gracenotes1

Ahhhh A nurse after my own heart. You sound just like me!!! Care and compassion go hand in hand. You know it does not matter if you can insert a PICC in 5 second flat--if you are not skilled in compassion hen you have missed the entire reason for nursing to begin with. Don't you agree? And we cannot eat our young!!! We have to help them. they come out of school with an idealistic attitude only to find that nothing they learned in school is actually the way things are. It is stressful and a culture shock. It is up to the veteran nurses to help them not hinder them. Maybe their "bad attitude" is coming from an overwhelming fear of the real world. The nursing homes of old are gone--gone!!! I know that if I were in need of skilled care I would rather go to a Skilled Facility any day. Just here is my point--Three weeks ago I was hospitalized (long Story) but the short of it is this---They had computers that did not work, thermometers that did not work. It took one nurse over an hour to do a history and physical on me. Because of the inefficent computer that she had to deal with. It was aboslutely ridiculous. I could write a very long story about the three days I spent at the local hospital---those nurse complained to me that they were over worked, under paid, and did not have time to do what they needed to do. I started to feel sorry for them--then I asked how many beds they had on their wing--40 beds. 20 patients per one RN, an RN super, a med nurse and an aide. Oh they just seemed to be worked to death,. At 4:00 pm my husband went to the nurses desk and came back and told me that there were 7 nurses--every one of them--sitting at the desk and ON the desk, eating and drinking. He was so angry and I was too. As a DON my nurses never behaved that way. They worked. They got breaks, and they got their work done. It didn't happen over night--because they were not like that when I started--but they were like that when i finished. I don't feel sorry for them when they spend their time and the patients time trying to get out of work. I realise that this varies from facility to facility but leadership is what makes the difference. As a DON you set the standard!!! Get out of your office---see what they are doing--sneak up on them. Do med pass every now and then. And set up a Nursing Admin team that is loyal to you and to your committment to having the best quality of care!! It can be done. I did it--or rather WE did it. And I know it can be done. I am a journalist--always have been. I have always kept a journal. When I was taken out of nursing by a terrible wreck---I went back to my journals and wrote a book.

Well down here in Alabama we don't have contract nurses so I don't really know what they do or where they come from. Maybe they do have an attitude. Just do the best you can for your facility. But if it were me and someone talked to me that way--I would start the paper trail, hold them accountable and fire them the next time they did that. Down here in the South we don't put up with such shenanigans--we got work to do. Gracenotes1

Anyone that expects the state to come in a pat them on tha back IS in the wrong place in LTC. They are there for one thing and one thing only--to find out your problems and prove they are happening. If you have been DON for a year then yep it is your baby. So, if you have done your job all year all you have to do is shadow the surveryors and answer questions. If your facility has been in a mess all year and no one is doing anything about it--then yep--you are in trouble. Money is not the primary motivating factor. It helps but it isn't everything. I always said (while being a DON for 7 years) "happy staff, happy residents" and that is what we strived to do. There are things in your budget that you can do for your nurses that will make a difference. And finding out where they want to work and putting them there and leaving them there also helps. If a staff person is unhappy--find out why--it usually is not money-- Find out where their strengths lie, who they work well with and make those relationships grow into a team that works. LTC is a huge industry and is getting bigger all the time. The level of care provided is getting higher as well. So be ready to grow with it. Just my opinion.

oh and the one threathening to blow up half the buidling needs to be reported to the authorities. I would call the police and make a report. Were there any witnesses to the threat? that one needs attention!!!

Sounds like you have some irrate family members. Get to the bottom of each problem--take it one by one. Just like there is a source to every odor--there is a cause of every problem. Take each one one at a time and try to see where all of this is coming from. Are you a DON? You do what you do because you care about the residents. Right? Their family does too--but they feel hopeless and helpless in these situations. Sometimes they just feel pure guilt. And unfortunately you take the brunt of it. Take time to listen to them and write down their concerns. When someone comes to you with a problem have pen and paper in hand and write down their major concerns. That way they feel like you are doing something to help them. After they finish complaining and you have the high points written down--read it back to them to make sure you have it all clear. Then look into their issues and followup. If you do this enough--especially with the ones that are always complaining--the problems will become less and less. It will take time but it works.

Great--you are doing the right thing. Just make sure that when the family comes you have an answer to the question--"well what are YOU going to do about it?" :)

I would take the job. Just remember that the job length expectancy of a DON in LTC is about 5 years. But, you will learn so much!!! And I have heard of DONs staying in their jobs for a very long time. It will be the experience of a life time. There will be problems but where can you go that there aren't any? Personally, I would take it.

