I work at a state run facility for the developmentally disabled. 100% of our residents have guardians/conservators. The patient may refuse any med or Tx, but if as Explorer noted, the situation is serious enough, the meds can be given IM against the wishes of the pt. I am guessing that much depends on where you work, state and facility-wise. In TN, all the state ICF-MR (intermediate care facility-mental retardation) operate under a federal injunction (bad abuse and neglect in the past) and the rules are strict. To give IM meds we have to consult the behavior analyst or psych examiner who will assess the situation. The BA/PE then gives the okay to the MD/PCP to write the order to administer IM meds. At our facility, this intervention is almost always considered an emergency and we have a case conference with the interdisciplinary team the next business day to discuss the situation. I think that this proceedure is particular to TN and so it may not be the case in your state.
I would suggest that you look up the laws in your state and also have a very good look at the facility policies before you sign up to be the only RN for 100 residents. The LPN's should have your back (I am an LPN) I always have my RN's back and he has mine, but we usually work one at a time . . .
I would be concerned by the staffing ratios for the care providers. We have one tech to four residents at a minimum during the day. At night the ratio is one to seven (state law).
Some questions to consider-What is the average level of adaptive and cognitive functioning? I have found that my pts that have higher IQ's, mild retardation as opposed to severe and profound, tend to have a greater propensity toward bipolar d/o 1 and antisocial personality d/o. This can be seriously problematic and potentially very dangerous.
How many people require total care? Are you caring for people with g-tubes, j-tubes, trachs, etc? How many have self-injurious behavior? How many have a history of aggression/violence? What are the proceedures regarding restraints? How does the administration support medical and other staff? The list could go on and on . . .
There are many wonderful and rewarding aspects to my work. My coworkers are, with a few rare exceptions, terrifically competent and passionate about serving this population. There are risks involved in any psychiatric setting though, so be careful. Let me know how it goes.
Best of luck to you!:chuckle