NurseGuyBri

I was actually an LPN-ADON in a SNF in Virginia. I have not yet seen in any state a requirement for an ADON position. Since the majority of ADON positions that I've seen revolve around an HR type of supervision, it doesnt cross the scope of practice. Example: As an LPN-ADON, i couldn't supervise or delegate a clinical decision, judgment, or procedure to an RN Supervisor, but I could delegate, supervise, and judge staffing decisions and other non-clinical issues. As someone else stated, the RN-RAC stepped in when the DON was out as second in command and it worked very well.

I wear a suit without the jacket and then add my clinical consultation jacket when on the floor. Looks good with a tie. I think I may try a bowtie and suspenders just to see what happens. :-) I wear RN ciel blue scrubs on Wound Rounds.. :-D

RNGarcia - you really need to sit down and decide what do you want to do. If you like the senior community and want to give what you have to offer to that clientele, you should go for it. If you really want to hone skills and get involved in clinical you can still get some good experience. I will share this with you, though- if you go the ADON route, it will be hell, but it will be rewarding IF and only IF you *want* it. I was a ADON, then DON, and now a regional nurse and I love it. Some people hate it, so it really comes down to what you think you will love as a job. Ignore the money!!! As far as signing as the "ADON," i can say that 34/hour is a good wage for an ADON in my hometown (Tidewater, VA, US). It is not a reported position (your responsibility is not going to be tied to the building to state, so it's pretty safe). The problem, however, is that you have already identified an issue with communication. It may be that you are new, though... Get some paper and do it the old way - PRO and CON for each, weigh them out, and decide what it is you WANT to do, not what people advise you to do. We can only tell you what we like.

yeah. The on-boarding process is not just NEO- it is an ongoing process that extends a long period of time after the initial NEO, and for companies that use it, there is a higher retention rate and better recruitment rates because the reputation of those facilities is elevated versus those that have TBF (Trial By Fire) as we have all experienced! When a company says, "Hey, I picked you to do this job and I'm going to spend a LOT of money and time on making sure that you do well and succeed," you actually do begin the process of buy-in. This is not only backed by evidence, but it is personal experience. You are ABSOLUTELY correct that buy-in to company processes will not manifest if the management team does not perpetuate it as well, as I also recently experience vicariously through by significant other. NEO and on-boarding matter, but they only start the processes, the environment has to continue it. I know I keep bumping this thread a long time late but I really want it to keep going!!! ;-)

Great thread! I am a regional educator and agree with the majority of your discussion points. I obtained my first degree in social work and then nursing. I find that the social work degree is somewhat more influential in my education as well. I focus on educating staff at multiple facilities as my current career, which can be difficult when creating rapport, a key to getting buy-in. Since I travel many miles by car or plane, sometimes night education is not possible. When in this situation, I always make sure that I educate the in-house staff developer on how to deliver information to the night shift because it is so important that they get first hand information. I do attempt at any time possible to be available on other shifts because let's face it, evening shift is left sometimes and night shift even more so. Although I do not have formal degree in education (which I am pursuing), the ANPD, ANA, and AALTC and having access to multiple EBP research engines has been instrumental in my success so far, so keeping them in mind is important.

Virgojd, It's been a while since you posted, I wanted to see how it was going!?

As I go back through and read these posts, I wanted to say thanks to everyone. I am settling into my Regional Educator career for a large LTC/SNF/Rehab and am really enjoying it. I'm not going to blast my last company and although I miss it, I know that I made the right decision. It should not be that bad, being a DON, but looking at my new company and how much they support their facility versus my previous one, I now see that if I want to be a DNS/DON, it will be with the current company and not the previous one. The level of support is night/day and there is no comparison. Cape Cod is right on the money because it is not the DON job, it is the company behind the job that makes it good or bad. Thanks!

