A day in the life of a developmental disability nurse...

FROGGYLEGS, LPN · Apr 29, 2004

I can't say that I actually know what it is like to work in DD.

I did get a job offer at a state MR/DD facility just two weeks ago. The facility was nice. The staff seemed very nice. The staff to patient ratios were low. The staff nurses were actually telling me how much they loved working there etc. while I was touring.

They weren't requiring any MR/DD experience. I am not sure if they hire new grads or not. They never said anything about a minimum amount of experience.

I wish I could have taken the job, but I honestly refused it because of the salary. It was by far the lowest paying job offer I have ever received. It was still a tough decision. I'm not saying all of the DD jobs are low paying; this one was low paying because all of the state jobs here pay poorly IMO.

I watch the classifieds like a hawk. :) Right now there are three very diverse job opening for DD nurses. Only one says they prefer 6 months experience in DD. Interesting sounding jobs too...one was at a daycare, one riding a school bus and attending class, the last is a homehealth/ visiting type position.

chwcjw · May 10, 2004

:balloons: Congrats on the degree,

I dont know what state you are in, Im NY. Ave pay for state DD RN 53k to 64k.

Duties? I teach infection control, train medication personnel(non-nurse), attend surrogate court, am main nurse for 2 ICf(intensive care facility) and 6 group homes. In addition plan clinics keep medical paperwork up to date including quatrerly and annual observations. Sounds alot but we all do this or carry a 200 load for home visitation-thats considered a plum by the way, weekends off. Private agency down the road uses 6 nurses for same client load, but less money40-45K and no security. But if you love your job whatever the field, it is going to fit like a pair of slippers. Dont get intimidated, especially by those who cant share their knowledge and help you out-its probably not worth knowing anyway-check some of my emails out.

You go where the job makes you feel alive and proud to be a Nurse and all it stands for. Do that and you'll rarely be wrong-lots of luck from an ancient nurse

Christopher class of 77

LPN1974, LPN · Dec 3, 2004

I live in Arkansas and I work in DD. I love working with our people, but it's hard work. It's not so much the people we serve, but what is expected out of us.

We have a census of about 115-120 now. We have 11 LPN's on staff. On my shift, evenings, we have 5 LPN's. OK, we work 4 ten hour days/week, off 3. {Which is NICE. I like that part.} We also do not have a night shift. It was closed down due to staffing. It didn't help much tho, to have those 2 nursing positions available for the other shifts because that's when she put us on a ten hour shift. It's all very confusing, I know.

Anyway, that schedules us, supposedly with 3 nurses MOST of the time. OK, here's where we get bit.....when one of us has to take time off, be sick, vacations, holidays or whatever, that leaves us with 2 nurses, for 115-120 people. That's what...about 55-60 people per nurse to give meds to, treatments, take care of emergencies, and every person there is supposed to be on a medication program of some kind, even if it's just you telling them what their med is for. Most of them take medication. Very few who don't. Maybe somewhere in neighborhood of 8 or 10 people do not take meds, may be less than that now. Some were transferred to another facility. Anyway, alot of these people take 8-10 medications at one time. Can you imagine going thru that many meds and doing that much talking every time you give meds to close to 60 people??? And the time limit for our med rounds are 2 hours... one hour before and one hour after the scheduled time.

They are also supposed to get their med in private....that means the nurse has to take that person to a private place to get his med. The aides don't help the nurses do this. The aides are busy with mealtime preparations or bathing duties at same times our med rounds are. We have alot in wheelchairs, also. Try pushing a w/c and managing a med tray at same time. It's difficult to say the least.

Alot of the people have boxes to open for their program. They open, set up their meds, and take it, with nurse supervising. All this takes extremely valuable time. DD people are slower, and I'm not criticizing them for that. I understand that. It's just that when one nurse has 60 people to give meds to, it can become very taxing on her, to get all this done. And don't make a mistake when an inspector is there. That includes just not medication errors, but make sure every person gets their med in private, their med program, and are told what their med is for. The med programs are as varied as there are people. Some are to wash their hands with a cleaner, some throw their cup away, some are to answer a question, on and on and on.

Medical director doesn't see it this way. She thinks we're just supposed to get it done, no matter what.

