Should I take a job at a failing facility?

Specialties LTC Directors

Published

Specializes in Hospice.

I was interviewed this past Summer for a DON position at another facility. I was the ADON and am now the DON at a very successful snf, but the team that I work with - even though they're amazing, they've all worked together for a decade and it's very hard to get into their circle. Because of that, I'm constantly kept out of the loop on what's going on with residents and staff, or abandoned when it's my turn in the on-call rotation. I've got an ADON and unit manager who have been best friends for years, and since they're both close to the administrator, my efforts to address the gross favoritism haven't been met with very kindly responses. On Thanksgiving our receptionist who was just hired, just randomly decided that she wasn't going to show up. I ended up sitting at the desk that day, which is no big deal at all - it's a desk! But it's the constant 'the DON can handle it. we're all on vacation/spending holidays/ enjoying an event together, not our problem' that has started to cause problems for me in my personal life. I have such a wonderful job aside from these issues. I just can't keep up with working 24 hours shifts on the floor when our nurses call in which is very frequently(We're privately owned and don't pay as much as our competitors - between that and being a SNF which is hard to work in anyway, that's what I've reduced the issue to.). And then being expected to keep up with all of my regular responsibilities as well. It's just too much for me as far as my personal life is concerned, I need more balance and as long as I'm there it's not going to happen.

So another snf has been after me to work for them since this past summer. I again was asked if I wanted to come work for them following their most recent survey. It was horrendous. I know the prior mgmt company was pretty awful and they were bought by someone else who's been trying to change things but no one wants to go to work there because of the reputation. I don't know much about the new owners but their most recent survey was so awful, in part because they simply don't have anyone willing to go in and work on cleaning up the mess. Is this a risk I should take? Has anyone else ever taken on this responsibility? I spent a lot of time with the administrator asking all of the questions that could cause problems later: Does the DON or at least a nurse have a say in what patients they admit? How does the on call rotation work, what's the corporate nurse involvement like and is the administrator planning on leaving at any time soon - if so, does the don have any say in the next one? etc etc. Just not sure if I should stay where I'm at or take this risk. There are other DON jobs I've been considered for but they're for companies I don't agree with in terms of the way they manage staff, patient care, etc. I'm to the point now that I don't even want to be a nurse anymore because I'm so exhausted in my current job. Not sure where to go from here ;|

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Can't speak for myself, but I worked at two facilities where DON's bit the dust after taking over horrendous situations. In another situation later on a former DON lost her clear license after getting canned by her boss. Talk was that he only used her as long as it suited him. In another career I took over a mess and got railroaded after cleaning up and starting a turn around. It seems it is not safe to be the clean-up wo/man. I would not advise this move for you.

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Specializes in retired LTC.

You know, at first I was going to say what harm could you be doing worse than where you are now. You sound like you have a very realistic & pragmatic grasp of your environment. You're not like making that stuff up - doesn't sound like you're a whiner. And yeah,

what you're talking about I have seen happen.

I remember when I took a UM position in a facility that made the local newspaper as THE WORST SURVEYED LTC/NH facility in NJ. Over some 100 deficiencies. At interview, I told the DON that I read that article and she asked my opinion. I felt there was no place to go but up. She liked that and I was hired. There were a lot of good, new people working there and we pulled the place up!!!

But then after reading caliotter3's post, I remembered that shortly after that survey, the DON was OUT by corporate changeover. Sacrificial lamb? Probably. I was shifted around too and I got out.

Changing positions could go either way for you. Same problems, just different faces. Good luck.

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Ultimately its your decision. It seems like you aren't in the loop at your current facility. They ( your UM and ADON) may try to get you out. You need to build your own team, I would not work somewhere I feel uncomfortable.

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Specializes in Gerontology, Med surg, Home Health.

Maybe it's just me, but I love a challenge. I've taken over facilities with horrible surveys and horrible reputations and have turned them around. What's the challenge in running a smoothly run building? BUT, if you think you're going to get canned after fixing the place, you might want to stay where you are, although where you are sounds pretty crummy.

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Specializes in Hospice.

I'm on call again this week and last night, an hour after getting home from work I had to go in for a nurse who started throwing up and finish up her 12 hour shift. Once again, I don't mind. But I'm a mom - and to be quite transparent I've realized that being a DON is not the best job for a single parent with no family/friend support at home. I work for quite possibly the best snf I've ever seen in 3 different states as a nurse. The people are truly amazing and you will never find an ED better than mine - her issues with her friend relationships aside. I'm going to try like hell to hold on while I finish my BSN and figure out how to transition out of SNF specialty or maybe work in MDS since I'm getting my RAC certification next week. Hopefully that'll help. Losing my job working at another facility and not having anywhere else to go after that or having to bounce around doesn't afford me the stability I need to take care of my family so I think I'll just try to hold on for now. Thank you so much for all of your insight!

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Always follow your heart, your heart beat will give you the answer and clarity that your are seeking.

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Specializes in Hospice.

I was sent to AANAC RAC certification training for 3 days this week by our consultant. Bear in mind that my facility usually has 50 medicare in the building and rarely goes under 40. We're down to 30 and my administrator is losing it. Last week I was on call and had to work a 24 hour shift. Even when I'm not on call that's a once a week thing. Our facility is known for being beyond perfect in every way possible as far as our ability to ethically maintain state and cms standards while being crazy successful since our doors opened 4 years ago. But it's at a very, very high cost. I frequently go at least 2 days a week without sleeping at all because I never leave work. I stay and cover shifts to keep our OT down. Our managers are amazing and they work very, very hard - harder than me. But after last week's on call rotation I missed writing 2 papers for school because I'm finishing my BSN full time also. I never did do them and I'm now failing both classes.

