stella789

I recently took over as DON where I was previously ADON and then Quality nurse for over 2 years. The executive director changed the organizational structure of our facility (prior to me taking over as DON) so now there are 2 Operations managers who are essentially the administrators-one over LTC and one over rehab. DON is supposed to be “equal” but this really is not the case. The operations managers are meant to deal with the “people” and the DON the regulatory. All of the nurse managers report to the OM, not the DON. MDS, staffing coordinator, nurse educator, and off shift supervisors report to DON. Last week I was told I’m “too involved” and they will pull me in as needed. I should also mention that of the 3 of them, none of them clinical. I literally know nothing that’s going on except what’s discussed in our morning meeting. Today state showed up on a complaint and I know absolutely nothing about any of it and was not included on anything. Instead of the nurse manager down on the unit where the complaint was, she was upstairs working on printing paperwork the state rep requested and doing other things. Im really just looking for some opinions on this situation regardless of whether you agree with the structure or not. I know there are so many knowledgeable and experienced nurses here and I’m interested to hear opinions from someone who has held the DON seat before but also just someone else clinical.

Breaking into long term care is also an option to get into leadership and I would say probably a little easier to make the transition into leadership.

I agree with Ruby Vee, there's always something to learn no matter where you are. In AL, there are sooooo many regs to learn that are necessary for compliance. I'm in St. Louis and you may not have these options where you are but we have several facilities that provide the whole continuum of care from Independent Living to AL to SNF to LTC. This week I started as ADON in one of these facilities and the LPN's are kind of shuffled between the different level of care so they do see more of a variety. These places also tend to pay higher than the stand-alone SNF's.

You could also try case management, utilization management, insurance companies

That always boggles my mind when a facility, a place of business, has no absenteeism policy. I think the points system sounds legit, hope it works out. I know my mom has a points system at both of her jobs and tardies are also included. This is one fear I had taking a management position was constantly having to cover shifts. The ADON position I just accepted doesn't seem to have this issue and there will be supervisors under me so hopefully I won't need to cover like that. But capecod I agree, I don't understand why people can't just be an adult. You're the one that chose to go out drinking or whatever, own up to it or don't do it when you know you have to work. A never ending battle I know í ½í¸í ½í¹„í ½í¸‘

Old thread but still helpful. I just accepted an ADON position at a large facility. Census runs about 140 I think I was told? Anyways, I almost cancelled the interview because I just didn't want to be on call ALL the time and the structure of a lot of facilities in St. Louis isn't as supportive as I would want. This facility has an ADON over rehab and then I will be ADON over Long term care . Each unit has a supervisor under me plus a charge. I'm anxious to get in there and get started

What you do in yourpersonal life IS your own business. However, YOU started this thread sharing your personal life, asking for others opinions. Did you honestly think everyone would answer with rainbows and skittles and agree with your decisions? You would not have posted this if you truly thought you would get all positive feedback... I agree with others that this is highly unethical regardless of how long it has been since he has been a patient. If you proceed with this relationship then you have to be prepared to accept whatever professional and personal consequences come your way. And the mere fact that you are so upset that no one here has agreed with you tells me that you are in no way prepared for this. Best of luck OP

I will definitely take that advice, thanks CCM. I have doing my research on the two companies so I can be hopefully somewhat prepared. Definitely nervous. BTW, I sent you a private message earlier!

Capecodmermaid I ended up taking the Case Management job at a Level 1 trauma center and I actually love the job but getting a little burnt out recently. It's just the same thing over and over. No longer challenged. But you are correct....why is it the case management gets the reputation of knowing EVERYTHING!?!? Just last week a nurse called me talking about a patient needing some discharge form for Afflac. I told her I had no idea what that was and she says "well can you go talk to her"? Lol I said NO! I had more than enough on my plate for the day. Anyways, I do actually have an interview for ADON position coming up this week and I was also contacted about setting up an interview for a DON position at another facility. I am really anxious and excited. I reviewed the star ratings and the tags received earlier this year and I feel like I could make a huge impact on the facility in the DON position. I have to say I'm not crazy about the ADON position mainly because I know I would be catching all of the dump from the DON and I feel like I can do so much more than that.

I'm currently Nursing Supervisor/House supervisor at LTC facility on med A unit. Leaving this facility (we'll just say "unfavorable working conditions" and needing to protect my license). Yesterday I interviewed for case manager position but then a coworker referred me to another facility for an ADON position. Obviously I don't have any job offers yet (second interview for CM position Friday) but I'm at least trying to prepare myself for the possibility of receiving an offer for each and having to decide. Just wanting to make an informed decision. Currently working on my RN-MSN L&M track so the ADON makes sense, however, I am also very interested in case management. Any suggestions from anyone would be helpful...

I'm currently Nursing Supervisor/House supervisor at LTC facility on med A unit. Leaving this facility (we'll just say "unfavorable working conditions" and needing to protect my license). Yesterday I interviewed for case manager position but then a coworker referred me to another facility for an ADON position. Obviously I don't have any job offers yet (second interview for CM position Friday) but I'm at least trying to prepare myself for the possibility of receiving an offer for each and having to decide. Just wanting to make an informed decision. Currently working on my RN-MSN L&M track so the ADON makes sense, however, I am also very interested in case management. Any suggestions from anyone would be helpful...

