Thinking of taking a DON offer

Specialties LTC Directors

Published

I am currently the MDS/POC RN in a 65 bed SNF/NF facility in Central

Iowa.

Our DON gave notice on Thursday (she will be greatly missed). The ADM

asked on Friday if I would consider the DON position. My children are

all grown and away from home, I love and know the residents, and I

like what I am no doing.

What should I all consider in looking at this position?

Staffing is always an issue...Medicare/QA/Restorative RN is strong

but does not like restorative or QA...Current Skin/Treatment/Staffing

LPN is also strong but does not like staffing.

What should I do??? Any info or ideas will be most helpful.

Thanks in Advance

SU

Specializes in Geriatrics, WCC.

I agree with CCM. I run the nursing department and usually go over financial matters with the NHA. I have in the past, worked with an NHA that was an RN and the previous DON ..... she micromanaged the nursing dept terribly and I almost left but, she is the one that left.

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Specializes in Case Manager/Administrator.

The role of an Administrator vs DON

As an Licensed Nursing Home Administrator my license goes on the facility wall. I sign the survey, and am responsible for the facility operations. Now the DON is responsible for the nursing department and I DO NOT interfere with those operations I do however ask for reports to ensure policies and procedures are being upheld (mostly finances). I have the upmost respect for nurses as I am a student nurse as well. I too think DON's job is tough but can be rewarding if you have support and a good facility.

An Administrator also works closely with Dietary, Housekeeping, Billing, Activities,Social Services and other department areas as we are trained in all areas of the facility operations. My job is to make sure all employees have what they need to do their job correctly to the best of their ability, and to ensure that the facility is safe and all provide competent quality care. Think of the Administrator as the conductor. It takes at the very least a Bachelor Degree in Business preferred Health Care Administration to become an Administrator. You take a national exam and alot of those questions deal with nursing issues. Some states also require a state exam. It is not easy and more common than not most LNHA have a Masters Degree in Business or Health Care Administration.

Long Term Care is the second most regulated industry in America....

the first regulated industry is nuclear energy.

Salaries depend upon experience and size of facility you can go out to web sites and get info but I average for a 120 bed facility 100,000 annually working average 12 hour days no overtime.

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Specializes in Geriatrics, med/surg, LTC surveyor.

I found it good experience but I wouldn't take it if you plan to stay there. What everyone has said is true. It is extremely rewarding and extremely frustrating. It is a 24 hour job. Your Administrator (no offense to Administrators here) will alot of times not support you. You are golden until the goal is reached then reality strikes. If the home is in trouble, they will give you everything you need to get back into compliance. All the staff you need, all the supplies, etc, etc. Once you have passed the survey, they clamp down on all of the above. I have been a DON 4 times. You do all of the work but get none of the glory. Of course for me, the glory was in my patients, so that was ok. I realized that the DON role was a short term role so became a trouble shouter. Once everything was in place, I left. That can be discouraging. The last job that I was DON at was recently. I loved the facility and planned to stay. But I could feel the writting on the wall. If you are known for being able to pull things back together, they will pay you very well, then put the pressure on you because they want someone cheaper. They will find a way to fire you. I never let them get there but I knew what was going on. There are exceptions, but they are very few and far between. A great MDS nurse is hard to find. If you are really good at that, I would stay in my nitch. :heartbeat

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No venture no gain. For me, life is about taking risks.

Though I am preparing myself for the nursing program and dont hv any nursing experience to be able to give you more effective advice, somehow I just wanted to give my humble opinion from my perspective.

Having worked in the company for a no. of years wld put you at an advantage. If I were you, I think I would take the offer. I cannot deny a DON position (like other higher level positions) entails alot of responsibilities. You will be answerable for the major things that go wrong, that is the expectation.

If you are a committed and responsible DON who does a good job and competent, I dont see why you ought to worry of "being fired". Should something inevitable happens(beyond your control), and you are made to take the responsibility and are fired it would be deemed as unfair dismissal. If that happens you would be able to provide legitimate reasons to prove to the Company and if they still fire you there is the law to protect you. There is no such thing as unreasonableness... to fire someone the Company has to have valid reason, otherwise it wld be deemed as victimization.

Speaking as a HR Manager and a degree in Industrial Relations with the assumption that the American law is not different from the British legal system.

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Specializes in Geriatrics, med/surg, LTC surveyor.

I don't know about Ohio but Tennessee is a freewill state. You can quit at will and they can fire you at will, no reason. Just something to check out if you do decide to take it.

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Specializes in Gerontology, Med surg, Home Health.

Most DON's are employees at will just like anyone else. The employer does not have to have a reasonable reason to fire you...a bad survey is sometimes all it takes.

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I have been offered a DON position with the stipulation that I can bring on a clinical specialist/ADON, RD, and MDS supervisor, and specialized training with coporate/regional support for at least 6 months. I have worked as a house sup in acute care. Would appreciate any feedback.:bowingpur

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I'm currently a DON. It SUCKS with a capital S. It is the worse job that I have ever been in. I am seriously praying that I can find a different job ASAP.

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Specializes in Gerontology, Med surg, Home Health.
I have been offered a DON position with the stipulation that I can bring on a clinical specialist/ADON, RD, and MDS supervisor, and specialized training with coporate/regional support for at least 6 months. I have worked as a house sup in acute care. Would appreciate any feedback.:bowingpur

House sup to DNS in LTC???????????????????????? Good luck. If you don't have many years of LTC experience, you won't be able to do it. The responsibilities are very different as are the regs.

When I was the nurse manager of a very busy sub acute unit, I had to visit a family member in an ICU. Of course it was an emergency so I went in my scrubs. The nurse asked me where I worked and when I told her she said "I tried sub acute and couldn't do it...too many patients, too many regulations...one guy is about to code and someone is yelling because they missed their appointment with the hairdresser!" She said her job was much easier.

They are two different worlds...that plus they want you to bring an ADNS, RD, and MDS expert with you. If the facility needs all those key players, it wouldn't be a good place for your first DNS job.

Think long and hard before you accept.

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I have worked at my present job for 1 year. There have been 2 state inspections. Both of the DON's were fired after each inspection.:crying2:

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Does it help if I am currently a Long-term care state regulator that is SQMT qualified?:bugeyes:

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Specializes in Gerontology, Med surg, Home Health.
Does it help if I am currently a Long-term care state regulator that is SQMT qualified?:bugeyes:

nope.

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