New RN working in Group Home

dondon44444 · Dec 7, 2008

Hi, I actually just started a job that manages thirty group homes that sound pretty similar to the one you work in. I am new to this field, I have one yr experience working on a telemetry floor in a hospital, I just started this job a week ago. Our positions are a little different, but it seems we are both starting out in similar fields. How has it been so far? Do you have a nurse that oversees, manages numerous homes including the one you are working in? Part of my job is to audit the homes, check the paperwork to make sure policies are being followed, being present at discharge from the hospital if any patients were to be admitted, and education of all the staff by giving inservices. What kind of company do you work for? Have you had any experience interacting with nurses in my position? Good luck with your new job, I think it seems like an excellent field to be getting involved with!

AddieRN · Dec 9, 2008

Hi, I actually just started a job that manages thirty group homes that sound pretty similar to the one you work in. I am new to this field, I have one yr experience working on a telemetry floor in a hospital, I just started this job a week ago. Our positions are a little different, but it seems we are both starting out in similar fields. How has it been so far? Do you have a nurse that oversees, manages numerous homes including the one you are working in? Part of my job is to audit the homes, check the paperwork to make sure policies are being followed, being present at discharge from the hospital if any patients were to be admitted, and education of all the staff by giving inservices. What kind of company do you work for? Have you had any experience interacting with nurses in my position? Good luck with your new job, I think it seems like an excellent field to be getting involved with!

Hi. Oh I love my position so far, even though it is only part-time. I love working with MR/DD clients, and I believe you have to have a special gift to be able to work with these individuals. They make work fun, and they make me appreciate what I do.

I basically do the same thing you do, audit the homes. I look over the medical charts and make sure that the Dr.'s appointments are up to date, I review lab work, I check physican's orders with the MAR. It's mainly paper work, but I make time to talk with the clients and interact with them a little. We have an LPN who manages the homes and is on-call 24/7, I am also on call should they not be able to reach her. We only have 2 homes and 12 clients total. I worked there for almost 3 years while I finished my nursing degree. Unfortunately, I haven't had any interaction with other nurses from this field, I'm kind of learning and making my own routine as I go. How about your facility, do you have other nurses who manage the home? Have you had any interaction with other nurses who work in this field. Do you have any advice or pointer for me, so that I can provide the best care to my clients? We also do quarterly evaluations (nursing assessments). How does your facility handle nursing assessments?

I worked telemetry for about 3 1/2 months and hated it. I quit it pursuits of finding a job that was more laid back and closer to home. I worked days and could not for the life of my keep up. My nerves were shot, I couldn't eat, sleep, etc. I still want to find another full time position in a hospital, because I need that experience. I'm just hoping that my next full time job will be the right job and be a night time position. Maybe a med-surg floor or something. Being a new nurse is so tough.

AddieRN · Dec 9, 2008

Oh yeah, I thought of one more questions for ya, do you have med-techs?

dondon44444 · Dec 9, 2008

hey, thanks for writing back. well, it sounds like we do alot of the same stuff. i think i mentioned that there are about thirty group homes that i manage. i have about eighty clients. ive just started my yearly audits...checking through the books, making sure all doc appts are up to date, meds, labs, diagnostics, etc. its quite a project i have, but i like that kind of stuff. we also have the mar reports, and i have to do quarterly audits on those as well. as far as nursing assessments, we dont have a policy on them, we just do them as we see fit. after im done with all my audits, i have until the end of the month to finish them, im going to go to each house and assess as many people as i can. we are pretty much supposed to do them with patients that have a problem going on, but i want to do them more often than that. there is one other nurse at my company that works part time, she has about ten houses in a different area and does the same thing i do. there arent any other nurses working in my company. its just us. each house has the home health aides, there 24/7, and a house manager, but they arent licensed health professionals. so, all the medical expertise is left to us! its only my second week on this job and i love it so much. i feel like ive been there for months, i understand whats going on and just basically jumped right in and got started with everything. another responsibility i have is to provide education for all the people working in the homes. i have to give two hour inservices every month on various topics that i pick. thats kind of scary for me, but i will get over it im sure. we dont have med techs. im on call for emergencies only, but they are pretty much supposed to send the people to the hospital when anything out of the ordinary happens. im sure there are some things im missing bc i just started this job, but im getting the hang of it.

