View Full Version : Encouraging LTC Nurse Administrators

02-19-2008, 11:41 AM
I was a DON for 7 years. 2 weeks into a new position I was involved in a wreck with a tractor trailer truck on my way to work. I haven't been able to work since. The Doctors told me that I would need face the fact that I could no longer nurse. I was devastated. Nursing was all I knew.
I continue to be a nurse advocate but my career has shifted to writing. I am a Christian Inspirational Writer and Author of two books.
I have always kept a journal, especially during my years as DON.
I really would like to mentor new DONs and ADONs. So if I can be of service to answer questions I will be glad to.

02-20-2008, 11:28 AM
May the good Lord bless you and keep you. And give you peace.

Follow the Leadership of Jesus
(1 Thessalonians 2:4-6 NIV) On the contrary, we speak as men approved by God to be entrusted with the gospel. We are not trying to please men but God, who test our hearts. You know we never used flattery, nor did we put on mask to cover up greedóGod is our witness. We were not looking for praise from men, not from you or anyone else.

Ask yourself why you do what you do. Do you do it so that you can advance yourself? Or do you make your decisions based on the good of all involved? As a nurse you will be asked to make some stat decisions. As an RN you are ready for that. But as a manager you may find yourself stomping out small fires all day long.

You must know from where your motivation comes. Every decision that you make is going to affect someone. Think about that before you act.

Donít react. Think about your reaction before it occurs. You can either think about it before you react or you can think about it after you act. It is your choice. Clean up now or clean up later.

Most decisions that you must make in nursing administration do not have to be done in a hurry. People around you may be in hurry but you usually do not have to be too. Just because someone else is all stressed out donít mean you have to be.

If you arenít sure about the decision you are making, go to your office and pray about it. It is ok to excuse yourself to think and pray. You donít have to say another word, just because someone is confrontational doesnít mean you have to participate. Stop and pray. Think. Think about the leadership of Jesus. What would He have done?

Making decisions can be very frustrating at times and people may push you. A person in your position may have to make several decisions in a short period of time. Donít let the frustration and stress over come you. Just take your time, take a deep breath and think about how your decision will affect your patients, their families and your nurses. Triage the problems and then care plan itójust remember to base your decisions on Christ and His teachings.

All your decisions will not be popular and may require a little extra effort on someoneís part, but if you keep your focus on pleasing God and taking care of your patients you will always make the right decision.

Being a nursing administrator is a lonely job sometimes, but you are not alone, God will help you. You have a high calling as a nurse, He is there for you. Just ask Him.

Dear Lord, As I face my work today, help me to keep You close in my heart so that the decisions I make will be the right ones. You are always right and I trust in Your guidance as I care for my patients and direct my staff today. Let Your light shine through me. In Your Holy Name I pray, Amen.

02-20-2008, 12:36 PM
Thank you for the encouragement.

02-21-2008, 05:35 PM
you are very welcome--Here is some more:
If you are like I was when I was a DON in LTC I needed all I could get.........................

Be Someone to Stand in the Gap

(Ezekiel 22:30 NIV) I looked for a man among them who would build up a wall and stand before me in the gap on behalf of the land so I would not have to destroy it, but I found none.

Ok. Letís say that that today God is looking for someone to stand in the gap for your patients or possibly your staff. Possibly He is looking for an advocate. As nurses you have to know what you stand for. Decide what you stand for and stick to it.

Your patients, their families and your nurses are your charge. They are all depending on you to be strong. Strength comes from knowing and doing what the Bible tells you to do. It is possible that you may have issues coming at you from every direction.

You have already decided that you are committed to your position and that you are not just an advocate, you are the head advocate of your facility. Jesus is your advocate. You have the best connection there is.

It would be so easy to turn your head and ignore things that you see that are wrong. Your job would be much easier if you just went along with some things and covered up other things. But, as a nurse administrator your job may be to put everything aside to investigate an allegation of abuse, or set up med cart checks because you think possibly your patients arenít getting their meds on time. Whatever the issues that comes your way, be strong, be courageous and stand in the gap.

I figure by now you already know that this job you are committed to is not an easy one. You probably do not get paid enough to stay at the facility 60 hours a week. But that is not the point. The point is that you must stand in the gap for your patients. Donít turn your head when you know something is just not right. Go with your gut instinct.

You may not be able to delegate everything. There are just some things that you will have to do yourself, not for any reason except that it is the right thing to do. Stand in the gap. Be the person God is calling. He has put you in this position of authority and to Him you are responsible.

The encouraging thing about that isóHe has got your back. When you feel the nudge to do the right thing, donít wait till He has to push you. Just do the right thing even if it is not the easiest thing. Youíll grow from it and your patients and your staff will respect you in the long run.