If we had 3 nurses all the time, it wouldn't be so bad. We would have more time to spend with each person to do what they need, but when it's just 2 nurses, I can't get it all done.

And if during your med round an emergency is called you have to drop what you're doing and go.

We have 8 separate homes there, for the people to live in. An average of, I'd say from around 11, 12, 15 people up to 20 people in one home. One home only has 6 women in it, as they have a more nonrestricted living environment. It's a real house they live in. The other 7 homes are institutional type buildings.

The nurses have vehicles to drive around the facility. Golf carts type things.

I love the people we serve. But everyday it seems that we have more that is expected out of us.

If you can get into a type of facility where your nurse to client ratio is better than at mine, I'd say you would love the work.

But at state run facilities, they keep saying that we have to "do more with less".

Budget always enters into everything. It seems like they don't consider the type of people we are working with.

I guess this post is too long. Sorry. I just have to vent sometimes.

It is a hard job, but I love the people. I only have 3 1/2 yrs left until I have my 28 year retirement and I'm out. The demands are just getting too great.

DDRN4me · Dec 4, 2004

There is really no such thing as a "typical 'day! :uhoh3: it really depends on what kind of job you have in DD...school,classroom,private duty or facility! the possibilities are endless, and so are the rewards!:) I would try to get some really good med surg or facility background..it will never hurt you!! Good luck!!

Claver · Dec 6, 2004

I work in the residential setting with MR/DD clients, I have also done home care with a home health agency. In the Residential setting the clients maybe in an Intermediate care facility (ICF) - which could be from 10 - maybe 40 clients, or in small group homes of 10. In an Individual Residential Alternative (IRA) they may be 8 or less clients in each home. My work consists mainly of medical oversight and supervision of the AMAP staff- specially trained to administer medications and treatments. Most of my clients are in very good health, but some are medically fragile. So it depends on the health and functioning levels of the clients and the kind of facility that you are working in. It would be good if you have a year or two of med-surg nursing, as you work on an independent basis, and really must have good judgement as telephone triage is a big part of the job.:chuckle

GingerSue · Dec 22, 2004

I'm checking all over - does anyone know where to find instructions about how to use the Denver II Developmental Screening Test?

Thanks.

lindylou54 · Feb 22, 2005

Hi, Iwork with the State of NY, with the OMRDD population.

I have worked for them since 1987 and have seen many changes in the system.

I opened a home in a town that I live in and have transferred to amny other homes and the insitution prior to closure.

I worked currently in an IRA with ten consumers. I am just like everyone else there: we do dishes, cook, clean, laundry, transport to and from medical appointments, pick up meds., take doctor's orders,have advocate responsibilities ie: shop for the consumer, make sure they have involvement in the community and maintain family contact if there is family also we maintain their room and keep track of their possessions.................................and do showers, programs, feedings ( tube and po) and if we get the time lol we are responsible to do the PRN notes on everyone each shift-we are under supervision from an RN, that is only available from 8-4 pm Mondays thru Fridays and we ahve access to a teleservices program where there is always an RN available to us. Needless to say, I am burnt out nad am looking for another field just not sure which way I want to go yet. The hardest part is working with a house director and assistant director that think they are medically knowledgable and they tell us-LPNs-how to do things-we know our rights and the laws, but these other people think they know it all; oh, well, bless anyone that wants this field of work-the pay is good as are the benefits, but now that my children are grown who needs the hassle ? My thouhgts- life is just too short not to be happy with what you are doing. Linda//

WhatToDo · Feb 23, 2005

Thanks for your post Louisepug, I'm also graduating nursing school in 2006. I'm still trying to figure out where I belong too, but I worked as a nanny for a year in college for a child with cerebral palsy and I absolutly loved it! I think this area of nusring would be interesting (I've also thought about OB, psychiatric nursing or something in pediatrics).

