DONs take care of business
Directors of nursing are gaining more authority in long-term care facility management, but with that enhanced stature also has come a heavier workload.
Advocates say they are confident, however, that DONs can shoulder the weight if the proper supports are put in place.
In many facilities, DONs are getting leadership roles traditionally handled by administrators, such as budget management, human resources, medical records management and matching staffing patterns with resident acuity levels.
"DONs are not just clinical specialists anymore, they are business specialists as well," said Betty MacLaughlin Frandsen, president of the National Association Directors of Nursing Administration in Long-Term Care.
Bottom line implications can be huge. Nurse managers and the long-term care industry are evolving together, as medical technology, clinical protocols and information systems continue to advance, and facilities become more like communal residences than institutions. DONs are at the heart of these developments so they are handling more responsibilities.
"The job has gotten more complex and overloaded as a result," Frandsen observed. "Responsibilities are being added and none are taken away."
Even so, DONs still have some rungs to climb up the corporate ladder before they are seen as peers by senior executives, says Linda Hollinger-Smith, director of research for Mather LifeWays Institute on Aging in Evanston, IL.
"The complexity of the role is growing and DONs are gaining more respect, but there is still a long way to go in terms of administrators seeing them as equals," she said. "They still need more education and skill sets."
High DON turnover – long an industry scourge and an impediment to progress – could finally recede if a sound educational infrastructure were put in place to adequately prepare candidates for the multidimensional demands of the job. That's the opinion of V. Tellis-Nayak, Ph.D., vice president of research for Wausau, WI-based consulting firm My InnerView.
"One reason for the high turnover of DONs is that many assume the position without any training," he said. "There is no national requirement for the training of DONs. Anyone can be appointed to be one without so much asan examination."
Tellis-Nayak, who has conducted extensive studies on long-term care management turnover, confirms there is a strong correlation between management stability and quality of care. For his research, he collated facilities into three categories – those that had not lost a DON in two years, those that lost one during a two-year span, and those that lost two or more in two years.
"Those that had no DON turnover in two years were better off on every quality measure," he said. "That is a very telling statistic – it shows that DONs are extremely critical to the well-being of the nursing home."
Moreover, the longer the DON stayed with a facility, the better it performed, Tellis-Nayak added.
"The nursing homes where DONs were better educated, motivated, trained and treated, the correlation with quality is even stronger," he said. "And even at those facilities that performed excellently, the quality declined almost immediately after the DON left."
Building a solid DON educational track starts in nursing schools, many of which sorely need to modify their curriculum, said Rikki Brady, director of health services at Clark Lindsey Village in Urbana, IL.
"Nursing schools need to include more courses that address leadership, b