Newer nurse to DD/MR nursing

  1. Hi everyone!

    I've been a long time visitor to this site, but have never posted before today. I graduated almost two years ago and started out in LTC and then moved to working in a day program for adults with developmental disabilities. It's a field that I knew NOTHING about, but have grown to love it! I actually enjoy going to work every day. I was hoping to talk to some other nurses in the field whether in day programs or residential programs, because I feel as though this is a very unique area of nursing, and would love to hear from you.

    Thanks :heartbeat
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  2. 20 Comments

  3. by   Holly0405
    Hey there... I am a nurse that has been working with this population for 3 years. I LOVE it!!! Im always looking for more resources...
  4. by   CiaMia
    I'm at a day program too! (and have lots of residential experience also).
    LOVE it. I love this population. <3
  5. by   Larrythenurse
    Good for you- we should not only do what we love but most importantly love what we do!
  6. by   HappyNurse09
    Glad to hear from all of you! I don't personally know of any other nurses that work in the field (except for the ones in my agency) so it will be great talking with and learning from all of you. For the ones that work in the day program what's your typical day like?

    Thanks!
  7. by   CiaMia
    We are a day habilitation program (funded by MassHealth/Medicaid), so there are strict regulations regarding the level of nursing oversight provided (0.75 FTE for programs under 28 participants I think; we have nursing on site for 6 hours a day) and what they must do.

    No-body can administer meds at dayhab except for and LPN/LVN or RN. This is different to the rest of the agency (residential programs) where direct care staff are MAP trained through the red cross. So a portion of the day is spent doing 12pm meds, PRNs as needed, nebulizer and inhalers before exercise groups or goals... and use of nursing judgement about all of the above!

    Also, consultation and oversight regarding diet and nutrition; especially to do with allergies and specialty diets. There was a big debate about whether adding Thick-It is a delegateable activity (very strict regs about what nursing activities can be delegated to regular staff with training and competency evaluation).

    The RN also is part of the interdisciplinary team that oversees each participant's service plan with goals, alongside the PT, OT, SLP and behaviourist. There's lots of communication with the residential programs or PCPs regarding concerns/issues that have come up also.

    There is lots of staff training, also, on things like blood-borne pathogens, seizures, dysphagia and a whole lot of other things that need to be done annually!

    So, really, a little of everything... med administration and assessment, education, communication with PCPs and residential programs... it's varied and like most other nursing environments, no two days are really the same!! :-)
    Hope this helps, it's a great world to be in and I love it!!
  8. by   marsy
    I work at a residential program with this population and I LOVE IT!!! I started off at a day hab center and from there went to a residence. I kind of prefer the day hab though because in residential I feel like I bring my work home with me (Especially when I have the on-call phone!) It's so hard to find nurses in this population so I'm happy that we have this forum.
  9. by   tainted1972
    For the past 20 years (since high school) I have mostly worked with people who have DD. I graduated last winter as an LPN and was hired by a previous employer. I absolutely LOVE my job. I work in a residential setting with a total of 22 residents (two homes). My place of employment is unique because we do not utilize delegated nursing.
    I am the only nurse in the evenings so I do all of the med passes and treatments for all 22 residents. I love the independence!
  10. by   momwithlicense
    I have worked in residential setting with DD adults, it can be challenging in every aspect, from getting direct care staff to follow recomended diets to having doctors who welcome them. All do not welcome them, and then a new doc is in order. Fear and anexiety are the biggest obstcles to getting even simple procedures done. Pre-meds when needed go along way to help reduce the anexiety that prevents the client from being compliant. Even then alot of reassurance and praise are needed. As you get to know them and they get to trust you it becomes easier. Of course many do not communicate well and much like the elderly, dehydration, UTI or illness often show up first with an increase in behaviors. It is not only nurses that shy away from this population, but public at large. It is difficult to find direct support workers even in this job starved economy. Most would prefere to flip burgers than to work with them. I think it is simply fear of the unknown, because once you get to know them, you can't help but love them.
  11. by   jdd112
    I work for an adult day care, and I can honestly say that I absolutely love my job. I do all the admissions, get orders from the doctors, take care of almost all of the paperwork the state requires the facility to do, as well as my nursing paperwork. I administer meds, take care of a couple g-tube feedings, a trach, modified diets, and usually a handful of seizures a day. Our facility serves DD/MR clients as well as elderly with Alz/Dem so things are always interesting around here.

    Sometimes I feel like I am losing some of my skills that I learned in school, and sometimes I wish I made as much money as my other nurse friends, but I don't think I would be this happy working anywhere else. Knowing I have an impact on each of my clients lives makes me feel really good about the work I do. People in other fields don't really understand just how close we get to our pts, and it would probably be considered crossing the line by their standards.

    The large majority of the families I deal with are amazing... but there are a few that make my life a little bit difficult. Anyone else dealing with a family that "knows better" than all the doctors, nurses, speech paths, etc?
  12. by   CiaMia
    Quote from jdd112
    Sometimes I feel like I am losing some of my skills that I learned in school, and sometimes I wish I made as much money as my other nurse friends, but I don't think I would be this happy working anywhere else. Knowing I have an impact on each of my clients lives makes me feel really good about the work I do. People in other fields don't really understand just how close we get to our pts, and it would probably be considered crossing the line by their standards.
    Oh, there are no words for how much I agree with this. Those boundary-crossing relationships are what makes our population so uniquely special and rewarding. These guys just personify the human condition to me -- granted, slightly simplified -- in all its unashamed, brash/crude, vulnerable, resilient (see! so many contradictions!) glory!! :heartbeat
  13. by   tainted1972
    The large majority of the families I deal with are amazing... but there are a few that make my life a little bit difficult. Anyone else dealing with a family that "knows better" than all the doctors, nurses, speech paths, etc? [/quote]

    Wow did you hit the nail on the head! I work in a residential setting where the majority of the residents have been living there for many years. They are getting older and they are beginning to need more medical intervention. Many of them have guardians who are responsible for making medical decisions. We (nurses) are trying our best to advocate for our residents but it becomes even more difficult when you have family members/guardians who disagree or think they "know better". It seems that the interventions that are permanent such as tooth extractions, peg tubes, dietary changes, braces (for limbs), wheelchairs etc.. are the things that are the most unaccepted by the families.
    here is an example.. resident has taken medications for many years that have caused teeth to become brittle and are decaying.. she is in pain.. father does not want teeth pulled because resident will not be able to eat the food she enjoys (dentures are expensive!) ... *****? the resident cannot eat the food she enjoys anyway because she is in PAIN!! Dietary modifications can be made in the form of an alternative texture so the resident can eat the food she enjoys. Dad does not want this to happen. So basically we have to wait for a tooth to become infected or is causing severe pain before he will agree to an extraction. It would be so much easier and more humane to have all the teeth extracted. ........yikes i think I just went on a little rant here.
    Anyway.. I feel your pain
  14. by   karray
    Nurse for 24 years, last 14 in DD worked in group homes, and currently am health coord. and QP for an adult day service. I have been certified as DDN since 2002. I would recommend joining the ddna. They are agreat source of info and networking. Most of us in this field know it can get pretty lonely out there. It is the best job I have ever had.

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