i also worked telemetry for a yr at a hospital. i was not too fond of it. i just wanted my year of experience and now that its over, im done with hospital nursing. its not for me. i like management, and the freedom of this job, plus its so much more laid back, which is awesome. from what i understand, a med surg floor would be pretty similar to a telemetry floor, but a more broad range of problems with the patients. i understand you want to get your experience in, do you have any interest in other fields? what was it you hated about the telemetry floor? i thought it was a good place to get my experience. i could focus on one thing, cardiac, and i learned so much. i did hate it for the first six months, it was scary, i felt like i had no idea what i was doing, but after that, i sort of got the hang of it, it just takes time. most people i know felt that way with their first hospital nursing job. let me know what you think of this. good luck with your current job, as far as i can tell, its an awesome one and you should stick with it if you like it. maybe you could go back to the tele floor part time to get some of your skills down before concentrating on your mental health/community nursing specialty. i know its tough being new, i still feel that way sometimes, but that one yr really changes things. wb if you can! and good luck with everything!!

donna:p

dondon44444 · Dec 9, 2008

one more thing, i worked twelve hr shifts, night shift at the hospital, which i feel is a much better time to learn things and you are somewhat able to keep up with things. you usually get more patients at night, but they arent always leaving the floor for tests/procedures so you can sit back and figure out what you're doing before you're bombarded with the next task. night shift really might make a big difference to you, i loved it...as much as i could. day shift would have not been for me at all, i know i wouldnt have learned as much as i did.

AddieRN · Dec 10, 2008

I was hired for night time, but the night time schedule was full, so I was put on days. It's hard enough just being a brand new nurse. It was task after task, and task on top of task, on top of tasks lol. Trying to pass meds, patients going to tests and trying to get them ready, doing assessments, charting, dealing with families with a million questions, patient teaching, etc., etc. I have a laid back personality so that doesn't help at all. It was mainly a telemetry unit that dealt with heart failure 90% of the time. The heart failure teaching got old quickly lol. I still like cardiac, and maybe one day I'll go back to it. I love interpreting strips and trying to find out what's going on with the patient just brainstorming in general. I do want my one year in an acute care area, but I really don't think that hospital nursing is for me.

We have med-techs in the homes that pass out the medications. They're not CNAs, and they are there with the clients 24/7. As far as inservices I'm guessing that the LPN and I will collaberate on those. I have a question for you, how about nursing careplans for the clients? This type of nursing is different from hospital nursing, so it's a little tough to adjust, but I love it. Also, one more question, do you carry Liability Insurance? I do.

dondon44444 · Dec 10, 2008

to answer your questions...

right now i dont carry Liability Insurance, i used to back when i was in nursing school and working at the hospital. i was actually out of work for about a year bc i needed surgery on my back, it expired and i never renewed it. i am going to though once i get a paycheck from my new job...thats how new i am. i dont think the risks are as great as they were in the hospital...for being sued that is...but its still a good idea to have. for what you call med techs...i guess they are similar to the home health aides, or "direct care givers" as we call them. they are at the houses 24/7, they do everything, give out meds, cook, clean, toilet them, etc. they aren't licensed or anything, but they do an amazing job. my job is basically to make sure they are doing everything correctly, from paperwork, to doctors visits, to any random problems that come up. and example...one of the ladies at one of the homes just came up with a positive tb test...all the employees are being retested and the other that live at the house. i am the one that communicates with the doctor, implements her orders, and the people working there dont know how to get a sputum sample, so i have to get over there and tell them how to do it, and show them how. basically, they call me with any questions they have involving medical or basically anything. im like a consultant almost. as long as i have my documentation that i was at the house, and recommended certain changes, and assess any new situations, my "ass" is covered. i cant make them do the things they are supposed to do, but im there to teach and instruct, you know what i mean? you work at just one house right? is that your main site, or do you have an offsite office? i work out of an office, but travel everyday to a few houses to check up on things and keep in touch over the phone. plus sometimes attend doc visits, hospitalizations, etc. if you really want this acute care setting experience, i'd say go for it now before you get too settled in where you are, while the nursing school stuff is still fresh in your mind. if you wait too long, you're not going to want to do it and you'll just fall into the setting at your job and might forget alot of the other important parts of nursing...all those hands on skills and experiences you get from working at a hospital. but, if you know for sure that you have no interest in that, and you have a secure job where you are, then just stick with it, but when it comes time to look for a new job, if you havent been at your job for a long time, you might have trouble finding something without at least a yr of hospital nursing. i had enough trouble with just one yr experience. luckily this job fell into my lap. most jobs like ours require years of experience with psych patients, and hospital experience. you did say you've worked here during nursing school right? i know it sucks....getting a hospital job, but maybe you could just do some part time work somewhere back in cardiac. my floor wasnt the heart failure unit, it was for open heart surgery, MI's, cardiac caths, valve replacements, etc. i personally found that more exciting and interesting than heart failure. maybe you'd like that. what state are you working in? when did you get your RN? all i can say is that you are lucky to have the opportunity you have now bc i LOVE my job, and alot of my nurse friends that still work at hospitals wish so much to have the opportunity that i got but there isnt much out there. realize how lucky you are to have this and if you truly love it, dont leave...which it doesnt sound like you will. its nice to talk to someone that is doing the same thing i am...pretty much. i forget if you had another question, hope i answered all of them. keep me posted on what you decide to do with the hospital job search. i might have some more tips for you on what to avoid, or what might be good.

