sls73

Congrats! I agree with the above post about not making changes right away. You need to learn the processes and procedures before you make improvements. Do not forget you have three shifts you are responsible for, not just dayshift. Come in during the night and see what is happening or stay for second shift. Be willing to lend a hand- I recognize you have a job to do too, but a simple offer means more then you know. More times then not, staff will handle on their own, but it is the thought that counts. Last be fair, consistent, and treat others with respect. You will be fine. Remember you will not learn everything over night, so don't beat yourself up if you make a mistake. It will take time to make it your own and to feel comfortable in the role. I believe I started feeling confident in the role- year 2 or 3(yes that long). If you need any support or help please feel free to post your questions on this board as others may have thoughts and suggestions to help you out. Best Wishes!

I took 6 weeks off under FMLA for a hip replacement. I had to report it to the state for length of time I was off and had an interim DON cover me. She was not the ADON, but someone who worked in staff development part time. She had been a previous DON in another facility, so felt comfortable helping out. My administration was also supportive of me taking off this time which I know is half the battle. They even allowed me to come back 1/2 days when I came back to gradually build my endurance.

We have staff dress up day and then we have trick or treat. Staff bring their children and residents hand out candy for about two hours. We were supposed to do it tonight but due to the hurricane it has been post-poned. I believe the residents enjoy that more then staff dressing up. It's also a safe place for the staff to bring the kiddos and it helps build the inter generational gap. We are a church based facility- we just ask the the staff and children not dress up as anything deemed inappropriate.

Well citation is in- we did get cited for F 0226 on accuracy of heights. Scope and Severity- D. On with the POC. I guess if that's the worst they could find I should be happy, it's just irritating.

We didn't used to measure again either after the admission height was obtained. When MDS 3.0 came into effect the dietician was asking us to do so. It is part of the RAI manual in section K 0200 that states "for subsequent assessments(after the admission/re-admission) if the last height recorded was more than one year ago, measure and record the resident's height again". UGH....but now it is setting us up for those folks that we have measured for the first time in years and the height is off. I am curious too as to the citation it will be.

We just finished our annual survey. We are still a traditional state, and they spent 4 days in our facility. We came out OK- infection control and heights are our two concerns. I will take it in the scheme of things as I know we are not perfect, nor do I even attempt to be. My question is this- you obtain a height on a resident at admission and then the following year with their annual assessment. When you obtain the later height you find that it is off by a few inches (for example 3 inches shorter). What procedures do you have in place to fix this? You cant make them grow the 3 inches- so do you follow a guideline sort of like weights. For example, if the weight is off 5 pounds we have the LPN verify the weight immediately. If it is still off 5 pounds we notify the unit manager and dietitian. In this situation you can adjust calories and fluid requirements and implement interventions for the weight. I am assuming if I re-verify the height and accept the new height as correct, I would complete a significant correction on the previous MDS heights? Do most get their heights on the evening shift with the resident laying in bed? Do you complete with each comprehensive MDS or do you only complete it a the beginning of the year? Thanks- I am curious...

NA/LPN 2 weeks minimum, sometimes if you are new I find you need more help with time management then I increase it to make it 3. If you are a RN it goes 2 to 4 weeks. The new RN's from school generally need the 4 weeks. I always tell the staff though I will individualize to their needs.

Our building is 59 beds. We only average around 7 on Medicare A caseload. I have one MDS nurse, but she does not complete the MDS/Care plans in their entirety. Social Services, Restorative, Wound Nurse, Activities, and Dietary have their own section and CAA's they complete. The MDS nurse reports to me(DON). She is hardly overworked and cant wait for the clock to strike 4 so she can leave. She is on-call one weekend a month and she does help with meal service. Yes, I was the RNAC for years prior- I can adequately judge the work load. I am also certified with AANAC so I understand the 3.0 side of things with the extra assessments. I believe it varies building to building and who are completing the assessments. I understand places out there have the RNAC complete the entire assessments including the care plans entirely.

We do not treat MRSA of the nares or give a private room. We just use good ole precautions like handwashing.

You have to work where your heart is- for me that is working in LTC. I have had multiple job offers at hospitals but have turned them down- it just didn't feel right. I have always worked in LTC- first as an aide, then as a LPN, then as a RN who even works in the dreaded word on these boards- management. Any position is what you make of it. I love LTC, including the residents I take care of and serve. I am sure there are facilities(and hospitals) out there that are not the best place to work- I guess I am fortunate. Currently my PPD's are running 4.60 to even in the low 5's. I work with an administration that really cares about the residents and staff. Do I have days that I want to run away screaming- yes, but then most jobs do. I want to make a difference and for me this is where I feel I belong. That is what makes nursing unique- we all receive the same degree (RN, LPN, NA), but there are many different venues to work in and what may be ideal for one is not ideal for the other. I guess what I am trying to say is you have to find what works best for yourself and where your niche is, not anyone elses. LTC is demanding(again as in the hospitals that have their own issues), but is also rewarding. I go home multiple nights realizing a small action I made was the difference in someone's day.

Sorry answering your question- I would probably say Yes. Since this is an Assistant Director of Resident Services I would compare it to a ADON. I hope the position is everything your looking for- Personal Care and Assisted Living are getting to be the long term care facilities of years ago- need caring people who want to make a difference. : ) Good luck!

I am from PA and it appears they are having you taking a Assisted Living Administrator exam- basically you would be able to practice as an Administrator in Assisted Living.

I also received my certification through AANAC. I took mine on-line by reading the material and taking the quizes and final at the end. The on-line learning is a self-taught course as you just read/study the materials and take the quizes/tests, but it worked for me. I too had been the RNAC for a few years before doing this course, so it helped for filling in the gaps.

Put a paper MDS in your admission packet and have the nurses fill out three items- name, date of entry and the ARD. They can pick any date up to day 8 for the 5 day that way you can say it is set. You can adjust the date when you come back to suit your needs.

Thanks for the information, much appreciated!