ALC solo nurse starting on the bottom floor

[ch232]

Hi! I was just hired to be the RN for a brand new ALC. It opened 2 weeks ago and has 4 residents. I am hired specifically to be the nurse at the ALC, but actually work for the clinic which holds the contract to provide RN coverage. My position is 20 hr/wk, 11.5 at the ALC and 9.5 at the clinic, to assist with case management. I will be given my intro tour of the facility tomorrow, but the RN from the clinic who has been 'covering' the RN duties while waiting for the position to be filled, told me today, that right now there is a great need to implement a nursing assessment tool and a tool for tracking client nursing notations, etc. There is apparently a computerized 'Service Plan', but the interim nurse told me it was not adequate for nursing assessment needed for admission. What should be standard on intake nursing assessment forms and evaluations? What type of form is used for following the clients daily, weekly, etc? Any info that anyone might have on how to organize an ALC so that it will run smoothly and document the care given, esp from the nursing point of view would be very welcome. I have the AALNC Scope and Standards, my state statutes, as well as infection control guidelines....what would be the priorities. I understand (again, from my conversation with the interim nurse) that the CNAs (1/8-hr shift) are intellegent, eager but not very experienced. Please offer your words of wisdom from the depths of your experience....tell me how you would go about launching this facility so the nursing care is as state of art as the facility is....I have >30 years experience as a nurse, but haven't worked in ALC or in LTC facilities. Thanks in advance, Cheri

[Elizabeth, RN]

I've done AL management for several years but it's always been a (more than) full time job. What is the capacity for the unit? Who administers meds? What kind of med management system is used? Med errors are the biggest problem in facilities with "med techs"--non-licensed aides who distribute meds. They mean well but just don't have the knowledge base or judgment to handle the job. They require CLOSE SUPERVISION. I use the facility's assessment tool as a guideline but make up my own, more detailed form. For placement, you want to ask questions that will cover social and medical history (it helps to know ahead of time if someone has hepatitis, won't accept a female caregiver for bathing, etc.), what assistance is required with ADL's (families often downplay this to try to get them in at a lower level of care; many need more care when they first arrive), skin issues, mobility and fall risk,, mental status exam (MMSE), etc. Residents should be re-assessed after any hospitalization or change in condition or at least annually. The more you can learn about that resident the better--and remember that we should adjust to their routine as much as possible, not the other way around. Put a new photo of the resident in the MARS, also helpful for in event of elopement. Ask what is the main reason for placement now--it could be wandering, incontinence, confusion, a fall, death of spouse, inappropriate behavior, etc.--so you can address that issue right away. Keep the family involved but direct most of your questions to the resident. I ask the family to always let the potential resident answer first, then add their comments. Teach the caregivers to always treat the residents with respect, preserve their dignity, be patient and make them smile. If I can help with more specific questions, let me know.