Need suggestions as I'm frustrated!

Claver · Jan 17, 2005

Hi Jlseki,

I can understand your frustrations. What kind of setting are you working in? Is it an ICF, IRA, or CR? There is very little difference in the nursing care, but ICF include those who need a bit more supervison. Usually the agency is responsible for training the staff to work with the consumers, and this will include certifying them for medication administration. The nurse in the house is responsible for ongoing inservice - that is training them on new procedures - e.g use of nebulizers, and also retraining on any areas in which they are lacking - also for yearly recertification of medication administration. In the agencies that I have worked nurses were not responsible for hands on training - only to demonstrate a procedure. We supervised the staff, make sure appointments are kept, checked on lab work, special test, and make sure that correct follow up is done - on call, triage, etc. There is no nursing plan written as we know it, but there are semiannual and annual nursing assessments that become part of the Comprehensive Functional Assessment - CFA - and in this document a review of all medical care in the past 6 months or year is done, and there is a section for nursing recommendations. I do hope that this is helpful.

For you that have been in DD awhile, I could sure use some advice. In the community where I live, nursing is a "new' thing for the DD pop. There are two of us, just hired in Nov. of 04. We serve 6 residential sites, and 2 day hab. sites. I can't even tell you right now how many persons we serve. My frustrations are: (1) I was hired on as a nurse to oversee meds, admin. meds (when frontline staff are unable to "access" for some reason), set and attend appointments, etc., etc. (2) I also work primarily at one of the residents because in order to hire us nurses, they had to do without frontline staff (3) I was recently informed that I am also the Lead Trainer for the one resident site (again because of the budget that didn't include nurses). Because nursing wasn't in place, there are no nursing care plans for our clients, no equipment (even thermometers!), and the little bit of filing that was there, is a mess. I haven't even had a chance to get to know all of the clients since I'm pretty much stuck at one house, haven't read but maybe 4 charts, am unable to go through meds, charting of meds, medication error forms, nothing. How in the world do I go about setting up a nursing dept. let alone be a nurse/frontline staff/lead trainer? Let me just say that I don't mind being frontline staff, as I love the hands-on with our clients. I wouldn't even mind being a lead trainer, but I'm starting to believe that they really don't need a nurse.

jleski · Jan 17, 2005

hi jlseki,
claver, i can always count on you for getting back with me. thanks!
i can understand your frustrations. what kind of setting are you working in? is it an icf, ira, or cr? i don't even know what an icf, ira or cr is??? i work for an outfit called community entry services. the house i work on has 6 adults: 4 wheelchair bound and severe mr, one adult in the 50's who has been dx with autism but i believe there is more schizo. in his patterns & he has also severe mr, and the other is an adult who is autistic/mr/seizure disorder. there is very little difference in the nursing care, but icf include those who need a bit more supervison. usually the agency is responsible for training the staff to work with the consumers, and this will include certifying them for medication administration. the agency is holding "us" responsible for the training of staff & there is no certification for administering meds. as i said, staff "access" meds "with" the consumer. the nurse in the house is responsible for ongoing inservice - that is training them on new procedures - e.g use of nebulizers, and also retraining on any areas in which they are lacking - also for yearly recertification of medication administration. in the agencies that i have worked nurses were not responsible for hands on training - only to demonstrate a procedure. we supervised the staff, make sure appointments are kept, checked on lab work, special test, and make sure that correct follow up is done - on call, triage, etc. there is no nursing plan written as we know it, but there are semiannual and annual nursing assessments that become part of the comprehensive functional assessment - cfa - and in this document a review of all medical care in the past 6 months or year is done, and there is a section for nursing recommendations. we too are responsible for all these things, plus hands-on training, and direct care. i do hope that this is helpful.

how do i set up a nursing program that only two nurses are responsible for, that includes all of the above, plus being responsible for the clients at the other houses (that i have never yet been to), and the two day hab. sites? i am overwhelmed to say the least and my partner, who is nearly at the retirement age is ready to throw in the towel because of all the lifting, cooking, cleaning, md appts., meds, etc. i don't know how to help myself, let alone her.

RoseKas · Feb 8, 2005

how do i set up a nursing program that only two nurses are responsible for, that includes all of the above, plus being responsible for the clients at the other houses (that i have never yet been to), and the two day hab. sites? i am overwhelmed to say the least and my partner, who is nearly at the retirement age is ready to throw in the towel because of all the lifting, cooking, cleaning, md appts., meds, etc. i don't know how to help myself, let alone her.

i've been in the dd field for quite some time...13 years...and have this suggestion: go to http://www.ddna.org. this is an organization of dd nurses, and there are lots of us out there. maybe someone there can help you.

in regards to your particular situation, what state are you in? there are rules and regs in every state that govern what nurses must do for the consumers in an agency such as yours. in illinois, we would call your home a "cila," a community integrated living arrangement. there is a reg in il governing the teaching of medication administration to the staff of such group homes, and it is called rule 115. it is very specific in regards to what is taught to your staff. and, i might add, a nurse should not be the staff who cooks, cleans, etc. for heavens sake, are there no other staff people there???

what you need to do is contact your state agency for developmental disabilities and find out what rules and regs there are for group homes for dd adults. that is the first place for you to go. this agency sounds like it is operating outside of the regs, or at the very least on a shoestring budget that puts your licenses in jeopardy, unless you learn the regs and get it organized to where you do what is within your scope of practice.

i truly suggest you get in touch with ddna, because there are dd nurses from every state in the union, i believe, and you should be able to get some help from them.

feel free to contact me via email for continuing support. [email protected]. i love this field of nursing, and would hate to see someone leave it too quickly without having had a fair shake at it. it has made my life immeasurably fuller because of all of the incredibly wonderful clients and experiences i have had over the years :flowersfo