LibAnne10

This site has some excellent information to share with staff: http://www.dads.state.tx.us/qualitymatters//qcp/nf/index.html I hope it helps! Libby, RN, DON

We use a product by Hormel called Fiber Basic. It's used during the med passes and the residents really like it. Here is a link for more information: http://www.hormelhealthlabs.com/protocols_bowelmanagement.aspx

Here is an interesting article about the flu vaccine: http://chemistry.about.com/cs/howthingswork/a/aa011604a.htm

In North Carolina there is a regulation that the Director of Nursing may not work as charge nurse if there are more than 60 skilled beds. We have 60 skilled and 72 assisted living residents and I have passed meds on a few occasions as the DON. I started there as a charge nurse, so I was aware of the routine, but it's not an ideal situation once you get out of practice. The last time I did it those poor residents were really wanting their regular charge nurse back! We have 20 skilled residents assigned to each charge nurse on each shift with the same duties as described in the first post. We also have an RN supervisor (7a-7p) who assists the charge nurses and relieves them for breaks if needed. On our skilled/rehab unit we have 10 residents per nurse and our memory unit is 10 skilled plus 10 assisted living per nurse. We all know how fortunate we are to work in this place!

Most of the time the only reference you can get are dates of employment. I know that subjective information is often baseless, but if a trusted staff member has informed me of specific reasons that an applicant would not make a good coworker then I take their opinions into consideration. We include our CNA mentors in the interview process and take their opinions seriously since they will be working with them.

One of the ways I find out about potential employees is by maintaining relationships with the other DONs in the community. We require a local criminal background check that they get at the courthouse before they are even hired. This has also kept potential "criminals" out. Another thing I do is take them on a tour of our facility and introduce them to as many staff as possible and then get the staff's input. A few times I've had our employees tell me "don't hire him/her" if they know something about them. The last group of survey people really focused on our abuse policies and quizzed staff members to find out what they knew about our policies. I used to work at a facility whose management staff did not want to hear anything negative and would put up with less than good care of the residents. The reputation of those types of facilities is well known in this area and they seem to be able to continue to operate. I don't know what the answer is, but I do know many DONs that do an excellent job and become frustrated when profit is more important than care.

North Carolina regulations do not allow residents to be disturbed before 6:30am. Residents may choose to get up earlier, but it cannot be for staff convenience. Our third shift is assigned 2 residents each to get up each morning, starting at 6:30am. It is always challenging for 1st shift staff to get residents up and into the dining room by the time breakfast is served. We are trying to work with the dietary dept. to help with "culture change" to allow those residents who are not early risers to still be provided with a fresh hot breakfast.

I don't keep up with places around the country, but I know of one other facility in my state that was able to be awarded the NCNOVA licensure. I'm involved in NADONA (DONs in long term care) and most of the members are not as fortunate as I am to work in a facility that puts residents before profit margins. If we have better jobs it leads to better care for the residents. It doesn't take alot of funding and could lead to higher reimbursement for the facilities that are willing to do the work. I hope more LTC leaders will accept the challenge. Thank you for the work you do to help our seniors.

This is the first time that I have posted, but I feel compelled after reading this thread. I am a DON in LTC. I started out as a part time charge nurse at my facility almost 13 years ago. On many occasions it was me and one CNA for 20 residents, but we worked together to give the best care we could. After years of many complaints from residents and their family members, more staff was hired each year. I have been the DON for over 5 years. During these 5 years we have worked to train our staff, created a CNA mentor program, trained the charge nurses in coaching supervision and were first in the state to receive a special licensure. Every survey we've had has been deficiency free. Last year our CNA turnover was 10 percent. The only time we lose a nurse is if they retire or sadly pass away. We do not pay as much as some of the facilities in this area, but our staff feel valued and appreciated for what they do. We do not have to advertise for nurses or CNAs. I have stacks of applications and not enough openings. All of them are from our current staff telling their friends about their great workplace! The changes that we have made did not happen over night, but they did happen! Ours is a non profit facility and from what I've seen profit is the only factor keeping others from doing the work it takes and our government officials are the ones that make that change.