep looking to keep your options open.

good luck to you. some ltcs are this bad, and a lot of times it is due to having the wrong people in the positions of the greatest responsibility.

as for the 24/7 on call, comes with the regulatory wording - even if you have someone designated as another person taking calls for different shifts or times (i.e. first call), you are still technically on call because you are the next level up if your first call needs help/guidance - remember, as the don, you have some respondeat superior responsibilities.

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