Does anyone here work on an ACT team?

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    If so, could you tell me what you do, what your roles are, what you love about it and what you dislike?

    It sounds very interesting and I noticed it is growing across America. I am just unsure what all the RN does in this team and what a 'typical' day looks like.
  2. 2 Comments so far...

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    In NY state, I work on an ACT team as the RN. The role of the nurse is multifaceted in that it can include activities beyond traditional nursing duties which are often fun and exciting. Mostly however, the nurse is responsible for administration of IM medication to clients during home visits. IM medication like Haldol Dec, Prolixin Dec and Risperdal Consta. This is usually the focus of the visits but the nurse will also conduct visits for completion of nursing assessments and plans for linkage/scheduling with a primary doctor. Additionally, the nurse is responsible for packaging of oral medication. Some clients get weekly pill boxes while others may get daily or two day supplies at a time. The medications are mainly the psychiatric medication prescribed by the psychiatrist on the team but can also be medical medications from primary doctors/hospitals. There are about 50 clients with my ACT team. You definitely get to know the clients very well, sometimes over several years. The clients are all adults, 18 and up. A lot of the clients also deal with a dual diagnosis in terms of having a substance abuse issue along with an Axis 1 diagnosis like Schizophrenia. This is a nursing specialty that I was initially drawn to because I really felt like the nurse was able to spend time with the clients and address their needs comprehensively with the support of the team. However, sometimes it can seem like there is just not enough time in the day! A typical day would consist of the morning meeting with the team at 9am to review the entire client roster, then home visits with clients throughout the county until 4pm and of course, documentation of the visits in progress notes, assessments, etc. Hope that helps a little!
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    It's definitely unlike any other job I've ever had. Our team consists of 79 patients (aka clients aka behavioral health recipients), 9-10 case managers, a clinical coordinator, a program assistant, an RN (me) and a psychiatrist. The case managers share all of the caseload and are only assigned to specific clients for administrative purposes. They each have a specific role. We have 2 ACT specialists, the one of each of the following- rehab, transportation, housing, employment, substance abuse, ILS (independent living skills), peer support... I am forgetting someone, because the numbers aren't adding up. They see the clients as little as once a week and some are seen twice daily. I put the case manager role in this post before mine because they are the ones who really provide the day to day care.
    It is really a team effort. I give the injections, see clients for labs and assessments, deal with rx refills and troubleshooting when the insurance won't cover something, and coordination of care with PCP's, inpatient units, and the jail. I am completely autonomous as far as the nursing part goes.
    Typical day- starts at 8am. Sometimes my first part is home visits, depending on where they are. The program assistant generally starts and ends my day near my place or my boyfriends place for convenience.
    I have 41 people on injections. I have about 10 in supervised living situations and I have to do monthly visits to those. The is a 90 minute meeting in the morning where we discuss all 79 clients. The CM's divide up the work as far as who brings who to appts, who visits the jails and hospitals, etc. If transportation is an issue and someone needs an injection or a surprise urine drug test I go out and do that in the field. Safety is a big concern but we know the clients so well that we can see if someone is starting to decomp and send 2 ppl to see them or have them come into the clinic.
    I love my job, and wouldn't trade it for anything.


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