Stand in the gap!!! Be a wall if you have to, God is there to help you every step of the way. Think of it this way, what does God want you to do? It is ultimately Him that you are working for.

Dear Lord thank You for guiding me and helping me to be an advocate for my patients and for my nursing staff. Help me to evaluate issues according to Your will for me, my patients and my staff. We are all in Your hands; help us to stay in Your will. Thank you for encouraging me today.

Feel strongóGod has got your back.

02-22-2008, 12:35 AM
Hi Gracenotes1,
Being a nurse, and a manager of nurses is a complex and often difficult thing. There are times when as you say you have to stand in the gap between patients and staff, in making sure that what happens for them is right for that situation. However, people gather their strength to meet these challenges in different ways.

Religious belief, of whatever denomination, is what some people have within them that gives them the strength and what they believe helps them to make the right decisions. I say of whatever denomination because it would be my belief that nurses who visit and contribute to Nursing Voices are from a large range of backgrounds and would be of different faiths. However, I can see that this would hold true for them.

However there are people out there whose conviction in a higher religious being is not so strong, and those people often gain strength to do the right thing, in the right way from other means. I would count myself within this. I have faith, but it is not part of me every day to the extent that I would look to a god to help me make decisions. For me I look within, and I also use the support of colleagues around me. I think, reflect, discuss, analyse and ultimately make decisions. I don't think they are any less effective, or I am any less worthy for that.

I think what I am trying to say here, is that we all gather strength from different places and we must recognise that. We must value each others culture and faith and recognise it may not be the same as our own.

02-22-2008, 06:41 AM
Possibly I could start a new thread and label it Christian Encouragement for LTC Administrators? Would that be better?

02-22-2008, 07:55 AM
Possibly I could start a new thread and label it Christian Encouragement for LTC Administrators? Would that be better?

Yes you could. However, you have some great things to contribute for everyone and that way others wouldn't know it as they wouldn't read the thread. Just trying to offer up some food for thought, what do others think?

02-22-2008, 09:32 AM
Maybe it is best if I just stop the long post to begin with.
I realize that these really are too long for a forum. sometimes I just have so much I want to say--Maybe I talk too much!! That is why I write--hahaha

Thanks for your reply. I'll just let this thread stay as it is and I won't add anymore long post. I didn't think I was being annoying but now I am even annoying myself. hahaha


02-22-2008, 09:48 AM
(((((a hug for Angela)))))

You do have great things to share. Keep sharing them. But do so more concisely, please and thank you. My tired presbyopic eyes and my short-term memory deficits (both courtesy of advancing years) can only manage so much at a time! :)

Since you like to write, perhaps you could also contribute to the non-nursing topic thread I began in The Breakroom which is entitled "My Mother." A couple-three of us have posted family stories there.

Onward, then! The best is yet to come.


02-22-2008, 10:39 AM
Yes Please keep posting Angela. You have lots to contribute here. You are an experienced nurse and manager and we need you to provide that wisdom for others.

I do hope I haven't offended as that was not my intention. :shakehands:

02-22-2008, 02:32 PM
First I want to thank Julie for saying much more gracefully what at least a few of us have also thought/felt. Angela, you do have a great wealth of experience that is clearly leavened with intelligence and insight. I too have a large investment in LTC, and trying to figure what we can do to help a clearly broken system. That's part of why I'm involved with the HCGNE Nursing Home Collaborative (

But when you started this thread by quoting the NT, and then I scanned down and saw all the G_d talk, well, I stopped reading. I think Julie phrased it beautifully in trying to make the concerns universal, but I guess I want to add a personal perspective:

I'm Jewish and a child of the holocaust -- not in that any one from my own family was lost (more like they were killed in Russian pogoms that were incited by "blood libel" -- killing Jews because we supposedly use Christian baby blood in making Mazo), I was raised in an atmosphere that emphasized celebrating/holding onto my Jewish identity. When people start talking about their beliefs in such a way that make it feel like they are stating universals, I get uncomfortable and yes, feel a bit threatened as I feel it is erasing the possibility of any other way of approaching one's spirituality/idendity.

Just as us 'mericans need to remember that this is an international discussion group, those of any dominant paradigm (be it white, heterosexual, in this setting female, etc.) need to remember, and leave room for other ways of perceiving and approaching the world.



02-23-2008, 09:07 AM
Oh no--I am not offended!! I have been a urse for 20 years it takes a great deal to offend me. hahaha
Maybe I can write some shorter type devotionals. I have so much going on right now with my book and everything involved in promoting it. Plus, I have signed up with to help recruit new nurses. I am a busy busy retired person!!!
I enjoy reading and posting here.


