Making rounds on my first full day as Director of Nursing in Long Term Care one resident I talked with asked me if I was the Doctor. I told her “no mam, I am the Director of Nursing.”

 

She said very honestly in a clear frame of mind, “Well I was wondering, I have been here for twenty years and I haven’t seen a Doctor yet.”

 

That was my first clue that we had a problem.

 

Working in a 103 bed Long Term Care facility was all new to me. I had no idea of the massive world of the Long Term Care industry but I had a feeling I was about to learn. The prior DON had taken all the books, records and files from the office. I did not even have a job description. I was literally flying by the seat of my scrub pants.

 

I did not know any Federal or State Regulations, yet. But I did know good nursing and that is what I had to guide me.

 

I quickly discovered that the Medical Director, Dr. Nix, actually opened the facility years ago and owned it for many years. He sold it five years before but remained as the Medical Director. The new management company had no idea of the medical direction he actually provided.

 

I had a jewel of an LPN in Margaret. She started at the facility ten years earlier as a CNA, worked her way up to LPN and was now in Nursing Administration. I knew early on that she was the best right hand I could have hoped for. She told me the DON had always met the Medical Director when he came on Fridays and she would be with me the first time to show me the ropes.

 

I was prepared to make rounds with him. When he came in he went directly to the Nursing Administration office where an entire rack of charts had been rolled in for him. He sat down, and proceeded to sign everything that had been flagged for him to sign. He never read one word of what he was signing. It took him one hour. When he finished blindly signing everything, he asked if anyone was sick. Margaret reported those that needed attention. He ordered meds and left. He never saw the first patient.

 

I thought-‘ok, this if ok—he knows all these patients and he will see them next Friday’.

 

Next Friday came and he did the exact same thing. The next Friday came and I had four patients that I insisted he examine. I went with him. He walked in the room, looked at the patient—I mean he actually just looked, wrote some scribble in the chart and left. He was obviously incredibly irritated at me for making him see a patient.

 

I definitely had a problem. We had Medicare Part A patients fresh from the hospital; they needed to be seen by a Doctor. I had only been there three weeks when the State Surveyors showed up. I had no idea who they were or why they were there. But I could tell by the panic on the Administrators face this was serious.

 

Sometimes blessings come in disguise. Sometimes the look like state surveyors. As a result of a horrible survey they gave the facility thirty five days to “clean it up” or they would be back to shut the doors. This seems ominous enough but it was a blessing, it started the change ball rolling.

 

 I knew there were some terrible problems and I was doing all I could to change them, but night after sleepless night I knew I could not do this alone. The Administrator stayed in his office all day and the nurses had been without leadership for so long they were flying by the seat of their scrub britches, too. Doing things the way they had “always been done” which clearly was not working. Many were not willing to change. The Surveyors did me a huge favor—they got some attention and some action! I was only too happy to oblige them. I wanted the same things that they did—better care.

 

Corporate came flying in with all their weaponry like the calvary. I had a great clinical director and a wonderful teacher as a nurse consultant. Help had arrived and I felt relief.

 

The Administrator was history and they hired a new one. The new Administrator and I spent five minutes together and knew we were going to change this facility together, beginning with the Medical Director. The problem was finding a new one before we fired the old one.

 

Amazingly enough I had a sinus infection and went to see my Doctor. While he looked in my ears, I had a thought, Dr. Mack! He would make a great Medical Director. He was kind and jolly smart and attentive. And he had been a nurse before he was a Doctor. He had the compassion and insight of a nurse and the authority and skill of a Doctor. He was the perfect candidate. Without even discussing it with my Administrator I talked to Dr. Mack about it. He seemed interested.

 

Within a few days to my happiness he was sitting in the Administrators office ready to take the job. He was hired. Then it dawned on me, somebody had to fire Dr. Nix.

 

Dr. Nix had been the Medical Director for twenty five years. There were two other sister facilities in that county and he was the Medical Director for all of them. He had been a Doctor in that county for thirty years. Even so, he had to go. These patients deserved a Doctor and I had to have a Medical Director that actually directed medically.

 

My Administrator decided, to my relief, that it was her job to break the news to him. Thank God. I was free and clear or so I thought. We waited until his normal visit day on Friday. When he came in there were no charts lined up for him and he was asked by Margaret to go to the Administrators office. He rarely spoke to my Administrator or me. I think we scared him.

 

She shared the results of the state survey with him. He had gotten a deficiency from them. The facilty had defieciencies because of him. That helped. Then she told him that we were going to have to make a change and that he was being replaced. The words had to come out somehow, so she just told him, professionally and bluntly. They worked out the details of the transfer of his patients to the new Medical Director and he left her office.

 

 Unfortunately he came directly to mine. He walked in, closed the door, and chewed me up one side and down the other. He was mad. Really mad and he blamed me for it. He threw a chart on my desk and left. He didn’t eat me. And it really didn’t hurt so badly either.

 

We had a reception welcoming our new Medical Director. He set aside one entire day a week to come to the facility. He actually came in, made rounds, examined patients, and really cared about their well being. I could call him anytime I needed to and he wouldn’t yell at me. We made things as easy on him as we could and worked together to turn the facility around into one with thirty five Level A deficiencies to a model facility that provided a high quality of care and life. When the surveyors returned, ready to close the doors, they were pleasantly surprised at what the team had done in only thirty five days. They said they could tell the difference when they walked in the door.

 

Of course they kept a close eye on us to make sure we were serious about providing quality care. We worked really hard, the staff worked really hard, and in three years we had a survey that was very close to being deficiency free. For some reason they just could not bring themselves to let us be deficiency free. They got under the dumpsters out back and wrote us up because our dumpsters were dirty.

 

Our Medical Director was the best the facility had ever seen. He really loved and cared for the residents and their families. They looked forward to him coming and they felt better cared for. It wasn’t about money to him. It wasn’t a burden to him. We actually talked him into playing Santa Claus at Christmas. He loved it. We loved it and our residents thrived. They thought he was the best Doctor this side of Heaven. Personally and professionally, I did too.

 

© 2010

Angela Posey-Arnold RN BSN

1272 County Road 296

Hillsboro, Alabama 35643

 

 

 

Angela Posey-Arnold is an award winning Author and Christian Inspirational Writer. Published author of The Nightingale Protocol, written for nurses and caregivers from her 20 years of experience as an RN Director of Nursing. Angela devotes her time to her passion for writing and music. Her work appears in Kaplan Publishing’s Anthologies, Reflections on Doctors, and Meditations on Hope and Final Moments: Nurse’s Stories on Death and Dying.

 Several of her stories have been published by Guidepost’s Angels on Earth Magazine and Life Way Mature Living as well. She has an array of writing projects and published works. Angela is a 500 member of Faithwriters.com, and a founding member of SonRise Writers Group.  She blogs at www.sonrisewriters.com

 

Angela lives adjacent to the beautiful mountains of North Alabama with her husband, Bear, of 21 years. Living on a 12 acre farm she can be found most days in the loft of her log home pursuing the passion of writing and music. She is the resident pianist at God’s Church at Courtland Baptist Church (www.CourtlandBaptist.com) in Historic Downtown Courtland, Alabama.