How does our license come into play?

What does your particular nurse practice act state as far as delegating tasks such as medication administration? You say the you have a QRMP supervising this. Is this an RN and if so is the RN delegating tasks to you. Also, your state department of human services should also have some documentation on what your role as a LPN can be as far as supervising. Have you asked for a copy of protocols/procedures/job description that the actual agency has written?

I do not manage group homes but I do manage the clients that live "independently" and those who live in a host home with a provider. Some agencies set it up to have a medical appt. "runner" and then communication is usually forwarded to the nurse. Quite frankly I supervise every aspect of my client's medical needs. I often attend the appointments as well. I find that I can better report symptoms that have been reported to me and any assessments I have made. This eliminates a lot of confusion because often times a PCP will write an order for something that may be unneccesary. PCP's have greatly appreciated this service and I do not know if this is something that you have the capapbility to do depending on how your caseload is setup.

Anytime I make a home visit, get a phone call (phone triage), or speak with someone from the medical team I make a note of it. I also review and sign all changes/new orders (I take a form for the PCP to write a SOAP note on) and also request any labs or other diagnositc data to be forwarded to my attention. If I don't agree with the way something looks or if the plan of care doesn't seem quite right, then I communicate this with the PCP to clarify or discuss an alternative. I don't do it for my convenience, but I've actually saved a few lives due to potential mistakes. This is supposed to be a team approach that has checks and balances.

I work as an IC. I own my business and the agencies that serve the DD population contract my services directly. I carry steady caseloads on most and others may last weeks to months. I keep my finger on the pulse so to speak and I like being in the know on how my folks are doing.

Keep me in the loop on what you find out.

Phatlipboardz, How do you have time to do all of that? I have 3 people (clients) a day going to doctor appts. How many clients are you overseeing? Meds are being changed ATLEAST twice weekly (for dif clients) Then dealing with direct care staff that are not giving meds correctly, training over and over again, making appts...I just dont know how to keep up! I wish I knew how other companies were running their nursing departments!

It can be an overwhelming task to stay on top of these caseloads. Even when you have your day or week planned out, there are usually a couple of "fires" that need to be put out. Managing difficult or incompetent staff doesn't make it any easier.

The one thing that I have noticed in this field is that there never seems to be enough funding and none of the processes seem to be streamlined. This is where I have made changes. Being an independent contractor allows me to essentially get the job done like it supposed to (meeting regulations), but I do it my way. I embrace technology and utilize it in my business everyday. I am always reachable whether by phone or email. Essential tools for me are a Blackberry, Netbook (small laptop), an online fax service (I get my fax in my email and can read these on the road), portable scanner and printer, and I take advantage of mobile offices in the area. I have access to co-op offices that have everything I need and don't cost a lot of money. No lease agreement either. Of course I could also use a restaurant/coffee shop with Wi-Fi. I also have a dedicated home office as well.

There are some areas that will initially take more time. If I have to write a brand new medical protocol for a condition/diagnosis, then this can take some additional work and research. But, one thing I do is save all of these digitally and I have built up a database of care plans and protocols that can be "tweaked" a bit for another client if needed. Establishing relationships with the primary medical team can take some effort as well. Once these relationships are established, the nurses, NPs and docs call me directly with lab and diagnostic results. They see me around enough and know what a vital role I play. Generally this population is non-compliant, but if a nurse is overseeing their medical care, then chances are things are going to get done.

It's not easy and I do work quite a bit, but I make an effort to work more efficiently. You might be surprised as to what a little technology can do for you, but I admit that I am a little bit of tech geek at heart.

The organizational chart here consists of:

An executive Director (oversees entire operation)
Program director (supervises the program coordinators and the day to day)
Program Coordinator (day to day management of the client's residential life)

The nursing department is basically on its own organizationally speaking. Many agencies sets this department up as an independent entity, but still under the same umbrella. Difficult staff can be, well they can be difficult. I try not to use a punitive approach, but encourage staff members to let me know if mistakes are made. They view me as someone who is willing to provide support and education and they see me in the "trenches." Once you get their respect then they will come to you. My phone and inbox are busy with questions. Again, my availability to them has helped fill a lot of gaps.

Some days are just nuts as we all know. It's like moving mountains to fix a broken system. I just choose not to fall into that cycle. I only have control over my department and business. No matter what business you are in, if you can't streamline a few if not all of the processes, then you are going to sink. Stay strong and work smarter.