I also wanted to add that you might as an intervention put them both on behavior management. Just an additional thought.

I would ask myself if this is the only nurse who doesn't get her summaries done? Is it a facility wide problem or just a lazy nurse problem. My nurses didn't tell me but one time that they didn't have time to do something. When they told me that I launched a full scale investigation to answer the question WHY? do they not have time. I found out--Sometimes there were things that I could do to help them better manage their time. Sometimes there were things I could fix that were wasting their time. Sometimes, I found out that they had time to have an affair with the maintence man. Make sure that the monthly summaries are as easy and quick to do as possible. Don't put too much on your med nurses. You may find an easier way to do the summaries--or you may find out that they take too many breaks. I would investigate WHY? Angela RN BSN former DON

It is definetly a fine line. When I was DON in LTC I had this problem but both were consent adults with repsonsiblity for themselves. So we closed the curtain and door and gave them privacy. Both of these residents you have have been declared mentally incompetent to manage their own affairs--right? If that is the case then you may be bound to report the behavior to the POA. If the POA finds out and knows that you knew and did not tell them--there may be a serious problem. This is my opinion--you take it for what it is worth-- I would call the families in for a conference. It may be difficult at first but at least you are putting it into the hands of the ones responsible and not in your hands. I would report the behavior to the family and let them make the decision as to what to do. Keeping in mind Resident Rights. Document well. It may work itself out but because you have knowledge of it--you may be obligated to involve the family. This is really something that you don't want to have on your plate alone. Treat it like any other behavior. Take the sex stigma out and think of it as any other behavior that should be reported. I don't think you have to report it as abuse--but I would do an Incident Report and began taking measures to advert the situation. Be creative. Have the staff redirect---Use measures that you would use to advert any other untoward behavior. Hope that helps Angela RN BSN former DON

Long Term Care Nurses are the best of the best. The stigma of old has changed. Long Term Care nursing is nursing at it's best and most basic. Care and compassion are a must. I never thought I would want to work in LTC but I took a job as an ADON---quickly I was DON and I loved every minute. Even the bad parts. I was DON for 7 years. It was the best job I ever had. I would still be there if I had not have had a wreck that disabled me. I am now a Nurse Author sharing my experiences and this huge heart I have for LTC nurses. Yall are the best of the best and don't let anyone tell you any different!!!! I have recently been in the hospital as a patient--I would have rather been in a LTC facility anyday!!! Keep on doing what you do. Love those patients and each other. Angela RN BSN former DON

I don't know how big your unit is--but activties for them must be individulaized. What works for one might not work for another. It is sad to think that someone is getting paid to do such an important job and they don't like it. People like that tend to have no patience and to work with Alzhiemer's patients--one has to have alot of patience and compassion. I would keep my eye on that person!! The patients won't respond well to her. They can tell a fake smile and fake love when they see it. She might even get a black eye!! Abuse is a fine line--I would really watch her--

She is right about that. Some of the older nurses have gotten set in their ways and it takes dynamite to change them. I remember having to terminate a nurse that had been at the facility for 25 years. She was lazy and I found out and proved that she was only giving meds to the patients that could talk. Now that is bad. No one believed that I actually would fire her--but what good was she to us or the patients? Once I read an article in a Nursing Journal titled--Nursing--Are We Eating Our Young? Sometimes I think this is true. I hope that new graduates are not all like the one yall have been talking about. And I hope that veteran nurses take young ones under their wing and help them instead of hindering them. It is sad to think that a new nurse behaves like the one you have been discussing. I just hope that she didn't get the idea that she could eat at the cart and not do her work from other nurses that have been training her in orientation. Now that would be a scary scenario. A new DON has a very difficult job until her team is her team. When a new DOn gets the people in place that she knows she can depend on things will run alot smoother. It just takes time and a great deal of patience.

Ahhhhhhhhhh now I feel at home. I am so glad I found this site today. My name is Angela and I was a DON for 7 years in 103 bed Long Term Care facility. I know this may sound crazy but I miss it so bad. I even miss the lazy nurses that eat on their med carts. I was on my way to work on morning and a tractor trailer truck turned over and slid into me. I lost my spleen and my career at the same time. I haven't nursed since. I still keep my license because I am a writer now. I am hoping to soon get my provider number and provide a CEU here or there to facilities. I even miss the stomping out fires!! Sounds crazy I know--but I do. I think I was a good DON and we had a good facility but the problems never ceased. I thrived on it I reckon. The one thing about being a new DON is it will take months to assemble your team. It will take months to showthem that you mean what you say and you say what you mean. I wanna help you guys. I am tickled pink that I found this forum.