Trouble in Paradise

[Tina**RN]

Hello,

I am a fairly new DON of a 60 bed skilled facility. I really enjoy the job so far, but it has had it's challenges! The biggest obstacle has been the longevity of much of the staff and them being resistant to change.

My ADON has been there 15 years and is very set in her ways. She is passive aggressive and does not ever want to be the bad guy so she plays the fence quite well between staff and management.

My recent struggles have been the medication pass. Getting the staff to not push the med carts in the dining room ect..

We also have all narcs passed via nurses. We are full, census 60 and that is quite a strain on the charge nurse. We only have one charge nurse, but when your full that is a lot. So I have added a 10a - 6pm nurse to supplement for both days and evenings. This has been a huge help, but my budget will only allow for this 5 days per week. Today we had a high BP bottom number being over 100, and the CMT wanted the Charge nurse to re check it, the CN did not and just instructed the cmt to give meds and re check it in an hour. Family was very upset about this.

My adon is really good friends with this nurse, and when I instructed the nurse to always follow up on these issues, and that is stroke level for a BP.. My adon says, well the nurses are just to busy..! This is why we need that 10a-6p nurse EVERY day!

I just feel like no matter what I do she is always working against me instead of with me. It is very frustrating!!! Funny thing is.. before I came they did not have the mid day nurse at ALL!!

She plays both sided of the fence, and it is causeing alot of stress and tention and mistrust with the staff.

Problem is.. she has been there 15 years, and I have only been there 3 months...

Any Advice???

Thanks so Much!!

[marthyellen]

Be patient. Rome was not built in a day. The average stay for a DON in a building is 18 months and for a new DON is 9 months. If your ADON has been there 15 years she has seen a lot of DONs come and go and she may not trust that you will stay.

If you make changes try to make the staff feel they have some say in the changes. Have round table discussions.

It is very frustrating when the staff has excuses for not doing the right thing. Keep in mind the most important part of your job is to educate your nurses. She not only should have rechecked the BP but also assessed for other symptoms.

[Tina**RN]

Thank you so much for you're response. I really appreciate it. Trust does take time.. that is so true and change can be really difficult for people, especially if you are not used to change.

Actually, in this facility.. It was established in 1964 and since we have only had 2 Administrators! That alone is amazing!! And I am only the 5th DON!!!!

That is pretty rare and I feel blessed to be there...

My survey window will be opening soon.. any tips??

[marthyellen]

Review the most common tags for your area and focus on them. You can usually find them on the state health care association website or on the state department of health website. Look at what you were sited for in the last 3 years because the surveyors look at these as well. It is always good to start where they start.

I too am at a facility with a lot of longevity. I have been there 5 years, my administrator has been there 10 years and my 2 unit managers have been there 7 and 13 years my PPS nurse 7 years. There are challenges but mostly I feel blessed and lucky to have competent, caring and knowledgeable nurses at my side. It is very usual to have this longevity in a major metropolitan area.

Good luck.

[lumbarpain, ADN, RN]

I was never a DON or ADON but being a Charge Nurse and Supervisor on occasion, in my experience if one part isnt functioning the whole machine gets messed up. It always appears someone was always purposely working against you either because they are jealous, too overworked, or just plain dont care and shouldnt be in the medical profession. Its a conundrum. I wish you the best luck straigtening out those hard grizzle types and set in stone nurses and staff. Ps..People are always looking for compensation, monetary gain, or just plain admiration and I mean PERSONAL admiration for a job well done. I always managed to stay somewhat close to my CNAS because I REALLY NEEDED THEM. So I get to know them a little more personally and would buy them dinner on evenings once in a while. I had my days but they listened to me.!!! Hope I helped you somewhat. Good luck.

[lumbarpain, ADN, RN]

PS. and with most people.....they resent being told what to do. Its like dealing with children at times when you deal with staff. But, its best to keep yourself at their level, get their views, feel like them, a sheer role reversal. I feel Managers or DONS MUST relate and have verbal contact with their staff always. NOT JUST A BIG MEETING OR A SCAREY MEETING where they just call you in.....Just a moment where you can verbalize what is on your mind once in a while. Managers and DONS should always be there for their nurses, NO MATTER HOW BUSY THEY ARE....if there is a crisis or emergency which warrants extra help.......HECK.....get your hands dirty again!!!!!

[lumbarpain, ADN, RN]

Dont know why the ADON just doesnt take the DON job at this facility.....she is acting DON most times anyway, isnt she?

[caliotter3]

The ADON probably doesn't take the DON job because some people like to be second in charge all the time. They can snipe at the boss and undermine them as a source of personal amusement and a feeling of accomplishment. "Look at me, I got rid of another one!"

[lumbarpain, ADN, RN]

Never thought of it that way.....true.....it relinquishes a part of responsibility on the ADONs part but then it overloads the DON......a Tsunami of Guilt ensues and the workload doubles yet for another poor nurse. YIKES.

[Chin up]

It does not matter how long, the ADON has been there. You are responsible for the facility. She is your assistant, you are her boss, what do you think should be done?