dondon44444 · Dec 10, 2008

sorry, just re read your questions. about nursing care plans...we dont really do specific nursing care plans. we do have a form for them, but dont use nursing diagnoses, or care plans...officially that is. didnt do that at the hospital either. again, the hands on nursing assessments that we do isnt due to a set standard or policy on how often they must be done. its to my discretion. and after im done with all my audits...they are due at the end of this month, then im going to tackle all my assessments. especially for the patients that dont cooperate at the doctor's office. there are so many of them where the doctor wrote: "unable to assess, patient was fighting me the entire exam" some of them havent even had a blood pressure reading recently. i dont want ANY of my patients to be unassessed like that. so, im going to try my best to see everyone and get a baseline of what im dealing with....this is something that the nurses that were there before me never did, but im very thorough and pretty anal about my work, but i really care about my license and dont want to have a patient under my care and not even know their baseline blood pressure you know what i mean? and instead of doing an official nursing care plan, im just going to go by each individual's needs and perform, or order the workers to perform the interventions that i see fit. thats one of the things i love about this job, the freedom and the way i can decide what i can do to better their care. for instance, this one guy eats way too much everyday. there is no protocol, or plan in effect about lowering the amt of calories and snacks he eats, and his weight isnt being managed except when he gets his annual physical. im going to implement a diet plan for him, with weekly weights and teach him and all the people in the house about the importance of all this so he can drop some pounds and get back to a healthy or healthier weight. so instead of actually writing out a nursing diagnosis for that and the interventions, i just do it in my head and do what needs to be done? i dont have to follow the care plan formula. does this make sense the way i wrote it? i cant find the right words to explain but im sure you get my drift. do you have to write out care plans and nursing diagnoses? i might end up starting something like that, but for now im not going to. my department is kind of just growing and finally staffed the way it should be, so im going to be implementing alot of new changes, procedures, and such. so im not sure exactly how im going to set everything up yet, but i'll let you know. tell me how you guys do it, maybe i could get some ideas from you. we dont have any strict rules to follow as long as we get our work done, and until i set up some rules. it would be interesting to compare how you do it, then i can get some good ideas from that. sorry i know i wrote alot. i have a problem with that. anyway, thanks again for writing back. its good to talk to you. hope all is well. feel free to keep asking me questions. :)

AddieRN · Dec 11, 2008

Careplans don't really fall into my job role with my position. My main concern was to just make sure that I'm doing everything the right way. You know what I mean. I like your way of thinking though. Just not really writing down, but doing it in your head and implementing a plan of action. Basically my job role is the same as yours in fact that's what they call it (consultant). As far as knowing a baseline BP , as anal as can be about stuff like that. I work in 2 homes and have 12 clients total. The hab-techs that work in the homes are awesome, and provide great care. The other week, I was looking through the old MAR, this one client is on like 2 different diuretics one being Aldactone, the other I can't remember what it is off the top of my head, and a couple other things that affect BP. It's ordered for her vital signs to be taken Q month and her BP to be taken Q week. Well, I decided to look in the old MAR for November to see if everyone had been doing their BPs and only 1 person had done it that month, and then recorded on the wrong day on the back of the MAR. Ewww....that just tore me up. I left a note in the log that the staff have to read daily for updates, the importance of taking the BP, and to take it before giving her meds so that we would have a clue about her baseline BP. Did I handle that correctly?? I think I did. How often do the vital signs and BPs get taken in the homes you work in. I'm so use to hospital practice and never giving an antihypertensive before checking the BP.

As far as a full time job is concerned, I'm looking. After reading on allnurses first year in nursing forum, I know I'm not the ony nurse who's first job didn't work out for them. I was a little worried about taking this part-time position with so little experience. I almost backed out of it, but it's nothing I can't handle. I'm more comfortable then I thought I would be. My boss was like, I wouldn't have asked you to do this if I didn't think you cared, and I didn't think that you would do a good job. So far I'm really turning things around there. They were in need of some good nursing care. I wanna make sure they get the best care possible.