Monday because our census dropped I looked at our PPD and adjusted hours and advised our managers that even though I'd be at RAC certification I would be available to help cover whatever shifts were necessary. I immediately got a call from the scheduling coordinator telling me that one nurse had gotten another nurse to cover her shift for her - a nurse who had been called off from the OT our nurses almost always end up with due to the way our scheduling is set up. All of our nurses are advised on hire that OT isn't guaranteed and that if census drops we'll need to cut the OT..they'll still get 36 hours, just not anything over 40. It's that or they can no longer have every other weekend off that we give them since our acuity is so high. I asked the scheduling coordinator if policy was followed as far as her giving approval before the change occurred and she said no, had someone not casually told her in passing she wouldn't have known. I told her to immediately advise the nurse who was scheduled that she would need to find PRN relief or work her shift - no full time nurses could cover it for her. The shift was for the next day.

Almost immediately I received a call from the ADON asking me if I was still going to help out with shifts that need to be covered as I'd just cancelled the only nurse who was able to cover the shift. Nope. I won't help out, because they didn't follow the shift swap policy that they signed they understood when they were hired and is posted all over God's knowledge. "The scheduling coordinator did approve it. She just forgot". Insert bald faced lie HERE. Come to find out, the unit manager had absent mindedly approved the swap - knowing that only the scheduling coordinator can do that because she's responsible for answering directly to myself and the ED for monitoring PPD and OT as well as clock in/out and break times. The ADON was trying to protect the unit manager, knowing I was going to be in downtown Houston for 10 hours and would then have to go directly to the floor. I told her that whoever approved it needed to cover it, no one should have to cover for a deviation from policy that's meant to protect everyone from problems related to hours and working too much. She's never lied to me. Never deliberately put me in a position and challenged me telling me that the unit manager who was on call this week "wouldn't be able to work and you'll just have to come in or cancel your training". I wasn't angry I didn't even realize exactly what she'd done and was confused by her vehemency. She loves this unit manager and is notorious for favoritism. But I responded calmly and showed her that the nurse who took the shift knew that OT was restricted due to our drop in census.

I immediately advised the ED, which I never do but the ADON was so upset at me that I let the ED know what had transpired without telling her that I'd been deliberately lied to to protect the unit manager. I just explained that I'd reiterated that if any manager approves a schedule change or OT in violation of currently policy that only the scheduling coordinator can approve schedule changes except in extreme circumstances, they will need to work the shift they approved and that I'm here to help and support our team but no one will be responsible for the consequences of not following policy except the party who created the situation as we're all working quite a bit as it is. The ED had me go over PPD w/her again on the phone, thanked me for the communication and all was good.

Today, i get an email from the ED demanding that I respond immediately with correct PPD as we're over, and cut 45 staff hours as we're still over PPD for current census. In the middle of the PPS course. So I did it. I walked out of RAC certification, calculated PPD after going through hell trying to get someone to tell me how much staff we were running for the day, trying to get a report from HR on yesterday's time punches for our staff and subsequently replying to the ED's demand that I give her answers immediately.

The ADON then sends me a horrible text telling me that I have everybody running around in circles and she already told me 03483 times that she's taking care of it so why don't' I trust her and go back to my class. I re-sent her the email from the ED demanding answers that all of us were copied on and told her that it wasn't a matter of trust, it was a matter of responding so that our ED knew she could trust me as their leader to monitor hours vs census and that I'd been copying her all morning on all of my texts and emails trying to get info that she was STILL withholding from me - with no response. She apologized for "misunderstanding" my intent and reassured me that she had it taken care of once again - without supporting her assertion with data. Just a vague "our PPD is under 4 nobody's in OT all shifts are covered and everyone is taking extra 15 minute breaks". right on.

An hour ago I got a text from the ED telling me that all of my managers have been working nonstop, that the ADON JUSTNOW left the building and that everyone's taken a turn working extra hours except me and that we were going to need to have a talk when I return on friday.

Meanwhile, back at the ranch, a consultant nurse for another privately held SNF in our area recognized my name just from being around and had brought a bunch of her nurses to the RAC certification. She asked me if I had time to talk with her and made me an offer. She sad she'd been asking about me for months and I told her that I had no intention of leaving but would be open to discussion. Needless to say her company would be happy if I could maintain 15 medicare they'd even take 10. And they use agency - the DON and ADON work shifts to monitor patient care practices and model clinical standards. Their staff have been in place for years and they rarely ever have call ins but if a situation ever did come up that's what they use agency for. They just had their survey and had 6 tags, all related to medication storage and MAR documentation and their last DON left after 10 years. They want someone who wants to stay long term and their ADON is an LVN and she'd been wanting to see if I'd had enough at my current facility yet for awhile now.

I'm going with her to tour her facility tomorrow as she wants me to see the building before I decide if I want to discuss salary. I've been trying to maintain for so long that I didn't even realize how bad it had started to get last week with census fluctuations that are perfectly normal right now and 30 Medicare while we're in our survey window. I'm being completely taken advantage of for the ED's glory and that doesn't bother me either. It used to make me really angry but I changed since I couldn't make anyone else change. I'm still at work with no help at all from my managers because they've been a "family" for a decade and I'm new and not a part of that. But all I want to do is keep everyone positive and motivated and get through this. It wasn't until my attitude changed and I've learned better ways to deal with unfairness and stress and nonsense that everything has fallen into place. Go figure. I have no reservations about this other offer and I actually can't wait for her to confirm that she wants me so I can put in my notice.

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It certainly can not hurt to tour the facility and crunch some numbers. Being the new person is hard enough let alone being the DON.

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