How does it work in your world?

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    Hi all! I'm in need of any ideas or assistance anyone can toss me. I'm with a fairly small agency, 15 people, 5 homes and a day program, and about 35 employees. When I was hired (RN) 7 months ago, we had 60 hrs a week of nursing, and I worked with an LPN. It's now just me, and about 20 hours a week. I'm gonna have to shift quite a few responsibilities, and turn several things over to the direct care staff.

    First, I'd like to know how other agencies do things. As nurses, what are your responsibilities? Do you manage Dr appts? What training do you handle? Do you maintain the charts?

    Second, what resources do you have in the houses? I'm looking at creating a decision tree, compatible with ARC guidelines and our company P&P to address emergent and non-emergent medical events. Does anyone have or use one of these? On what topics do you educate your staff?

    Third, are you on "Perma-call?" It seems I'm now the only one on call, for all eternity. I average 30 or so calls a week. Is this typical?

    This is a HUGE transition for this organization, and I'm trying to make it as smooth and positive as I can. I'd really appreciate comparing notes and methods with anyone who'd like to share. Thanks!

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  2. 2 Comments...

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    You and I could definately chat!

    I work with a residential home for disabled children, and am also on perma-call! I care for about 40 kids- all school health needs, plus dr/dentist/eye appts, illnesses, immunizations, flu shots, etc... Uggh... I do lots of delegation because I HAVE to!!!

    I am supposed to to medication tech training, CPR, AED, etc... training, but to be honest it's all I can do to keep my head about water with my other duties for the last year! I am outsourcing my training for now.... Hospital offers CPR, etc... and public health trains medication staff. I still have to orient all new employees (turnover seems high, so it is a never-ending duty!), and monitor ALL medication inventories, logs, counts, etc...

    I orient staff to basic first aid, seizures, my phone #....???

    I had plenty of concerns and did contact my state board of pharmacy and state board of nursing, (who are presently chatting amongst eachother about this school's needs) just to make sure everything we were doing was approved as far as delegation issues, etc.. go. Though I don't have ALL the answers I need yet, we are working on it! And I feel better for asking and getting their input!!! I was glad to learn I wasn't the ONLY one who didn't know!

    Just incase it is of value to you- we are using a decision-tree type model developed with the Ohio school district and the American Academy of Pediatrics. It would be a great reference if nothing else! Google it, that is where I found it. I still need to personalize ours, but the copies are in the cottages now and that is a start!

    Good luck!
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    I'm a Residential Nurse over here in NYC and manage 4 apartments and one house (24 pts in total) The Managers do all of the appointment making I review every medical paper that comes through. I maintain their medical binders and when I do my monthly nursing notes I review each consumers file and make sure all is being followed up on. As far as medications are concerned I go to each place at least once a week and go through their MAR and med cabinets. AMAPs (not sure if its only for NY) give out all the meds, fax refills needed to the pharmacy, and make sure there are appointments for meds with no refills. Things run pretty smoothly...


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