DON 2000: back in control.What will a director of nursing be like in the year, 2000? In four more years (assuming a "best case" scenario), most of the original and updated "OBRA mandates" should have been met. DONs can then evaluate to see exactly how their nursing departments have evolved. They should notice things beginning to swing back under nursing's control because, as we all know, the responsibility for virtually everything that happens concerning the facility (except maybe the landscaping) falls on the DON's license - and when your license is on the line, you had better have control.
Nursing will find itself more responsible for the costs of care. No one can begin to predict exactly what will happen with all the changes underway in health care, but there will definitely be a strong trend toward more controlled, managed care.
When you or your nurses request an order for a new medicine, test or hospital admission, is the cost ever considered? Could an earlier intervention have prevented what is now a more expensive need - and more importantly - could earlier holistic Holistic
A practice of medicine that focuses on the whole patient, and addresses the social, emotional, and spiritual needs of a patient as well as their physical treatment.
Mentioned in: Aromatherapy, Stress Reduction, Traditional Chinese Medicine measures have kept the person healthier?
A deceased deceased 1) adj. dead. 2) n. the person who has died, as used in the handling of his/her estate, probate of will and other proceedings after death, or in reference to the victim of a homicide (as: "The deceased had been shot three times. resident's daughter recently related to me the sad tale of her mother, who was very lonely and had a demanding personality. The staff in the nursing home where she lived, according to according to
1. As stated or indicated by; on the authority of: according to historians.
2. In keeping with: according to instructions.
3. her daughter, avoided her, which exacerbated her demanding nature and made her frightened fright·en
v. fright·ened, fright·en·ing, fright·ens
1. To fill with fear; alarm.
2. that her needs would not be met. The resident frequently related to her daughter that when she put on her call light, someone would come into her room, turn off her light and say that they would return - but never did. As this intelligent lady deteriorated and lost control of her bowel and bladder, she complained that she was left to, as her daughter said, "mess her bed, then lie in it until someone finally came to clean her up." She was eventually sent to a psychiatric psy·chi·at·ric
Of or relating to psychiatry.
psychiatric adjective Pertaining to psychiatry, mental disorders ward for several weeks, from which she returned to the nursing home several pounds lighter (she was already thin and frail frail 1
adj. frail·er, frail·est
1. Physically weak; delicate: an invalid's frail body.
2. ) and confused - but on medication that made her less demanding. This hospitalization hospitalization /hos·pi·tal·iza·tion/ (hos?pi-t'l-i-za´shun)
1. the placing of a patient in a hospital for treatment.
2. the term of confinement in a hospital. cost Medicare, for the bed only, over $10,000.
Was this necessary? Was this resident a threat to herself or others? Could this incident have been avoided if she had been treated more like a person, without the "demanding" label attached?
A nurse consultant friend of mine was evaluating a facility for a restorative re·stor·a·tive
1. Of or relating to restoration.
2. Tending or having the power to restore.
A medicine or other agent that helps to restore health, strength, or consciousness. nursing program and the facility's therapist told her he had recommended three days a week of range-of-motion for a particular resident and was told, "We are not allowed to do ROM on this lady." Would you want your nursing license to be on the line in this situation?
Nursing lost control chiefly because entirely too many changes were mandated over a short period of time. Many DONs began allowing anyone who seemed remotely capable of taking some of the load off her/his shoulders to take it. It was a way to survive while still trying to cope with staffing problems, obstinate ob·sti·nate
1. Stubbornly adhering to an attitude, opinion, or course of action.
2. Difficult to alleviate or cure. physicians, families' complaints, resident care basics, finding clothes lost in the laundry, and checking charts, meanwhile making sure that all medicines and treatments were given, that all prescriptions were delivered from the pharmacy pharmacy, art of compounding and dispensing drugs and medication. The term is also applied to an establishment used for such purposes. Until modern times medication was prepared and dispensed by the physician himself. In the 18th cent. and properly stored, that the narcotic narcotic, any of a number of substances that have a depressant effect on the nervous system. The chief narcotic drugs are opium, its constituents morphine and codeine, and the morphine derivative heroin.
See also drug addiction and drug abuse. count was always right, that care plans were completed and absentee One who has left, either temporarily or permanently, his or her domicile or usual place of residence or business. A person beyond the geographical borders of a state who has not authorized an agent to represent him or her in legal proceedings that may be commenced against him or her staffers covered for - and watching out for fire, flood, earthquakes and tornadoes!
In resuming control, ask yourself: Are all departments pulling their weight and working as teammates with nursing? Are all residents receiving the physical, mental and social stimulation needed to keep them at their highest level of functioning? Is dietary monitoring its feeding procedures and food and fluid intake, or do the dietitians feel their responsibility stops with preparing the food? Does nursing help to encourage residents to attend activities, and willingly assist with their transportation? Do your physicians and therapists understand restorative nursing and the potentials your residents have for increased independence?
Only one person can be "ultimately in charge" of your health care team, or there will never be continuity of care and adequate communication. Again, it is the DON's job description, responsibility, and license at stake - so she will want to be in control, and staffs in the good facilities will acknowledge that.
The DON of the year 2000 will always think holistically - looking for Looking for
In the context of general equities, this describing a buy interest in which a dealer is asked to offer stock, often involving a capital commitment. Antithesis of in touch with. underlying reasons for a problem, at the whole physical and emotional person, and stressing that person's dignity. She/he will be well educated - not necessarily with degrees, but with knowledge of wellness, of human potential. She will keep her staff focused on the "person" and not the "machinery", always trying to keep her facility from becoming overly technical instead of focusing on simple, basic human needs. Though she will work on special projects in a timely, progressive manner, she will always see that day-to-day care comes first.
Our colleagues in acute care may even find they have something to learn from us!