St. Marys and DePaul are both part of SSM, I like St. Marys better but it would be about a 20-30 minute drive from St. Charles with traffic depending on exact location. Maryland Heights is a great area, easy access to everything and close to DePaul.

That bedside shift report in semi private rooms always gets me. I know it states it is "ok" to discuss but if I'm the patient and I have some potentially embarrassing thing going on...I would NOT be ok with that. I worked at a large teaching hospital and bedside shift report was a MUST. They did frequent audits on that and the white boards. In my opinion, they could have put their focus on other more important issues...

I'm in St. Louis and just made the switch from hospital to HH for multiple reasons and I'm loving it so far. The money is surprisingly comparable here. I'm starting out prn and am also in the process of getting signed up with an agency to do some local agency in the hospital to keep up my skills. HH is a HUGE change and there's definitely a learning curve along with tons of glorious freedom Before I made the switch I did a ton of research and read through every post I could here in the HH forum....very helpful. Good luck!

I just left my assignment at an HCA facility. From what I was told it was one of the worst HCA facilities and they aren't all that bad but I was only able to stick it out 5 weeks. Needless to say I will not be attempting another Parrallon contract. It was extremely unorganized and inefficient. I could go on for days....

You may make the same at your current staff position but you have to consider that the cost of living elsewhere is not nearly as high. So while you may be making the same you should still essentially be "making" money if that makes any sense...

I actually met a traveler at my last assignment that requested on interview she only work Monday, Tuesday, Wednesday...it was more of a must. They accepted (I think out of desperation as this particular facility was 95% agency/contract). I dont mind mind working weekends at all. I much prefer conducting all of my business and anything I might want to do during the week. I guess when I worked nights I got so accustomed to grocery shopping in the morning after work before I made it home to bed or at 2 am when there was no one out and I couldn't sleep, I can't hardly stand the crowds anymore. But I agree with others, keeping your schedule as flexible as you can is your best bet. Most require every other weekend or so many a month. But I haven't worked anywhere that didn't allow me to essentially make my own schedule.

The first facility (i was there 9months) I went to was one day hospital orientation, one day nursing, and one day computers then one day of orientation. The second facility (only stayed 5 weeks) was a FULL 5 days of hospital/nursing/computer orientation. It was brutal. And the first couple days we didn't even get a lunch and even bathroom breaks were minimal. Of course orientation on the floor was only one day. I find it interesting how focused facilities can be regarding those pesky orientations we've all been through numerous times. I know it's all for compliance purposes but giving very limited orientation to the floor after making you sit through five days of the same repetitive information just seems so backwards. I'd much rather "read through" the info on my own time and get to work. But that's just me...

When I first started traveling last year my agency actually set everything up for me. I just had to provide my own mask. I just went to an urgent care. I'm in St. Louis (hometown) and I believe I went to Concentra....

I've been thinking about a career move to another field of nursing and HH has been on my interest list. But I must say that I found this thread so interesting I read every single post and have decided HH is exactly what I should be doing. I work very well with a team but there's nothing I enjoy more than autonomy and my independence. Thanks for all the insight

Yes, day shift. 7 patients is rare where I am right now but 6 is very common. I'm currently working an ICU contract but I'm really med-surg/tele.

I also agree with OKinOKC. If there is already a second IV running with a drip of some sort or you can't get a second line then I would definitely call pharmacy to check compatibility. Also, if there already is two lines then I will run the noncompatible in one line on its own then secondary the others into the other with the fluids (if receiving) or do another primary and hook it below the pump.

I would also go speak to the supervisor and bring her attitude to their attention. This way you are able to give the full story without being called in and feeling "attacked" off the bat.

YES! Great rant NedRN. I could not agree with this more. The agency is only guaranteed what we are contracted for. If we (the traveler) decide to work OT, the agency should be bending over backwards to give us incentive to work OT because that just means that much extra in their pocket. This is something I have been going over and over with in my head for a while now as I have a friend with an OT rate that is a complete joke (AMN of course). The only reason she even took the assignment was to get her first contract under her belt and will be moving on from them once it's done. I always take my weekly take home and divide it by my guaranteed hours and guage things by my "regular time pay". So if my OT rate is lower than my "rate" of my guaranteed hour, then no deal. Why should I bust my hump on my feet 60 hours a week only for the agency to keep everything I've earned?!?

Wow, I agree with most of these responses. You are definitely way in over your head. You never should have even been considered for this position without any previous tele experience or even true med/surg experience. I also agree all parties involved are to blame, but the top priority here is YOUR license! Sounds like very dangerous situations for you as well as your patients. Amiodarone drips are NO JOKE and the fact that you have never given IV Lasix before this concerns me even more (more so because IV Lasix is very common). Honestly I would get yourself out of this situation and either stick with strictly med/surg or get a staff position to gain further experience. Best of luck to you!