Please help me with this new job overseeing group homes

[FolksBtrippin]

I've had no orientation. I'm the only nurse. 

I don't want to rant and I also don't want to quit because I like the job and I think eventually I will be good at it. 

There are 10 group homes each with 1 to 4 developmentally disabled residents.

Unlicensed staff passes meds. This is a bit stressful for me. 

Even insulin and opiates. ?

Will I get used to that?

Right now I am fixing problems arising from having no nurse for a few weeks and also just problems.

This means I am upsetting the apple cart. I'm walking a fine line here between trying to fix whats wrong (unsecured meds, orders not matching meds, no labs for 3 years, no PCP, no psychiatrist) and developing rapport with staff.

Director asking me to do things that don't really make sense. Like schedule an appt for a specialist based on a referral that's over a year old. ?

I worked in the community before but I had a team that met every single day and we provided most of the services ourselves. This is really different.

General info and advice appreciated in advance. 

[FolksBtrippin, BSN, RN]

4 hours ago, NRSKarenRN said:

I'm familiar with PA regs, NJ is similar.

NJ Dept of health regs: https://www.nj.gov/health/healthfacilities/

Group homes covered under: Comprehensive Personal Care Home unless licensed as assisted living program

https://www.nj.gov/health/healthfacilities/about-us/facility-types/

 

NJ Regs covering assisted living and personal care homes:   N.J.A.C. 8:36

http://www.hpm.umn.edu/nhregsplus/ALF by State/New Jersey ALF in process.pdf

This is survey form that references above regulations:

AAS-24 Affidavit of Compliance Assisted Living Residences, Comprehensive Personal Care Homes and Assisted Living Programs

14.3 (b)  One joint drill with local fire department. (yearly)

14.3 (c) Facility tests one pull alarm per month and documents result.

7.4 (b) RN develops nursing practice policies and procedures 

AAS-45 Reportable Event Record/Report

 

Check that all personal care staff giving meds are certified medication aide with current cert --- office staff should maintain list.

Certified Medication Aide regs

CMA covid wavier

Hope this helps in addition to above nursing advice.

Very rewarding position once you get everything in order.

 

Thank you, I also feel like this will eventually be rewarding for me.

The regs we follow seem to be under DDD instead. Our direct support staff are not CNAs or HHAs. 

The medication aide stuff is especially concerning, because I am 99% sure that our DSP staff do not have any certification above the training they get internally from our organization. 

[amoLucia]

I repeat - you have a SUPER GINORMOUS task ahead of you!!

We're here to listen!

NRSKarenRN - TY for all your citations. Muy helpful. 

[NRSKarenRN, BSN, RN]

OK.  Here's the link to Division of Developmental Disabilities (DDD)

https://www.nj.gov/humanservices/ddd/home/about/

Mandated Training and Development

The following mandated training information applies in the Medicaid-based, fee-for-service system. 

Prevention of Abuse, Neglect, and Exploitation (PANE) Supervisor Q&A Guide

Prevention of Abuse, Neglect, and Exploitation (PANE) Competency Assessment Form

Medication Administration: On-Site Competency Assessment Forms

Medication Administration: Training Module Updates

 

 

[jobellestarr]

On 9/23/2020 at 5:41 PM, amoLucia said:

A little voice was whispering 'New Jersey, New Jersey'. !

Big suggestion - check out your last survey. See where old problems were and that any corrections made back then for the POC are still in place and haven't fallen by the wayside.

Your admin should have access/availability to state R&Rs for DDD. Will be interesting reading!

to jobelle - been meaning to ask, what is DES? I'm thinking like a surveyor for DOH/Ombudsman Office? 

Department of Economic Security. I investigate complaints for anyone that receives services from Division of Developmental Disabilities.

[amoLucia]

jobelle - TY. I was almost close.  Like DOH or DHSS here. Which state? Don't think I ever heard of a DES, but a name  is just a name.

(Altho I do remember waaaay back when DES meant diethylstilbesterol. Showing my age.)

[hppygr8ful, ASN, RN, EMT-I]

On 9/24/2020 at 4:27 AM, FolksBtrippin said:

Thank you, I also feel like this will eventually be rewarding for me.

The regs we follow seem to be under DDD instead. Our direct support staff are not CNAs or HHAs. 

The medication aide stuff is especially concerning, because I am 99% sure that our DSP staff do not have any certification above the training they get internally from our organization. 

it is a rewarding job but there is a tremendous amout of fraud in the industry which is why I finally quit - It just didn't go with my personal code of ethics but if you have an ethical management It can be fun and rewarding.

 

Hppy

 

[jobellestarr]

18 minutes ago, amoLucia said:

jobelle - TY. I was almost close.  Like DOH or DHSS here. Which state? Don't think I ever heard of a DES, but a name  is just a name.

(Altho I do remember waaaay back when DES meant diethylstilbesterol. Showing my age.)

Hi, you can message me privately if you wish. 

[FolksBtrippin, BSN, RN]

On 9/25/2020 at 12:42 PM, hppygr8ful said:

it is a rewarding job but there is a tremendous amout of fraud in the industry which is why I finally quit - It just didn't go with my personal code of ethics but if you have an ethical management It can be fun and rewarding.

 

Hppy

 

What kind of fraud did you see?

[FolksBtrippin, BSN, RN]

I might quit. This is too much.

I'm reticent to give details, but there are some people in our homes who are way too sick to be there. I'm really scared for them.

I feel like one of our folks might need palliative care.

It's a lot to handle no matter how you slice it.  

I'm quite upset that a meeting was scheduled for when I will be out of town. I needed to be at that meeting. 

? 

I feel like I'm purposely being kept in the dark. 

I'm not sure why. Either its because I'm being prepped to be the sacrificial lamb, or that they are afraid of giving me info that will make me run away screaming. 

Tough decision ahead. Your thoughts?

[caliotter3]

Do not try to do everything in one day. Start by planning. Write a complete list based on info given in prior responses and then start with one item and work your way through. Carry a little notebook to jot down things you see or hear or read day to day for follow up. Take each resident chart and MAR and go over care plan, med sheets, med profiles, with a fine tooth comb, one by one. If it takes you three days to do one, it takes you three days. Then go to next resident. Identify a primary staff member for each and document a meeting where you touch base. If all staff responsible, meet with one at a time. Prioritize. Don’t worry about getting everything done by November, worry about doing it right and being thorough. In the military we would prepare day and night for a big inspection. If you want to spend your own time then don’t clock in for overtime. Just do it. Once you have things under control it will just be a matter of keeping on top of things. Be careful not to discuss negativity with staff. They know what has been going on and not going on. Instead emphasize appreciation for their efforts in getting it together.

[caliotter3]

If you can change being out of town, go to that meeting. Based on intricate communications and interactions with the bosses in very near future, you will decide if resigning seems to be the only solution for you. 

[Jedrnurse, BSN, RN]

11 minutes ago, caliotter3 said:

 If you want to spend your own time then don’t clock in for overtime. Just do it.

Sorry, I have to disagree. The situation that the OP describes can't possibly be rectified by one person during a regular work week. Being a martyr now just sets the "I'm a doormat, hand me more stuff to do" tone from the get-go.  And you just KNOW that this position is:

1. underpaid

2. not bonus eligible

3. only going to get pathetic pay raises.

I've worked human services group homes before. They often talk a good game about human "rights" and "dignity", but that talk stops when it comes to their staff.