I need your help on this!

bargainhound, RN · Jan 27, 2006

So, he is at home?

Marci Raye · Jan 27, 2006

Currently at a nursing home but we need to be making a decision if our agency can support the client in a home based setting. This would be their own apartment with unlicensed staff.

Antikigirl, ASN, RN · Jan 27, 2006

I think staying in a SNF/LTC is the better option for this pt because of the licensed staff...but understand the reason why a private home is wanted.

When I was working for an agency where I was a nurse for a DD group home most of the staff was unlicensed, but with the exception of myself (RN) and an LPN who was there weekdays during the day (we took turns being on call on weekends). The staff was excellent with issues and conditions for DD people, and understood many things I didn't expect (in fact I learned from them)...but I was very lucky! You can not be guarenteed of that!

If this winds up happening, inservices on the importance of neuro checks, how to do them, and general info on VP shunts is needed. Followed up by re-training every 3 months to assure understanding. Make up a book so that the staff can get to it with this information at all times in a easy to get location, or even post a general neuro checklist in the room (behind a cupboard door, or even in plain site).

Another thing I did was to make check lists for their hourly/2 hourly checks...something rather simple to follow or it wouldn't be done...that way I knew they at least were doing them, or the patient was being checked on! The caregivers liked having a check list to follow with just little boxes to check and when to call me or 9-11!

Hope that is helpful!?

Marci Raye · Jan 27, 2006

Thanks TriageRN, the information was excellent. If our agency decides to take this client back, I will use your ideas to train staff. Thanks!

TheCommuter, BSN, RN · Jan 28, 2006

I work for an agency that provides community care services for the developmentally disabled. Direct care staff is unlicensed. We have a client who has long standing neurological problems and a vp shunt. The neuro problemes have become worse after recent brain surgery. The client falls often (unable to restrain) and I am concerned about delegating unlicensed staff to assess for neuro changes after falls, or anytime for that matter. What do you guys think? Would you be comfortable with this type of client in a community based program?

Five years ago I was employed as one of these unlicensed direct care staff members in a facility where 6 developmentally disabled adults resided. The pay, $8 hourly, was crappy. However, the wealthy owner of these facilities liked it that way.

Why pay skilled nurses when the owner can save thousands by hiring unlicensed caregivers? I would be uncomfortable with the post-surgical client in community care; however, the people in charge of your agency know how to thicken their wallets. The way to do this is by assigning poorly-paid direct care staff members to provide basic care for this client and, meanwhile, hope that nothing too serious occurs.

Just my honest opinion.

clee1 · Jan 28, 2006

Why pay skilled nurses when the owner can save thousands by hiring unlicensed caregivers? I would be uncomfortable with the post-surgical client in community care; however, the people in charge of your agency know how to thicken their wallets. The way to do this is by assigning poorly-paid direct care staff members to provide basic care for this client and, meanwhile, hope that nothing too serious occurs.
Just my honest opinion.

Quite blunt, aren't you?

However, I agree 100%.

TheCommuter, BSN, RN · Jan 28, 2006

Quite blunt, aren't you?

I speak my mind. I'm too old to remain quiet and refuse to bite my tongue.

However, I agree 100%.

Thank you.

clee1 · Jan 28, 2006

I speak my mind. I'm too old to remain quiet and refuse to bite my tongue.

Agreed.

There is one major benefit to ageing and being relatively independent - I no longer have to suffer fools in silence.

(I wonder how many nursing jobs I'm gonna lose that way?)

TheCommuter, BSN, RN · Jan 28, 2006

There is one major benefit to ageing and being relatively independent - I no longer have to suffer fools in silence.
(I wonder how many nursing jobs I'm gonna lose that way?)

If I had the choice between job loss and kissing the rear-end of a boss, I'd much rather take the job loss anyday.

Marci Raye · Jan 28, 2006

Thanks TriageRN, the information was excellent. If our agency decides to take this client back, I will use your ideas to train staff. Thanks!

Marci Raye · Jan 28, 2006

Thanks everyone, for your thoughts and great sense of humor! We all need a laugh sometimes. These appear to be fixed neuro deficits and I worry about unlicensed staff recognizing any neuro changes. Sometimes I worry about ME recognizing neuro changes. The client is mostly non-verbal, so some of the check and info I would want (do you have a H/A?, what's your name?, etc.) aren't going to be applicable. Keep your suggestions and thoughts coming, I appreciate all of them.