I have a master's in public health and will be receiving an BSN, I'm wondering if public health nurses do work with children with disabilities? Any thoughts would be helpful.

chwcjw · Apr 3, 2005

I live in Arkansas and I work in DD. I love working with our people, but it's hard work. It's not so much the people we serve, but what is expected out of us.
We have a census of about 115-120 now. We have 11 LPN's on staff. On my shift, evenings, we have 5 LPN's. OK, we work 4 ten hour days/week, off 3. {Which is NICE. I like that part.} We also do not have a night shift. It was closed down due to staffing. It didn't help much tho, to have those 2 nursing positions available for the other shifts because that's when she put us on a ten hour shift. It's all very confusing, I know.
Anyway, that schedules us, supposedly with 3 nurses MOST of the time. OK, here's where we get bit.....when one of us has to take time off, be sick, vacations, holidays or whatever, that leaves us with 2 nurses, for 115-120 people. That's what...about 55-60 people per nurse to give meds to, treatments, take care of emergencies, and every person there is supposed to be on a medication program of some kind, even if it's just you telling them what their med is for. Most of them take medication. Very few who don't. Maybe somewhere in neighborhood of 8 or 10 people do not take meds, may be less than that now. Some were transferred to another facility. Anyway, alot of these people take 8-10 medications at one time. Can you imagine going thru that many meds and doing that much talking every time you give meds to close to 60 people??? And the time limit for our med rounds are 2 hours... one hour before and one hour after the scheduled time.
They are also supposed to get their med in private....that means the nurse has to take that person to a private place to get his med. The aides don't help the nurses do this. The aides are busy with mealtime preparations or bathing duties at same times our med rounds are. We have alot in wheelchairs, also. Try pushing a w/c and managing a med tray at same time. It's difficult to say the least.
Alot of the people have boxes to open for their program. They open, set up their meds, and take it, with nurse supervising. All this takes extremely valuable time. DD people are slower, and I'm not criticizing them for that. I understand that. It's just that when one nurse has 60 people to give meds to, it can become very taxing on her, to get all this done. And don't make a mistake when an inspector is there. That includes just not medication errors, but make sure every person gets their med in private, their med program, and are told what their med is for. The med programs are as varied as there are people. Some are to wash their hands with a cleaner, some throw their cup away, some are to answer a question, on and on and on.
Medical director doesn't see it this way. She thinks we're just supposed to get it done, no matter what.
If we had 3 nurses all the time, it wouldn't be so bad. We would have more time to spend with each person to do what they need, but when it's just 2 nurses, I can't get it all done.
And if during your med round an emergency is called you have to drop what you're doing and go.
We have 8 separate homes there, for the people to live in. An average of, I'd say from around 11, 12, 15 people up to 20 people in one home. One home only has 6 women in it, as they have a more nonrestricted living environment. It's a real house they live in. The other 7 homes are institutional type buildings.
The nurses have vehicles to drive around the facility. Golf carts type things.
I love the people we serve. But everyday it seems that we have more that is expected out of us.
If you can get into a type of facility where your nurse to client ratio is better than at mine, I'd say you would love the work.
But at state run facilities, they keep saying that we have to "do more with less".
Budget always enters into everything. It seems like they don't consider the type of people we are working with.
I guess this post is too long. Sorry. I just have to vent sometimes.
It is a hard job, but I love the people. I only have 3 1/2 yrs left until I have my 28 year retirement and I'm out. The demands are just getting too great.

I hope I replied well before this, my 'puter got the virus, knew I should of given it a shot. My case load has been reduced to 74, no meds just site visits in community as well as making hospital rounds where of course hippa rules stupidly supreme. 3 of the 5 nurses for 500 people are retiring this month no replacement of course the state needs them to run errands for the director. Looking forward to florida as soon as my wife's Fa and mom are ready-may be long their 85 and built the complete house themselves even cleared the land-doesn't that sound pioneer. Any who her dad is Alz. and its only a matter of time oh well pleasant change ie hippa joke

nkock knock who there hippa hippa who-I can't tell you

#2 Of course I can give you the medical data, the arresting officer will bring it with him.

