set up for failure

Specialties LTC Directors

Published

I need to tell you all a story because i have read some other threads of some nurses dealing with a decision i once had to make. I have worked in long term care for almost 15 years. I started out as a CNA in long term careand went back to nursing school and received my associate degree in nursing. I have worked in the er and telemetry/med-surg but decided to return to long term care because I feel good skilled nurses are desperately needed plus it is what i have always loved. I have been a nurse for 5 years. I worked as a RN supervisor but was approached to consider the job as DON. At first I thought maybe i needed to work and get more experience first, but it was my dream to become a DON at some point and time so I accepted the opportunity because I wanted to make a difference. Well it did not turn out how i planned. I know now I was not prepared for this challenge just yet. I still don't know where I went wrong, but nothing went right. I felt as though even though I was the DON none of the decisions were made by me but corporate. And when the #### hit the fan the responsibility fell on me. It got to the point where i could not depend on the staff that was hired to do a job could not be depended on to do their job which put more responsibility on myself because i wanted it done right and so did my boss. After leaving the position I was devastated because I have never failed at anything like this before. I take so much pride in my work and wanted so bad to succeed. Where did I go wrong!!??? Is my dream of being a DON over???

well with the big fines I am sure my hours are gone with that. There is always something to do at the nursing home. I dont know about physically being a full time nurse aide lol that is the only thing readily available. I could stay busy 24 hours per day. Nurse aide proficiency audits, fall risks assessments, careplan updates, Nurse proficience audits and the list goes on and on. But they just hired a full time ADON because I could not do it anymore since I had my last son who has downs syndrome he really needs me and has lots of therapy appointments not to mention, dr appts. My husband my mom- just give in your notice. I am not a quiter and I did not even stop working while I was on chemo I did cut hours back but I want to stay in the game. But I also dont want to lose my license and sad to say as long as they keep a few extremely poor nurses this is only going to continue. I am only doing MDS stuff according to cooperate people and they think that is just point and click- actually had them say that. They get mad that nurses control the money so they have commented several times. Well I did not make that rule for RAI assessments dang this gets fustrating. I have a few days to think on where I go from here.

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Yeah -- I am just bummed because I truly love teaching the nurse aides and when that light bulb turns on I feel very good. When they go on and get there nursing license I feel even better. When I have the residents tell me hon, you are sure putting out some nice girls to take care of me. I feel very competent in the Instructor role- in the MDS role I dont always feel as secure as I should and the Care Plan - I feel I do ok but am not an RN yet so somethings I still need to brush up on. I did apply for a teaching job near by so hopefully that will work out will have to drive some but should not be too bad. I am just considering al my options

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Specializes in LTC since 1972, team leader, supervisor,.

The surveyor said that the nurse failed to do an assessment, and I agree, the resident was transfered to the hopital, and had another CVA and passed. Looking at it from the nurse's standpoint, this resident had frequent emesises and dx that supported that. She was aphasic and a hemi due to previous CVA, she was difficult to regulate coumadin--she would have a critical INR with the slightest change. The DON came to me yesterday about the plan of correction and kind of dumped it in my lap, which is ok, but she was very scarcastic. How are you going to fix this so it won't happen again. What constitutes a change of condition and when do you call the family and dr, it is subjective and every resident is different, the first emesis and every single one after--next we will be calling for pooping. I feel that if the nurse had done at least a full set of vitals, and did a head to toe assessment for that first emesis, we would not be sitting in this kettle of fish.

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OH gosh I just was up all night doing an inservice regarding changes of condition with will email it to you if you like

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Specializes in Gerontology, Med surg, Home Health.

Unfortunately, surveyors tag us and sometimes that causes us to go overboard with our plans of correction. We took a tag once for failing to notify an MD of an abnormal lab....the lab was 2 points above normal and the resident was fine. The DNS said we were going to call every doc with every abnormal lab. The doctors had a hissy. WHY ARE YOU CALLING ME WITH A BUN ON A 99 YEAR OLD WOMAN WHEN IT'S ONLY ONE POINT OVER NORMAL???????? The poor staff nurses got hollered at every day. The docs demanded to speak to the supervisor. I had to explain the whys to them and we came up with a plan. Each doc wrote orders on when he/she wanted to be notified that were patient specific. It took a huge amount of time but in the end it worked.

When I do plans of correction now, I try to base them in reality. Why have a plan that you can't possibly follow?

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yeah that is why we got so badly tagged this time on falls because the old RNC put will do fall risk assessments by 24 hours after admission, q 3 months, q 48 hours after readmision and a post fall assessment that was 10 pages lol. and to do them correctly you have to get orthostat. bp's, well most just put 0 on that section and forget about it. I use to do them all when I was there 5+ days a week but now only 3 days well without the class I can be working on stuff more. and I have learned a lot about what they want to see on a careplan regarding pain. So I just have to look at it as that. I was told if I want the class back 'I" need to appeal -- I am clueness how that process works. Gosh I so wish to have some guidance and it makes me want to study harder because I want to be able to help others and know where to get the information from if I can not get it from higher up's . I did make some mistakes on the CP's, I can see and I see that I will have to daily communicate what is going on with the residents for the days I am not there because it sure as heck will not be in the charts. When I go back monday I plan on hitting the floors running, and talking to every resident I see about anything and everything but I know I am not super nurse and still unsure if I am up for this after this process.

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Specializes in Med-Surg, Ortho/Neuro, LTC, OR.

Hi there. I am a new DON, about 5 months in. I am pretty young (30) and worked Med Surg, Ortho, and only LTC for 7 months before moving into this position. So far, it has ran smoothly and the clinical systems are vastly improved. I do work for a privately owned facility which I feel contributes to my success. If I want to change a policy, I write it and put it in place. The control I have over my department and its function really helps. We are in survey window, and I feel really prepared. Now beforehand my job title was "Nurse Manager" at the previous LTC facility I was at for 7mos. That place was corporate ran. BIG difference. I would not want to be a DON there. I understand the corporate way and it can be so hard to be successful in that environment. Thoroughly evaluate the whole picture before blaming yourself.

Do they support your decisions or ideas? (Corporate)

Do you have a strong team and ADON?

What was the status of everything BEFORE you came?

What have you cleaned up or improved?

DO you work well with the NHA?

Keep your chin up. Being a DON is not always easy!!!!

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Specializes in er,med-surg, telemetry,long term care.

Thanks for your comment. It helped me put alot of things in perspective. To answer your questions No Corporatn e did not support me. They would come with their bright ideas on how things need to be, ask me my opinion but still go with their plan. Thats what irritated me the most. I am there I know what I need to have to run a successful building but i was not allowed to do that. To be honest I inherited a mess and I was only in the position for a year and it was gonna take a lot longer to fix the problems in that building. I did have some things improve but it was only because they became my personal projects and my ADON was no help to me, but it wasn't her fault. Corporated decided to drown her in other duties. The previous administrator that was there was great we got along very well and worked together and dealt with issues head on. We both believed in being out there on the floor and seeing what was going on. but when this administrator resigned. and the corporate administrator came I feel she had her on agenda already to replace me because we definitely did not do things the same way. We were not compatible at all. Reading everyones comments has helped me put things in perspective but I still dont know if I would ever take another job as DON even though I still feel I could make a difference and change the culture of LTC, but I dont feel like i would be given the power to do so as long as corporate wants to run the show.

:nurse:

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