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When a person is in need of care, the care we provide and the way we treat them FAR outweighs our appearance. People would rather receive good care from an "ugly" person than bad care from Ms America

So it sounds like there is a lot to learn and probably a lot of stress while at work, but there is possibility of work life balance? Right now I never know when I will have to go into work. I went three weeks without a day off. If people don't show up I am the last ditch effort. My MDS coordinator doesn't show up about half the time and my risk manager Calls in sick a lot. Plus I never got oriented to the DON position and this is my first long-term care job. I'm pretty proud that we passed survey because this is the first time in years that this nursing home has not got a lot of substandard tags. I can handle stress, but I am not giving up my weekends anymore.

Thanks for your response. It's for a payer. I'm wondering how the stress level would compare to my LTC DON position. The same corporation has a utilization review nurse position open and, although it would pay significantly less, I'm willing to take a pay cut for lower stress and fewer hours than I'm experiencing in my current position

I'm currently DON in a LTC and can't take the stress and long hours any more. Don't get me wrong, I'm doing a great job. Just passed survey with flying colors. But in the past 3 weeks I've had 1 day off and my bosses feel that's just how it's supposed to be. So I applied for a position as "Utilization Management Manager," and a recruiter called me today. I'm wondering what a day in the life of a utilization management manager would be like. I'm especially wondering if they get out of work on time and get their weekends off.

If you ever find a nursing job where you don't have to deal with ******, snarky, petty, ridiculous bosses and coworkers, too much work, and abuse.....send me the address and I'll move there! I've been an RN for 18 years and only recently come to the realization that it's that way every place you go. I'm DON now and STILL dealing with it! Of course now it's State doing it to me, and forcing me to come down on my nursing staff in order to avoid penalties. If you find a way to deal with it, pass that info my way as well. Some people just let it roll off of their backs. I wish those people could give lessons on how to do that.

The applicant I would be most likely to hire would say something like "I have a car that works and a backup plan if it has trouble. I either don't have kids or if I do have kids I have a babysitter and a backup babysitter and a plan for if the school/daycare calls and says they have to be picked up in the middle of my shift. I always remember to come back from my breaks and don't go outside 10 times per day to smoke. I spend my time working, not gossiping, and have no interest in bashing my place of employment or my coworkers. I will not be in my DON's office every day complaining about my coworkers. I do my job and I promise to stay at least one year, even if I realize this is not my dream job and I have to work very hard." Haven't seen an application like that yet.

You seem to be having anxiety over the requirements of nursing school. Are you over the age of 18, or are you a minor? Is somebody forcing you to go to nursing school? Are you sure you want to make the commitment to becoming a nurse, driving to work every day and most likely working 12 hour night shifts until you get seniority, working very hard until your back and your feet hurt, and then driving home after a long shift? Do you think you would be able to sue your employer if you got in an accident on the way home after work? Have you considered the possibility of finding a job that does not require driving, or does not require you to come to work if the weather is bad?

What are co-working spots? That sounds promising!

And it's not as if there's a nationwide shortage of housekeepers! They keep driving off my staff. So then the CNAs will be working short because we're fresh out of CNAs, and the housekeepers, medical records person, dietary aides etc. just continue to get after them like Cinderella's stepsisters. I've been very insistent and constantly repeating "Nobody is to treat my staff with disrespect," and now of course they're all going overboard and pretending they're not allowed to make eye contact with the CNAs. Freaking ridiculous.

Hmmm I wonder what I would have to pay for an office space

Hi I'm considering getting out of being a LTC DON and working from home. My cousin works in an at-home QI position for Humana now and she loves it. Unfortunately, I live in a rather rural area and we don't have cable internet or DSL. I can get 4G internet and I'm wondering if anyone on here knows if mobile internet would be fast enough?

Yes - I would think people would act like we're all on the same team, and work together to get the job done as efficiently as possible. Instead, it's a constant war between departments. I guess I won this battle. The corporate DON 100% backed me on everything and it has been made clear to the administrator and the director of housekeeping that the nursing staff are not below housekeeping. The director of housekeeping may not order my staff around. The housekeepers are to clean the poop off surfaces and laundry is to clean the poop off of the laundry. Why did it have to be such a battle? It's all common sense. Of course we went to war again today. Corporate is demanding that the floors on one hall be stripped and waxed immediately, which means that the nurses are going to be unable to use the nurses station or their computers and many patients had to be moved to the other hall for at least 24 hours. So of course everyone has to come screaming at me about it like I'm the one that ordered the floors to be stripped and waxed. When I mentioned to my administrator that my nurses need computers to chart on he accused them of thinking they were too good to use the touch screens on the walls that the aides use. I wish he would follow a charge nurse for a shift and learn what they freakin' do. I tried to explain that they have to have a surface to write on and that they need the computers to order labs and get lab results etc. etc. but it was like talking to a wall. The administrator, maintenance, and housekeeping blocked off all the halls going to the nurses station before we had a chance to take any of their charts or anything they needed somewhere for them to use it. I had to climb over the freakin barricades to get the charts etc. I had to get up from attending to subpoenas for information regarding things that happened before I became DON, to move charts, and then everyone started fighting about where the charts went. I have residents with medical issues that I'm supposed to be addressing and instead I had to spend my day dealing with BS and drama, then I actually left at 5:00 because I was so stressed out I couldn't think straight anymore. And yes - EVERYONE thinks they can do everything a nurse can do, better. Nurses are the dirt under people's feet I swear. I don't know how much longer I can do this - and it's not because the job itself is difficult but because of all the hell the other departments have to constantly give us.

