The Truth About What We Do — And Why It Matters
by Kally Hoffman, BSN, RN | Director of Nexus On Call Care
Over the years, working in and leading triage departments across long-term care, one theme has never left me:
People don’t need just a service — they need support.
In this space, urgency is real. When I say clients need help "tomorrow or next week," I mean it literally. That’s the reality many DONs and nurse leaders are living in right now.
The DON role has evolved. What used to be a position that could pause at night has turned into a 24/7 responsibility. And with the growing complexity of healthcare — the constant flow of new treatments, medications, regulations — it can feel like the work never ends. The pressure is real, and it’s taking a toll: staff burnout, turnover, and overwhelm that’s not always said out loud, but is deeply felt.
So when facilities partner with us for after-hours triage, it’s never about promising, “You’ll never get another call again.” That’s not honest — and truthfully, it’s not what most DONs even want.
What they want is peace of mind. To know that when they step away, their team and residents are still being taken care of. To know there's another experienced nurse — someone outside their organization — who they can trust, collaborate with, and lean on.
That’s what we’re building.
It’s Never Just One Thing
What usually starts with burnout or a staffing shortage often becomes something deeper.
Because we don’t just “take calls.” We take the time to see the whole picture.
We regularly bring in other departments from our team to help support a facility holistically — not in silos. Why? Because in long-term care, nothing exists on its own. A staffing gap impacts communication. A compliance issue stems from systems that are stretched thin. When you only fix one piece, the pressure just shifts somewhere else.
So our support evolves into:
Helping cover vacations or trainings
Providing real-time reports, documentation, and communication tools
Offering leadership support during audits or transitions
Identifying recurring problems — and helping solve them before they grow
Our role goes beyond just being there in urgent moments. We walk alongside leadership to create a partnership that is steady, thoughtful, and lasting. It’s deeply felt every day in the assurance, consistency, and confidence we bring to those we serve.
When Big Doesn’t Mean Better
One trend I’ve noticed lately is larger healthcare organizations trying to create their own internal triage programs — and while the intention is good, the result isn’t always what they hoped for.
Even with internal resources, many of them are still facing burnout — and sometimes even faster than before.
Why? Because internal nurses are deeply invested. They care so much, they carry the weight of the role in ways that go beyond the job description. They’re tied to the outcomes, the people, the pressure. And without outside perspective, it becomes hard to separate personal from professional — which only adds to the burnout.
What I’ve found fascinating in our work is how our nurses can step in, care deeply, and offer real solutions — without the emotional entanglement. That creates clarity. It creates calm. It allows our team to truly help in the moment, without bringing in workplace dynamics or long histories.
This is something no one really talks about — but it makes a big difference.
Fresh eyes bring fresh energy. No internal politics. No tension between co-workers. Just support.
And that translates to less burnout for leadership, too.
Let’s Be Honest
There isn't always a simple fix. Healthcare is far too complex for that.
But I am here to say: support can look different than you think. It doesn’t have to be transactional. It doesn’t have to be “one-size-fits-all.”
Because what I’ve seen — over and over — is that the strongest partnerships are built on trust, flexibility, and collaboration.
When leaders finally feel seen, heard, and supported — not just covered — something changes. They get to exhale. They stop surviving and start leading again.
And that? That’s what our industry needs more of.
If you’re a DON, a nurse leader, or someone who’s been feeling overwhelmed — we see you. You’re not alone. And you don’t have to keep doing this without support.
Let’s keep having the real conversations.