Building a network: Joan Warden-Saunders, Founder/CEO, NADONA

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At age 17, while working as a certified nursing aide for a nursing home in Madisonville, OH, Joan Warden-Saunders told a nurse she noticed a resident looking "a little funny." The nurse ignored her. The resident died later that day. That experience left a lasting, haunting impression.

"I never forgot how that resident died alone," Warden-Saunders recalled recently. "Somewhere in the back of my mind I thought, 'I'm going to become a nurse and change this.'"
But she didn't envision a career as a long-term care director of nursing, at least not at first. Early on, she was a critical care nurse in a children's hospital and a nursing team leader in an adult intensive care unit.
The DON position would be far less demanding than her previous roles, she predicted. She quickly learned how wrong she was.
"When I took the job in 1982, I didn't even know the difference between Medicare and Medicaid," she remembers. "But I was reassured that I was qualified and that I would be properly trained."
That much-needed guidance never happened — a common complaint of many DONs, she discovered. Taking matters into her own hands, she quickly identified a lack of an effective quality assurance program and nursing support system, as well as other areas in need of improvement.
"When I made my rounds, I didn't like what I saw," Warden-Saunders explained. "I felt the only way to improve that was to get the nurses more involved."
She called other DONs in her area to come to her facility to discuss job-related issues. Nearly everyone contacted came.
"We quickly discovered we were all dealing with similar issues, but there was nowhere to go for guidance on a [broader scale]," she said.
The meetings continued and Warden-Saunders began incorporating educational programs to further support the nurses' needs. As she did, she was bombarded with mail and phone calls from other DONs who were pushing for a professional organization, she said.
With little more than a $10,000 personal loan, a bedroom office and a malfunctioning copier that burned paper, Warden-Saunders got the ball rolling in 1988.
About a year later, she planned the first official association meeting in St. Louis, chartering the National Association Directors of Nursing Administration/Long Term Care with 40 members.
"Joan knew DONs needed a voice of their own, so she made it her mission to build an association that would give them that voice," said NADONA President Sherrie Dornberger.
Twenty years later, NADONA has 37 state chapters and a membership base topping 7,000 DONs and RN nurse managers throughout the United States and Canada.
Earlier this year, the group plowed new ground, opening its membership to the assisted living sector. Nurses from some 700 assisted living facilities have already joined.
Witnessing the heightened level of recognition for the DON profession is one of her greatest sources of pride.
Nursing aside, her other source of pride is her three grown sons: Michael, an artist; Jim, who's pursuing a career as a paramedic; and Gary, an actor who recently completed a film with Clint Eastwood's daughter. Gary also happens to be his mother's right-hand man at NADONA.
Her other loves? Three young grandchildren, ages 21⁄2 to 10; Jess, her antique-loving, musician husband of five years; and five cherished chocolate poodles.
But no matter how one ranks priorities, Warden-Saunders' desire to help DONs be recognized — and fully recognize their power — has to be near the top of the list.
"There's still a lot of work to do in that regard, so I'll keep going for as long as it takes," she says. "I doubt I'll ever retire, actually. I'll probably die trying to catch a plane."

1976 Earns Associate's Degree R.N., University of Cincinnati

1976-79 Works as critical care pediatric nurse for Children's Hospital Medical Center, Cincinnati

1981 Earns B.S. degree in nursing from Miami University, Oxford, OH

1982-86 Assumes a DON role for Manor Healthcare Corp.

1987 Founds J.C. Warden & Associates, serving as legal and healthcare consultant for LTC

1988 Officially founds NADONA/LTC

2006 Opens NADONA to the assisted living sector