When I imagined all of the hardships that would be associated with DON, I thought they'd be over more important things than poop and "who's better, nursing or housekeeping." Good Lord. I've got bigger things to worry about but it appears the head of housekeeping is going to drag me into the administrator's office tomorrow so she can complain about her displeasure to him and my corporate DON! I think what set her off was that the other day she came and drug me away from checking labs and medications to show me some laundry with diarrhea on it. I guess she expected me to go running, screaming down the hall to fire an aide for not rinsing it out in the hopper. Instead, I asked her to put it in the soiled U and then I asked the charge nurse to have an aide rinse it out when they got a chance....in between feeding and toileting and answering call lights. In my hospital days, the understanding was always that the aides clean the poop off the patients, housekeeping cleans it up off the equipment, and laundry cleans it off the laundry. I guess in LTC aides have to do ALL of the poop work. Because it requires extra special training, I guess? Anyway - I guess I wasn't mad enough to make the director of housekeeping happy. This morning while I was still in bed she sent me a bunch of texts saying she wasn't going in to do her four hours of MOD this morning because the charge nurse supposedly told somebody she didn't want her there, walking around with her clip board, ordering aides and nurses around. I am pretty sure what the charge nurse actually said was that she didn't need to come in and take care of an issue with an aide that the charge nurse and I had already taken care of. IMO, a housekeeper shouldn't be able to order an RN or an aide around. She actually had the nerve to go into a room where an aide was assisting a nurse with a resident in respiratory distress while waiting for the ambulance, and tell the aide that she needed to get back on the floor and answer call lights. The nurse over-rode her decision and I supported the nurse. But I guess that's how it's done in LTC? Every department head, regardless of experience or education, is considered an expert in nursing? I think it got back to her that I said to another one of the department heads that, if I was working as a floor nurse, I'd be damned if I'd let a housekeeper tell me how to do my job and that anybody telling others what to do needs to learn how to do the job they're supervising. I'm getting pretty tired of every single department critiquing the nursing department. I don't go room to room checking to see that the housekeepers and the social services department, therapy, and billing are doing their jobs correctly. I have my own job to do.

I've been "fired" by patients and family members a few times in my 18 years of nursing. I'm working LTC now (after ER, ICU, then home health). The most recent time I got "fired" was when I was working the floor covering a sick call where I'm DON. One of our residents has a 12:00 and 5:00 pain pill that she believes is due at 11:00 and 4:00. I brought her first pill to her at 11:05. Later, when I was outside her door at 4:00 getting ready to bring her 5:00 pain pill, the administrator brought me a letter she'd sent him. She said "That new aide you hired clearly does not know what she is doing. She was very late bringing my pain pill and I'm afraid she won't bring my next pain pill at all. I don't want her taking care of me any more." Nobody is immune from being "fired". :)

So today I had to talk to a CNA about her attitude. I reheorificed the conversation before having it - made sure to emphasize her many positive attributes before asking her to please "reign in her negativity" a bit. She's been very loudly negative in the hallways, within hearing of residents and families, complaining because she's RA and gets pulled to the floor a bit. Every time a new CNA quits, one of the reasons they give for quitting is "Tish," and her drama and negativity and constant complaining. When I tried to talk to her, she threw a tantrum and quit, and immediately got on Facebook and started bashing the facility and me, specifically. I know I shouldn't take anything she said about me personally, but there's a little truth in anything a person says. One of the things she said was that I hide in my office with the door shut because I'm afraid of confrontation. This got me wondering - how much time do most DONs spend out of their offices? I've been an RN for 18 years but only in hospitals and home health. All of my DON's spent almost all of their time in their offices taking phone calls and doing paperwork. Is this the norm for LTC DONs or do they usually get out and about more? I don't have an ADON, it's a 90-bed facility with census of 67. I have quite a bit of paperwork to do and had an open-door policy at first, but people would come into my office to talk and complain so much that I could never get anything done. So I set "complaint hours" and I shut my door when I need to concentrate.