LPN working with Developmentally Disabled population

[MEL55]

Hi all

I posted this in another forum... I don't remember which one, but got only one response & it was kinda vague, so I wanted to post it here.

I'm an LPN working for the Arc(association of retarded citizens), in their Special Needs Day Program. Here we have maintenance therapy(OT & PT & Speech Therapy services) along with technicians, caring for their needs. (feeding, changing, etc...along with the therapists under the supervision of a Center Supervisor.

The agency also ,about 5 yrs ago, hired an RN because they wanted to take in more skilled care clients(G tubes), and also have her work out in the field visiting the group homes if there were any medical issues( going to the hospitals to act as a liason etc...)

The Arc always had an LPN on staff, even before the RN came aboard, but there were no G tubes, so there was no skilled nursing involved, & the LPN, from what I was told, did meds and took on 3 clients to provide care for.

Since I have been working there, I have had my RN there. Her office was in our building, & if she were out in the field, or on vacation... she was always a phone call away.(I assumed this was OK,being new to this field of nursing, & not knowing the legal ramifications of an LPN working skilled care if an RN were not available.)

My RN is resigning her position, & there is noone to take her place. They are advertising for a full time RN, but in the case that noone is hired by the time she leaves..... where does that leave me, in regards to performing skilled care(tube feedings, hydration & meds through a G tube?)

My RN states things are really so unclear with her also, a reason why she is resigning. She does though want to help me in my dilemna before she goes as much as she can. She says she will contact an outside Nursing Agency, and ask them if they have an RN that can come to the Center I work at from 10 AM until 2 PM to oversee my skilled care.After 2 PM there is no more skilled care I do, mostly paper work, & oversee the health & safety of the clients while there are at Program.

My question is... what are the legalities involved? I was told by the Program Supervisor(who is my boss also, along with my RN as my boss),not to worry. Not to worry! She has no license to worry about,nor does her position require a college degree. I have my license to cover.

No one else with the Arc is a medical professional that I can go to for advice.

Do I tell the Director of the Arc Agency I cannot work until they get an RN hired? I don't know. There is nothing written in their policy & procedure manuals about my situation.

If you need anymore info let me know. I do know there is an RN that works with DDD,but the Arc isn't really associated with DDD, even though we have to follow their guidelines plus our own.(My RN told me the DDD nurse couldn't & wouldn't put his license on the line for the Arc, & even told her she was crazy for accepting the position as the Arc Agency RN.

Let me know what you guys think of this mess I'm in... I don't want to jepordize my license. The Arc is very loosely run & it is non profit. I do love the job I have now, & would hate to resign my position.

Thanx !

[EricJRN, MSN, RN]

Scope of practice varies from state to state, so I don't have specific suggestions about that, but do you think they'd be willing to send you through some inservices on relevant topics? Wouldn't address the RN vacancy, but it might help you to feel more comfortable with some of the stuff you're seeing.

[DONN]

Most states require that an LPN be under the direction of an RN and I can tell you that I worked for pretty much the same setup and when the RN quit I was done that same day. Its absolutely ridiculous that you have to be under the direction of an RN for simple things like tube feedings but if you check your states laws I would bet that you need an RN somewhere on staff to cover your butt.....

[MEL55]

Thanx for the feedback.

Just found out today the way they're getting around it untill they can hire the RN is get an outside agency LPN to come in daily & pay her to do the skilled care part(tube feedings... meds through the tubes & hydrations)She's covered by her agency, so no need for me to worry.

The Arc agency is willing to keep me aboard while paying the outside agency to bring their LPN in, & I'll do the rest of my duties there which pretty much is just overseeing the health & safety of the 20 clients we serve, keep medical charts updated, and help the techs out. Plus... I won't need coverage if I want to take a vacation day... have to call out sick.... there's an LPN there from the outside agency doing all the tubes & meds!

That's cool because I love the population I work with & I socialize with them as if they were my friends... neighbors. They're severely developmentally disabled, but they sure can smile & laugh knowing they're loved & cared for while at our Program!

[Fiona59]

I'm sorry but I don't understand what you are worried about. If an outside LPN can do your tube feeds and crushed meds why can't you do them? I've always done them under my scope of practice, we are even responsible to attempt to unclog the tube, if unable to we advise management and the patient goes to acute for a tube change.

I'm not trying to upset anyone, are you unsure of how to do these procedures and need a refresher, or would it upset your workload to assume these duties??

[HeatherLPN]

I work part time in MR/DD and I am the only nurse there when I go in to pass meds and do my tubefeed. My supervisor is an LPN also. We have an RN that comes in a few hours a week to take care of certain paperwork, but no other RN's on staff in our homes, just up at regional. I'm not quite understanding why you can't do tubefeeds and things like that? And it sounds like you help with client care? Where I work, I can't help transfer anyone or anything like that b/c I'm not covered on thier insurance for liabilities like that since I am considered nursing dept.--at least, that's how it was explained to me.

[MEL55]

Do your clients live there, where you work? The clients I deal with don't live in the Center I work in. It's a Day Center that the clients come in a school bus to mon. thru fri., & then go home... to the Group Home they live in, or to their families or home to a Provider/Caregiver

[HeatherLPN]

Oh, I see. Yes, my clients live there. We have a workshop that they go to that has nurses on staff thru the day.

[MEL55]

Fiona

An outside Agency LPN is covered under her Agency RN. She can come into the Day Center & do the tubes and go.When the Arc RN resigns...there is no RN.

[lmcgraw]

i work in a group home i am not a cna or and rn i have a high school deploma. am i allowed to opperate a g-tube for a resident for feedings and medication adminastration. i am in illinois and if i am not to do this where can i print out somthing that says so. i feel as if this is something i licenced profetional should be doing...