02-23-2008, 09:10 AM
I am so sorry Miriam. Please accept my apologies for being so thoughtless and not considering the feelings of others. Please forgive me.

02-23-2008, 03:21 PM
Angela, you are more than forgiven. I know how it can be that something this is so central and important to one's life can make one blind to other's perspective. I am glad you're part of this community and here to share your knowledge.

02-27-2008, 06:52 AM
I have been trying to think of some tips that I could give to Lonng Term Care Administrative Nurses: Especailly for DONS

I came up with a few that helped me during my "tour of duty"

I'll just post one at a time--see if yall have any comments or tips that you have found helpful.

(1)*Attend care plan meetings at random* (sneak up on them):):creep:

It helps to show support and involvement. If you are interested in the MDS Care Plan process then your staff will be interested as well. Spend a day with the care plan team and do so frequently. And never let them know when you might be coming. Give your input but also be there to learn.

For example: We had a little problem with our care plan team getting all cozy in an office and just MDSing and care planning their little hearts out, amongst other things.

These MDS assessments could not possibly have been accurate because you cannot do an assessment without assessing the patient. So first problem solved, MDS coordinators had to actually do assessments. Now I know that might sound crazy because what kind of nurse would complete an assessment and not assess the patient? The answer is a lazy one and an overwhelmed by paperwork one.

How could a licensed nurse sign her name to an MDS that she completed without ever even seeing the patient? Believe me, it happens and as the DON or nurse administrator it is your job to make sure the MDS reflects an accurate picture of the patient at the time of care planning.

What good is an MDS and a care plan if it is not for the care of the patient? Yes, I must admit that the MDS was created by the government and it does not make sense in some places but the overall concept does make sense and it is what we all learned in nursing school. It is an assessment, an ongoing assessment.

It has to include the actual patient. Without an assessment how can you set goals and interventions?

I was a sneaking little DON. My nurses always said that I could be standing right behind them before they ever saw me coming. I learned alot by doing that. hhahahah And it tickled me!!!

So--what do yall think about that?:questionmark:

03-02-2008, 09:10 AM
Calling all nurses!!!
Consider yourself HUGGED today. You deserve a great big bear hug!!
For every patient you have cared for this week. For every Doctor you have dealt with professionally without hitting him.
For every family you have encouraged and helped
Consider yourself hugged!!!

03-05-2008, 10:58 AM
One of the most effective characteristics of a great leader is the ability to listen. Many times I have heard people complaining about their boss saying that ďthey just donít listenĒ.

Listening to other people is sometimes difficult for one reason, it takes time. Time is not something that you will have an abundance of, but there are ways to save time and listen effectively at the same time.

Because you hold the position that you do many people will want your undivided attention. You will have staff members that will want to talk to you, you will have family members, patients, your boss, other department heads, hospital social workers, and sales reps, well the list could go on and on. You will have to take the time to listen to people. Take notes and really listen.

Say for instance, one of your 11-7 LPNs is waiting on you when you arrive first thing Monday morning. Now, on the first thing Monday morning you will have many things on your plate and a thousand more things on your mind. But, you will have to take the time to listen.

So approach these Ďlistening sessionsí with an open mind. Probably and more than likely it will take this LPN 5 minutes to tell you what they want you to know. Your response and your reaction will dictate how much time it cost you after that. So listen the first time, write it down and read it back and then decide what to do from there. Triage again.

As people report information to you, get out your pen and paper and with pen in hand, listen. Write down the main points.

Make sure that you convey to the employee the feeling that you have nothing else to do but to listen to her. Donít talk; donít try to solve her problem before she tells you what it is. Have you ever seen anyone do that? It isnít pretty. You have to hear people out. Donít be thinking about your response until you know you have the facts. Just listen.

Donít sit there and think of how you are going to answer, just listen. Make sure you write down the main points. The last thing the person says will probably be the most important thing they have to say. If the repeat something be sure to write that down. People repeat themselves when they want to be sure you are listening.
Your job at that point is not to talk, it is to listen. Even if she has 22 problems to present to you, all you have to do is listen. The quicker you acknowledge their problem the quicker you can move on.

When the other person is finished telling you, maybe in 10 different ways, possibly beating around the bush, be patient. Go ahead and review with her what you heard her say. let her know that you heard her.

Whether you are able to solve the other personís problems or not, you have done what you needed to do and you have done what she needed you to do. She needed you to listen.

What ever action you need to take will come later. But for those 5 minutes, you listened and that is all she needed you to do. Donít look at your watch; donít do anything else but listen. The more you act distracted and detached the worse the situation will become and she may keep you tied up for days on end. But, if you listen, really listen you will gain her respect and her loyalty. Plus you saved time and effectively solved a problem all at one time. Two birds with one stone, so to speak.

