A little background first, TLDR at the bottom.

So I’m a LPN(Licensed Practical Nurse) and I work as a ADON(Assistant Director of Nursing) directly under our DON(Director of Nursing) and I’ve had this position since 01/2021. I’ve been under two different DONs now. When I first took the position we did not have a DON working for our company so I worked with the State RN. I do not supervise any RNs just our other LPNs and then our DSPs(direct support personnel) I work for a nonprofit organization that provides care for intellectually developmentally delayed individuals. Our individuals have some form of intellectual disability that can also have a physical disability also, we staff their homes with staff 24/7 to provide the care needed for them to live as independently as they can. They do not live at home with a family member or anything like that. They rent their own homes and will have one to two other roommates. We do not have more than three clients to a home. We assist them with ADLs(activities of daily living) we carry them to any and all appointments be it doctor or otherwise, we take them on community outings and keep them involved in their communities. Some of our clients have jobs if their disability doesn’t prohibit it.

I am responsible for region II and I am over four counties. We have about 16 homes at this moment so roughly 48 clients that I am over the medical care on. I am responsible for our two medical residential homes, which are the homes that require some form of nursing care, I have to make sure that the homes have the required nurses staffed be it only for 12 hrs a day or 24hrs a day. Our 12hr nursing house is fully staffed at the moment but our 24hr home is down one full time day shift nurse so I have to rotate shifts with the other day shift nurse. When any of our nurses call out I am responsible for finding coverage, be it with a PRN(as needed) nurse or going through our contracted agency. If I can not find someone to go in then I cover that shift. I have been left on shift at our 24hr house for upwards of 30hrs straight due to the oncoming nurse not coming in and none of my other colleagues wanting to pick up that shift and agency not covering either due to the location of that home being 2 1/2 hours from that agency.

When I am not working in a home my set schedule is Monday-Friday 8am-4pm in the office about an hour and fifteen minutes from my home. I did have a medical assistant in that county until the first of November and she was responsible for scheduling and following up on doctors appointments, getting copies of any diagnostic testing done, keeping all medical files up to date, following up on medication changes, ordering PRN medications when needed, doing our monthly medication counts and letting our homes in this county know when medications arrived on top of any other routine medical or emergency medical needs. I also did these things when I was in the office and even when I would be working in a home if I could do it from my phone or laptop, both of those personal not company provided. I do have a company phone since I am technically on call 24/7 but it is old like iPhone 4 or 5 and doesn’t hold service or charge at all so everyone who has to have my number has my personal number. Now that my medical assistant dropped down to being a house manager and is working in the home only I am now responsible for everything in that office by myself on top of rotating shifts in my 24hr home and covering any call outs or emergency situations. My other three counties have not had a medical assistant ever the RMs(residential manager) and/or PDs(program director) are responsible for those things and I just do oversight.

In Region I where the DON is located, he has someone specifically for scheduling and covering open shifts/call outs, he has two medical assistants and then him. He does not have to do everything I do by myself. He isn’t required to work in a home if someone calls out or an emergency happens. He’s been with us since Julyish and has had 2 vacations already and went on a company retreat. During his two vacations I ended up having to pull 24 hr shifts and when I reached out to him about it he did not respond or anything.

I planned my vacation for after state audit and took nine days off from 10/29 to 11/06 just so I could be home and work on my fixer upper home. During that time the county that lost its medical assistant called the DON multiple times because they can’t seem to do anything by themselves so in turn he contacted me multiple times, even though me and the medical assistant made sure everything was together for the first half of November so they wouldn’t have to stress. He also let me know that the nurse that was scheduled to work tonight would not be able to come in, I am the one who worked the day shift today, and he said that I could see if agency would cover. All while I’m supposed to be on vacation not being pestered by work. I was able to get my PRN nurse to come in tonight and let me go at regular shift change but if I couldn’t have gotten someone to come in I bet you $10 I’d still be a work right now instead of our DON coming down and letting me go home.

My responsibility just keep getting more and more with no help to relieve some stress and I’m getting tired. I make $1/hr more than my LPNs that work strictly in the homes. And I make considerably less than the DON and I found out I make $10hr less than the scheduler in region I.

I truly miss just being in the home providing the care and compassion these clients need. Would I be stupid for me to step down also, take a $1 cut in pay and work just my 3 one week and 4 the next 12hr shifts and leave the office work and drama to the DON? There’s probably more bullshit I’m not adding but this is getting long and I’m doing it on my cell so it’s a little laggy.

TLDR; I am a ADON I have more responsibilities than the DON I make considerably less than him and I make less than the nurse scheduler in Region I and deal with a lot more stress I am considering a $1/hr cut in pay and a lesser title to return to working strictly in the homes with my clients to lessen stress and anxiety would it be stupid?