As far as some clients being "unable to assess" we have some of those. Some have to be put under sedation for some exams. I just make sure those are being followed up.

As far as our med-techs are concerned. I also have to med pass them. I have to watch them give out meds, and pass them off. Anyways thanks for the pointers. It's really cool talking to you.

dondon44444 · Dec 12, 2008

hey, sorry it took me so long to get back to you. this week has been so so busy at work. ive been working on these audits, which have to be turned in by the end of the yr. since i have so many houses, its pretty stressful and a lot of work, pretty slow going too bc i have all these houses spread out all over the place, so just driving there takes awhile. im doing well though. my boss saw the audits ive already completed and she said that she's never seen an audit so thorough before and ive done such a good job she wants me to teach the other nurse....who has been there for months, she trained me....how i do them. so i guess im doing well. i just hope i dont cause any conflicts by creating more work for the other nurse whose been there for awhile.

anyway, about what you did with the bp issue, i dont know who you are supposed to report to, but for me, i give my boss all the problems i found with the audits, she forwards them to the house managers, associate directors, and directors. then the staff will eventually get it too, and hopefully fix the problems. they are given a two week period to fix the problem and get things up to date, then i go back out to the house to see if they did it. do you have someone overseeing all the houses in your program? or are there only the two houses that you work at? either way, you have to document that you found the problem, and document what should have been done in the first place. and it would be a good idea to talk to the staff as a whole, or at least the manager and tell them what to do. then your ass is covered, the documentation is a must, then when the state comes to audit your job is documented there for them to see. what i would do in that situation is also check the patients blood pressure myself whenever i was in the house. at least it shows that you yourself are taking action to check it. i know you cant do it everytime they get their meds....but thats in a hospital. remember, the reason you do that in the hospital is bc these people arent stable so they need to be checked for these things. once they are living in a group home, they shouldnt have problems with this stuff, it should have been worked out during a hospital stay, or their doctor would have ensured their bp meds were regulated correctly so as not to cause any major drops in their pressure from their meds. do you get what im saying? i dont know if i worked it correctly. its easier to speak this stuff rather than write it. with my job, i dont have anything to do with med administration. i do quarterly audits, checking that they are following procedures, and i do narcotics counts too. thats about it.

again, ive written alot to you, i cant help it. sorry. one more thing. for your hospital job that you want to get, have you thought about getting some relief work at a hospital? most of them have the option of working just one or two weekends a month, or one shift a week. that way you can get your skills and still focus on the job you love. i think that might be a good idea. you should do it soon though before all the knowledge from nursing school starts slowly getting forgotten. it just happens unless you are exposed to it on a semi regular basis. i know ive forgotten alot of things already and i did work for a year, though from that year i learned and do remember so many things that ive found useful in my current job. i know i keep mentioning it, but i think it would better your nursing career and you would be much more sure of yourself. either way, its your call. did i answer your questions? i like writing to you too. i dont know anyone, except for the part time nurse i work with sometimes, that does what we do. its fun to compare notes and see the similarities in our jobs.

did i tell you that one part of my job is to educate the staff? i have to give inservices to all the people that work in the houses...two hrs each. that is something im very nervous about, but i know its necessary. im starting with one about the importance of documentation...tying it in with all the paperwork i find missing from the patients binders during my audits. the next one im doing is on pressure ulcers, how to stage them, prevent them, and treat them. both of them are so important. these people that work in the houses are not trained/licensed healthcare professionals. they are awesome at their jobs, but they dont have a strong background in medical, so this stuff i think is very important for me to teach them. i just HATE public speaking, but this will get me over my fear of it i guess.

well, thats enough for now, ive written you a novel. get back to me when you can. i enjoy reading your responses. let me know about any potential jobs you see in hospitals.

see ya!

donna

AddieRN · Dec 13, 2008

Well I was back in one of the homes yesterday, and had to pass someone off to give medications. It just so happens that it was the day for that clients BP to be taken. It's been taken faithfully so far this month, so my little note must have helped. One thing I really want to do is hold an inservice on how to take a manual BP. Everyone uses the automatic ones, and sometimes they mess up. I don't always believe that you can trust them either. Yes I do have someone I report to, she's not a nurse, but she's over both of the homes. I'll be getting busy in the next couple of weeks, auditing and doing some evaluations, etc. I'm still lookin for a job, but it's kind of a hard time to be looking with the economy like it is and the holidays here. Anyways, thanks for all the wonderful advice. I'll keep you updated on how I'm doing.