Tina**RN

Thank you so much for you're response. I really appreciate it. Trust does take time.. that is so true and change can be really difficult for people, especially if you are not used to change. Actually, in this facility.. It was established in 1964 and since we have only had 2 Administrators! That alone is amazing!! And I am only the 5th DON!!!! That is pretty rare and I feel blessed to be there... My survey window will be opening soon.. any tips??

Hello, I am a fairly new DON of a 60 bed skilled facility. I really enjoy the job so far, but it has had it's challenges! The biggest obstacle has been the longevity of much of the staff and them being resistant to change. My ADON has been there 15 years and is very set in her ways. She is passive aggressive and does not ever want to be the bad guy so she plays the fence quite well between staff and management. My recent struggles have been the medication pass. Getting the staff to not push the med carts in the dining room ect.. We also have all narcs passed via nurses. We are full, census 60 and that is quite a strain on the charge nurse. We only have one charge nurse, but when your full that is a lot. So I have added a 10a - 6pm nurse to supplement for both days and evenings. This has been a huge help, but my budget will only allow for this 5 days per week. Today we had a high BP bottom number being over 100, and the CMT wanted the Charge nurse to re check it, the CN did not and just instructed the cmt to give meds and re check it in an hour. Family was very upset about this. My adon is really good friends with this nurse, and when I instructed the nurse to always follow up on these issues, and that is stroke level for a BP.. My adon says, well the nurses are just to busy..! This is why we need that 10a-6p nurse EVERY day! I just feel like no matter what I do she is always working against me instead of with me. It is very frustrating!!! Funny thing is.. before I came they did not have the mid day nurse at ALL!! She plays both sided of the fence, and it is causeing alot of stress and tention and mistrust with the staff. Problem is.. she has been there 15 years, and I have only been there 3 months... Any Advice??? Thanks so Much!!

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Please email me a copy. Thank you Tina...

I am a new Director of Nursing in a small Non for Profit home that was opened in 1964. Most of the employees have been there 10-25years. I have never seen longjevity like this before! It is an exceptional place, I can see why people stay. The benefits and the staff budget is awesome!!! I am only the 5th DON ever and the current Administrator is only the second ever!! I love this job and am so thankful to have it. I am having just one small problem, the ADON has been there forever as well and she does not take to change well at all!! And to top it off she has some really odd views on things and since this is the only nursing job she has ever had this is all she knows. Example: There are no standing orders in this facility and she thinks its horrible for me to ask the medical director to look over some of our protocals and get some standing orders in place. She panics thinking about doing anything like that stating that would be against state regulations. I want standing orders for tylenol, mom, and skin tear protacol.. ect. She freaked out when a nurse put TAO on an abrasion without first getting a doctors order!! Also she had major stress because I took all injectable meds off the TAR and put them on the nurses MAR. I felt all meds should be together, but they have been placing it on the TAR so she just could not handle this change. She only wants moisture barrier cream (like calmoseptine) used IF there is excoriation or superficial open areas.. I say use it with incontince reguardless.. lets be proactive! Preventive care is important also .. but she says NO, state can give us tags for this, it will set us up for failure... WHAT!!?? I mean it's little things that should not be such a big deal and she goes on and on and on about them and it DRIVES ME CRAZY! She can not handle change well AT ALL and it makes trying to bring this place up to speed very difficult. And this is not a place that is a revolving door, these people have been here forever!! She is a fixture that is there to stay.. How should I handle her? How can I help her see another way? What should I do? Thanks in advance!

There is another RN there that they do not title, ADON.. but she does wounds, and MDS. It's a small place, 60 bed. The administrator has been there 20 years and she does all the staffing her self.

Wow! This made me giggle! What have I gotten myself into!!??!! No, I am actually ready for the challenge! To be honest, the fancy lunches get old after a while! lol... Ok, what is a good description of what you do.. Do you keep a close eye on your MDS process? Do you have a morning stand up meeting? How is your QA meetings? Do you do all the employee counseling? What is the survey process like? Wound reports? Falls? Oh, I could go on and on... lol BTW, have you ever considered getting your administrator's license?

Hello, I just recently accepted a DON position of a small home in a rural area near my home. I have been an LPN for 13 years and recently went back for my RN. The last 8 years of my career as an LPN I found myself in positions of leadership where ever I worked. I've done MDS, ADON, Wound Nurse, Infection controll ect.. I left LTC 3 years ago and went to home health because I was so tired of the politics in LTC and stresses that came with it. The break was a good one and I gained a lot from trying something new. This past year I have worked as the DON for a HH company. As the director of this HH agency, the majority of my time is in a big fancy office at our city location. I rarely have any direct patient contact. I do a lot of teaching, marketing, policy writing/renewals ect..ect.. There are many things I love about this job, but have found myself missing LTC and that day to day contact with my residents and their family's. There have been a lot of perks and goodies for me as management here, but I no longer feel like a nurse. This longing is what has led me to accept this position as DON. It's a Not -For- Profit home so the pay is substandard, but I believe the care is fantastic there. I will no longer have the big beautiful office, the fancy luncheons, go on the trips to HH seminars whenever available, But I will get to see and feel the effects of what caring for others is all about. I will get to see the fruits of my labor and that brings me great joy.. I have never been a DON of a skilled facility so any thoughts, Ideas, suggestions, words of wisdom ect would be greatly appreciated. I am hopeful that because this facility is not Corporate owned, my experience will be a more positive one. Thanks In advance for your input...

I do not believe a title is what defines a person. The old saying, "Actions speak louder than words" rings true here. I think nurses are special people and we need not loose sight of that or why we became nurses in the first place. There is a place for all of us.. CNA, LPN, RN, ect...