Close up image of a caretaker helping older woman walk

I am a new director of nursing, and the staff is tired due to a lot of changes in the last year.  Where do I start?   

First of all, congratulations on having the BEST job in the whole world.  It is not easy! 

You need to get to know your staff. Know their names, know something about them and care about them as people. Trust me, they will be the key to your success.   

Being the director of nursing is a big responsibility since pretty much everything revolves around clinical. Embrace your interdisciplinary team: They will be the difference. 

Ensure quality of care is being delivered. You will need to review all clinical systems, including the following:

• Residents’ diagnoses and medications

• Include high-risk medications, i.e. insulin and anticoagulants. Do they self-medicate?

• Pain

• Weights/nutrition

• Events

• Wounds (personally check, never assume) 

• Infections/immunizations

• Dialysis

• Restraints

• Contractures/splints/restorative

• Catheters

• Smoking

• Elopement

• Psychotropic medications 

Review Quality Measures and establish your QAPI (Quality Assurance and Performance Improvement) for the issues that you find. Then, develop programs around each of the problems, in order of priority.  

Reach out to the local NADONA association; it will be a good support system. They can tell you hot topics in your area for surveys. 

Let the staff know what you find out and give input to the goals, mission and vision of the nursing department.