Developmental Disabilities Nursing

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    [font=arial][quote]

    i work for a ddso that has approx 130 group homes. direct care aides pass all of the medications. in nys there is a bill being considered to repeal the exempt clause that allows this to happen. we will then need to hire about 720 nurses to cover 24hrs/day in each group home to pass meds. although i agree that only licensed personnel should be doing this it will be extremely difficult to hire all those nurses with the nursing shortage. i was wondering what happens at other omrdd/ddso group homes. i also would like your opinion on repealing the exempt clause.

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  2. 14 Comments so far...

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    I truly do not believe it will ever take place. I don't think the
    nursing shortage will be the barrier, it will be the cost. Most states have a budget deficit now and it is certainly less expensive
    to hire aides. Are your aides licensed or not? The state I'm in
    has the exempt clause in the Nurse Practice Act that allows unlicensed personell to administer medications. Is VERY scary
    to me, as the RN's license is at risk, especially if the nurse is not
    good with the level of supervision it takes to ensure good technique. Will be interesting to see what happens in your state.
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    I currently work for an association with about 26 group homes and have done so for approx. six years in Ontario, Canada. I am also in nursing school and will be going into my third year in the fall. But before nursing school I graduated with a DSW developmental services worker, this is a two year program. This allows me to care for people with developmental and physical disabilities. This program that has a pharmacology course that teaches medication dispensing and the drugs that are more commonly used in a group home setting. This allows us to hand out medications safely and effectively. As a DSW we are not liscensed but we are tested on handing out medications through the college. This program also teaches basic care needs that an RPN (registered practical nurse) can do. We are paid much lower than an RPN and are still capable of doing our job the same as an RPN. The only difference is that we were taught more psych courses than health courses. In my opionion we should be paid the same as an RPN but that is another story.
    The health care aid or Personal support worker program is only a six month certificate program, and my understanding is that they are not allowed to hand out medications because the course does not offer a pharmacology class. When a PSW or health care aide is hired in our association they are required to take a pharmacology course through the college or the company.
    If RN or RPN were hired to do my job I would be very ****** off considering I went to school do this job and be able to hand our medications. The asscociation would also have to pay more for the RN's or RPN because of there skills or they would keep them an the same rate we are at. This would never happen here though because the local colleges decide who they can an cannot hire. An RN or RPN can apply for the job and will get the job, but they will only get paid the same amount as a DSW. So on that note most nurses will not take a major decrease in pay just to work in a group home.
    I really hope this makes sense and sorry for babling on.
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    Shamrock: I think cost will be another factor, however, if it passes and the exempt clause is repealed they will have to close the group homes and place the individuals in institutions again to decrease the number of nurses needed to pass meds, etc.

    Our aides are not licensed and the exempt clause is in the mental hygiene law for NY state. It can be scary to have these aides pass meds. I have very good aides that take this job seriously. I supervise a day program site and the meds are minimal.

    It will be interesting to see what happens with this. I will be curious to find out if any other states have done it.

    What State are you in Shamrock?

    Giggles: It sounds like you have had extensive training. The aides in our system that do the same duties as you describe only have 40 hours of medication training, and then are tested in both written and practical exams.
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    I have no qualms about persons who are not licensed passing medications in a DD group home if the nurse who is delegating her license is at least involved in the selection of whom passes the medications under her license.
    In many places the program managers do the selecting based on how long someone has worked in the facility. The nurse must then maintain accountability for that person's decisions good or bad. I also think that if the persons are passing medications they should be trained by the nurse and not an unlicensed training facilitator. I have nothing against training facilitators but med issues should be addressed by the nurse under whom you are supervised, I think
    noreenl likes this.
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    I am a nurse in Ontario, who also works as a (DSW)front-line worker in a group home.
    Even though the rate of pay is much less for a worker, I enjoy it very much.
    I am wondering if there are any nurses or DSW on here from New Brunswick? I may be moving there in a couple of years and would like to know what type of work is available there as far as nursing and DSW go.

    shyann
    Last edit by shyann on Dec 12, '03
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    I've worked as an aide in dd group homes. We had to take a nurse delegation class, and afterwards one med error meant you were no longer able to pass meds, probably lost your job although not always. Giving pills is not rocket science, you just need realy attentive aides who will take the time, every night, to count pills and double check names.
    med errors did happen once or twice, mostly missed meds.
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    Hi,
    Ive been with NYS 28+ years and trained the firs AMAP program on Long Island. You have 2 factor to be concerned about with non nursing medication passes other than the obvious.
    !. CSEA union wants amap program- indeed they were instrumental in the starting of the program so as to maintain jobs (yes, I am pro-union) and their members get no harsh termination for med errors as do outside agencies.
    2nd factor is that the state has been getting away with per diems to pour meds(at least on long Island). Yes hiring outside agencies with no union challenge. We get concerned here for our consumers but also for OUR jobs.
    noreenl likes this.
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    Here in WY, we use our frontline staff to "access" medications "with" the client.

    "Accessing With" being the key words. This implies that the client is medicating him/herself, with the help of another. A very thin line, yes, but I believe that is how we get away with it.

    I came out of being trained mostly in a hospital setting into this situation. Very different. I also learned a very important lesson not so long ago. Just because I'm use to how nurses apply their knowledge of medications and all that includes, doesn't mean that everyone else has that knowledge.
    Simple point: Counting meds with a coworker, she was the one visualizing and counting, I was the one documenting. Instead of checking the "label" for the name of the medications and dose, she was going by what the pills looked like. Yes, count was off because the phenobarbital looked exactly like accolate. I didn't (like a dumb you know what), question it. In the hospital, my coworker (who would have been a nurse), would not have gone by what she saw, but by the label.
    I'm sure that the training that our frontline staff gets is not at all like it should be. As some have already stated, it probably has more to do with money than anything. I just thank God that I learned a lesson now, one that was not costly to myself or a client.
    Last edit by jleski on Dec 20, '04 : Reason: I realize that the initial posting is from "03" but hey!
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    Hi jleski,

    Were you counting control medications? or just the pills that were not in blister packs? I would suggest that if you have to count meds with an unlicensed staff that you be the one doing the actual count, and the other person can record. In my program the medications are given by the program specialist. They are responsible for giving the control medications and counting them q shift. I am usually in each residence once a week. At that time I will count the control meds and make sure that they are being documented correctly, review the MAR's and check to make sure that there is enough medication in the residence. I have medical assisstants in each house who are responsible for ensuring that medications are given, appointments kept etc. As for the program specialist, some of them are very responsible and do an excellent job with the limited training that they get. I reinforce a lot of the training through frequent inservices.


    Quote from jleski
    Here in WY, we use our frontline staff to "access" medications "with" the client.
    "Accessing With" being the key words. This implies that the client is medicating him/herself, with the help of another. A very thin line, yes, but I believe that is how we get away with it.

    I came out of being trained mostly in a hospital setting into this situation. Very different. I also learned a very important lesson not so long ago. Just because I'm use to how nurses apply their knowledge of medications and all that includes, doesn't mean that everyone else has that knowledge.
    Simple point: Counting meds with a coworker, she was the one visualizing and counting, I was the one documenting. Instead of checking the "label" for the name of the medications and dose, she was going by what the pills looked like. Yes, count was off because the phenobarbital looked exactly like accolate. I didn't (like a dumb you know what), question it. In the hospital, my coworker (who would have been a nurse), would not have gone by what she saw, but by the label.
    I'm sure that the training that our frontline staff gets is not at all like it should be. As some have already stated, it probably has more to do with money than anything. I just thank God that I learned a lesson now, one that was not costly to myself or a client.


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