You must listen to your staff. They work those floors directly with the patients for 8-12 hours a day. They are your eyes and your ears. Feel confident when they come to talk to you. Be glad that they feel like they can talk to you. The worst thing you can do is to have an open door policy with a closed mind atmosphere.

It doesnít matter if your door is always open, if your mind is closed and your heart is locked up, the physical door makes no difference. Actively listening takes skill and talent and you must develop this ability.

When they leave your presence make sure they leave knowing that you heard every word they said.

Making a practice out of listening will be an asset to you. There may be times that you see somebody coming and you want to run and hide. Donít do that no matter how bad you want to. You will look silly hiding in the med room.

I had this one family member that would come in my office and stay for an hour. It got to be really a problem, but all he wanted was for me to hear him. I started out listening, just listening and trying to respond. I learned that if I wrote down his concerns without responding, then he accomplished his mission quickly and stopped coming so often. This meant he was spending more time with his mother than chewing my ear.

So learn from my mistakes, donít try to respond. Just listen, write down the main points and you will accomplish several different things at once. You will gain their respect and loyalty, you will set family members minds at ease and the word will get around that you are a leader that can be reached.

03-07-2008, 08:09 AM
Well ladies and gentlemen!! It is Friday. If you are off the weekend then whoohoo. enoy the rest and relaxation--especially if someone else is taking call!!!
Do something fun--whatever you like to do!!
Don't even think about Monday until Sunday night!!

03-08-2008, 07:43 AM
My position as a Director of Nursing in a long term care facility sometimes required long hours. On this particular day in January of 2001, I was running later than usual on my commute to work. The day before, I had worked 16 hours and I almost took the day off because I was so late getting home the night before. But I really needed to attend an important meeting at 10 am.

I had sold my 1997 Mustang in order to get a bigger car with a smoother ride. I borrowed a car from my Daddy until I could get another one. So, I was driving what I lovingly referred to as, ďthe land bargeĒ, a 1989 Mercury Grand Marquis, built like a tank.
As I was driving to work, a day just like any other day, I stopped at a red light at a busy intersection. I remember thinking that I should pull up to the driver beside me and tell him that his hubcap was about to fall off. The next thing I remember is hearing a loud noise and looking to the left. I saw a huge truck on its side sliding toward me at a phenomenal rate of speed. Sparks flying I knew that it was going to hit me and it did. I only had time to say, ďLord, that is going to hit me!Ē. I grabbed the steering wheel as tight as I could. It happened so fast.

I never lost consciousness. I do not remember feeling the actual impact. Jesus and His mighty angels got to me before the truck did. I do not recall being knocked 275 feet into a gas station parking lot. I donít remember being airborne. I do remember something else though. I remember an incredible feeling of awesome peace and love like I have never experienced before. I had a glimpse of heaven. The hedge of protection came between me and that huge truck. My car was crumpled into a heap of metal and I was trapped inside. But inside the car were angels. I saw them and I felt them. They were there immediately, and I remember saying to them to go ahead and take me if it was time. I had no fear of going with them. I wanted to go with them. Nothing else mattered. I did not hear any audible voices but I knew somehow that I was not going to die, not yet. Somehow they told me that. Jesus was there. He did not speak but I felt His arms around me. Even after the paramedics got me into the ambulance, the angels were still with me, I knew they were there and that was all that mattered. Their presence was overwhelming.

At the hospital I could hear all the nurses and doctors talking and scrambling while they worked with me. I knew that I was critical and that I was loosing blood. I could feel myself slipping away. I knew that the angels were there just in case. By the time I was evaluated in the emergency room the pain was almost unbearable. Again, I saw the light of the angels, small tiny brilliant lights circling around above me. Even through the pain I smiled and felt comforted by their presence. I talked to them, this time asking for them to take me because the pain was so intense. The things of this earth were ďstrangely dimĒ. The next thing I remember is seeing my husband and my parents. Then I started to cry. Doctors were rushing me to surgery. A surgical nurse leaned down and called my name, ďAngela, in a minute you will be asleep and you are going to be fine.Ē Then she started praying for me so quietly and sweetly in my ear as the anesthesia took effect.

I woke up in the ICU and recovery began. The first thing I told my mother was about the angels. I continue to improve everyday and I have come a long way in healing since that day. My life will never be the same. I strive to never forget the feeling I had that day. I almost left this world, and in the process I was given a great gift from God. He offered to me the blessed assurance of His presence and His awesome power and love. I never want to forget this small glimpse of heaven. I felt the incredible love of God present with me in ďthe land bargeĒ.

Soooooooo the moral of this story is be happy you can still nurse. I miss it so badly.