Brief Essays and Comments From the Readers of Nursing Homes/Long Term Care Management.

When Is a DON a Don?

If you work in healthcare, you know who--or what--the DON is. It's an odd title, often spoken with tongue in cheek, sometimes sung to the tune of "the godfather goes to the nursing home." My durable medical equipment delivery guy addresses me this way. At first I thought it was cute, but now I know there's more to it. Just for the fun of it (and with tongue firmly in cheek), let's compare DONs and "the Don."

Our appearance is a good place to start. The godfather wears a business suit that fits well. It has to; he might need to dive under furniture, repair bullet holes, talk his way out of a paper bag or, if all fails, at least look professional when someone kills him. The DON often feels the need to slide under the table at care plan meetings that she mistakenly joined and then realized "the family from hell" was attending. (This family has at least one "RN" granddaughter and a lawyer in the family, who are never seen or heard from prior to this day and swear they know more about Grandmother than the MDS does.) Unfortunately, some consultant has spread an ugly rumor nationwide that all nurses, including the DON, need to wear white lab coats, because it is supposed to make everyone think you have lots of nurses available to care for your loved ones. I say let's get back to reality: I want to wear "a suit that fits well" in case I need to dive under furniture.

What we say is also comparable. Unfortunately, most DONs don't sound like the godfather. The godfather is not an English major. He either speaks in run-on sentences with enough graphic detail to scare Stephen King or incomplete phrases that are as sharp as Mack the Knife. Either way, he makes his thoughts crystal clear to the victim. The DON has a similar conversational style (when needed). An example of graphic run-on might occur when a brand-new CNA, who can't seem to remember not to wear tons of jewelry and makeup, whose long, spiral-permed locks refuse to be tied back, let alone off her collar, while doing patient care, has worked three weeks and called out twice (once on her Saturday), and now has the audacity to say, "I was just wondering, can I have this weekend off? I have plans to go out of town."

Note: The weekend in question is Christmas Eve and Christmas Day and is requested on Thursday at 5:15 p.m. My response would have made the godfather blush.

The godfather uses realistic people skills. He honors, fosters and protects loyalty and blood kin. He knows whom he can squeeze and who will squeal. He takes calculated risks and accepts paybacks as if it were a well-played game, with expected casualties. The DON knows these skills, too. Your staff will screw up. The DON considers how long the employee has been there, how good his or her attendance is, whether she can carry the ball with an agency aide or a "newbie" in orientation, whether she sneaks a quick cigarette out by the dumpster or some other acceptable place vs. the careless ones who stand outside the door by the time clock with time card in hand, waiting to step in long enough to clock out and go home, which is the first place the administrator looks? A loyal CNA looks out for the DON, actually knows when the DON forgot to have lunch, and just happens to have an "extra chalupa" for her.

Most DONs have someone they trust that deeply. But, like the godfather, if they break the trust, you blow their heads off. CNAs help or hinder the DON, just like mobster thugs. If they get sloppy and draw attention, they get to drive the decoy car-or, the CNA can accompany the demented resident and their "Ivan the Terrible" spouse to the doctor's office at shift change.

Calculated risks include understaffing for all holidays, anticipated sunny weekends, payday Fridays that precede warm, sunny weekends and, my personal favorite, the last day of summer before the first day of school (the greatest call-out day of the year--like school shopping can't be done in advance). This time, I plan to schedule off those who called out last year and, I assume, will probably do it again this year. After all, I have to protect these loyal followers from having too many absences and voluntarily terminating themselves!

In reality, my briefcase doesn't look like a violin case, but at times I sure could use one. Let's have a little respect.

Amy Mullins, RN, C is a director of nursing residing in Missouri. She didn't want to get more specific, for security reasons (you understand).