hope this makes up for long wait

Christopher

:rolleyes:

nurseinmo · Jun 14, 2005

My experience is much the same as LPN1974; but there are times (every Fri & Sat) when I am the only nurse in our building of about 60. On those nights, there is typically an RN across the street who can be consulted for emergencies or questions that I may have and she is usually very good about responding. However, she is expected to pass medicaitons, do all of her "RN duties" AND help me. It would be overwhelming for only one person. Last Sat. was the worst day I have had since being "on my own", (I am the only LPN left on my shift in either building so we use med-tech's and we are down one RN or I wouldn't have to be working by myself so much) We have one "living area" with 8-9 higer functioning (and more dangerous) men. These are the ones who may be slightly MR, but are mostly there to avoid going to jail. Anyway they had been on edge all day and then about 8pn, close to the end of my med pass they called and said that they had had to do a "take down" and that there were injuries they needed me to assess. They described them as cuts (minor) scrapes ect. so I told them to give me 10 minutes to finish up and I would be there. Less than 3 minutes later, they called me back and said that they needed two chemical's. I locekd my cart, put it where it was less likely someone would get to it (nothing harmful was left, just juice, cups, spoons ect) and told the staff on that living area I would be back when I could. I proceeded to check the charts for allergies etc and called the Doc and told him the request and the med that each was normally given. He o.k.'d and I got the injections and gave them. In the meantime, they had had to put one of the men in mechanical restraints because he was trying to pull the carpet out of the "quiet room" to get to the tac strip. Long story short(er), I wound up having to send 2 staff to the local ER for {minor} injuries; then had to find someone to replace them; had injuries on 5 of the men who lived there and wound up giving one more chemical before the night was over! The med tech who was working with me that night had to go to the area where I had been giving meds and finish them up and made sure the narcotic count was right with the next shift because I wound up being 2 hours late that night!

As I said before, this was my WORST night and luckily they are typically few and far between. I might also add that our facility is slated to be shut down in 1yr and that is part of why it has been so hard for us to find someone to fill the holes that we have. I have worked in the facilty for five years now, only one as an LPN (just went to school last year, and am now going back for my RN) and I think it is harder to do "just my job" bucause I know what is expected from the staff {who BTW are wonderful}. Anyway, sorry this was so long...

lindylou54 · Jun 17, 2005

:rotfl:

My experience is much the same as LPN1974; but there are times (every Fri & Sat) when I am the only nurse in our building of about 60. On those nights, there is typically an RN across the street who can be consulted for emergencies or questions that I may have and she is usually very good about responding. However, she is expected to pass medicaitons, do all of her "RN duties" AND help me. It would be overwhelming for only one person. Last Sat. was the worst day I have had since being "on my own", (I am the only LPN left on my shift in either building so we use med-tech's and we are down one RN or I wouldn't have to be working by myself so much) We have one "living area" with 8-9 higer functioning (and more dangerous) men. These are the ones who may be slightly MR, but are mostly there to avoid going to jail. Anyway they had been on edge all day and then about 8pn, close to the end of my med pass they called and said that they had had to do a "take down" and that there were injuries they needed me to assess. They described them as cuts (minor) scrapes ect. so I told them to give me 10 minutes to finish up and I would be there. Less than 3 minutes later, they called me back and said that they needed two chemical's. I locekd my cart, put it where it was less likely someone would get to it (nothing harmful was left, just juice, cups, spoons ect) and told the staff on that living area I would be back when I could. I proceeded to check the charts for allergies etc and called the Doc and told him the request and the med that each was normally given. He o.k.'d and I got the injections and gave them. In the meantime, they had had to put one of the men in mechanical restraints because he was trying to pull the carpet out of the "quiet room" to get to the tac strip. Long story short(er), I wound up having to send 2 staff to the local ER for {minor} injuries; then had to find someone to replace them; had injuries on 5 of the men who lived there and wound up giving one more chemical before the night was over! The med tech who was working with me that night had to go to the area where I had been giving meds and finish them up and made sure the narcotic count was right with the next shift because I wound up being 2 hours late that night!
As I said before, this was my WORST night and luckily they are typically few and far between. I might also add that our facility is slated to be shut down in 1yr and that is part of why it has been so hard for us to find someone to fill the holes that we have. I have worked in the facilty for five years now, only one as an LPN (just went to school last year, and am now going back for my RN) and I think it is harder to do "just my job" bucause I know what is expected from the staff {who BTW are wonderful}. Anyway, sorry this was so long...