I will tell you this from a corporate perspective. The big companies ARE checking your facebook. They are looking at how often do you cut people down- how often do you judge patients or complain about your job. Is your picture tasteful. When looking for potential employees, we use EVERYTHING to determine what kind of person you will be when you represent the company. So yes, they do check. My company also has an EXTENSIVE policy, up to including that we post a disclaimer on any social media main page that "anything on this page reflects the opinions of the individual posting them, not any corporate or business entity, whether directly stated or implied" or something similar. Funny thing- If you follow corporate social media policy, it actually makes you act a little better on face book. In turn, makes you a little less judgement, a good quality anyway. We need to be critical of things as nurses, but not judgmental. huge difference.

Nugget, I know this has been up for a few weeks, but trust me- your anxiety is well founded, but isn't it true that all things that create anxiety and discord can help us grow? I had little experience in LTC when I took an ADON and then DON position in skilled long term care and it turned out very well. If you want to do it, I think you should, but do it SMART. Make sure that you have CORPORATE support and that you have other resources available to you. You cannot do it alone- the key to my success was to always ask questions and when i wasn't sure, I called my friend who was a DON. Also, just because you have less nursing experience does not mean that you haven't had other business experience. What did you do before nursing? All experience is experience, not just nursing. It is a lot of regulation and be prepared to spend your OWN time reading and learning them. Use SLIDESHARE and google to find all kinds of powerpoints and education on things that will help you. Good luck whatever you decide!

Just for comparison, my old company PPD was generally 0.98 to 1.03 - RIDICULOUS - with only 0.23 (high average) of that being RN. My new company is much closer to DOUBLE that at average 1.9 to 2.2 NURSE (not cna, NURSE) ppd with 1.0 RN. So much better, the care truly shows! (and these is a similar skill mix from old company)

Unfortunately, I just left a company with this being one of the major concerns. It was a 30:1 nurse ratio on the floor and 1 unit manager for 60 patients. No desk nurse. It was a mixed skill unit (about 25% skilled). It is way too much and very unsafe. My new company has many, many facilities, and the standard seems to be about 12-18 skilled per nurse on skilled care or 20-25 long term per nurse on non-skilled, plus a Unit manager for each 45 patients, supervisor all shifts, and lots of support from other departments and corporate. It's quite refreshing!

When I first started as a DON/ADNS, I had all of the staff meet together and passed out a list of all staff names. I had each nurse write at least 3 positive things to at least 2 separate staff members and turn them in to me during the meeting. Yes, they put some mean stuff on there, but that's ok because I kept all the papers. I then typed the positive comments on paper ensuring that everyone had at least one positive statement and then put them up, anonymously, on a public board in the facility. It was received very well and went a long way to starting morale boosting. I also had an inservice on lateral violence and how to build teamwork because lets face it, we cant do any of this alone!

Hello everyone! I know that legend drugs are prescription and non-legend drugs are non-prescription when it comes to basic definitions, but that doesn't seem to be the only explanation to how to "reduce my non-legend drug" cost at work. Does anyone have insight on this? My Administrator wants me to educate on how facilities can improve their cost management by reducing their non-legend drugs. It seems that logically this would mean reducing non-prescription drugs, but that doesn't make sense for all patients. I plan on sitting with the RDO to ask for details, but wanted some insight before I do that. I need to get a better understanding on how a LTC facility can reduce their non-legend drugs. I need some help! Thank!!

And P.S. HouTx - I agree with majority of your post, but I am leaving my current company because of the company, not my manager. My team is great, but my company is not able or willing to provide some of the things we need to provide the care for which they are asking us to provide.

I agree that in orientation we cannot engender loyalty, but the actions of the company and the amount of time spent with a new employee up front sets the tone from what the employee can expect. For example, my boyfriend left a company that had little orientation and ultimately was not well structured. Moving to a well structured company with on-boarding gave him a better feeling of security and professionalism from that new job. It really did help him feel part of the company and set the tone for his time there (he is still there). I saw a difference in how he perceived the company. That is a huge factor in loyalty, of course- depending on the size of the company and whether or not they are truly involved in activities of the business in which they own.