Emma Lawler, RN, is the Director of Nursing for RCM, a provider of group homes for adults with developmental disabilities in D.C. Ms. Lawler is known for her excellent work. Georgetown's DC Health Resources Partnership asked her to talk to us about how she is able to make such a positive contribution to the health and well-being of the all the RCM clients.

Ms. Lawler said her interest in working with people with developmental disabilities came about when a coworker suggested recommended her for a part-time job at a group home in Virginia. "It was the coolest job ever"," she said. She went with her clients to 6 Flags, to church services on Sundays, and to a horse farm. Ms. Lawler described many joys and strengths she saw in her clients and how she enjoyed building relationships with them. ""I never imagined a job could be this fun."

She graduated with a nursing degree and worked several happy and successful years in Virginia before she was recruited by RCM last year.

Typical Day Starts with the Cell Phone
Her day starts with her cell phone. "The whole week can be set by Monday" she laughed, because she has to get quarterly reports done the first of the week, go from group home to group home throughout the city, signing off on medication administration records, getting reports, and every day brings phone calls!

She is on call every day for emergencies, and is called by monitors, QMRPs, and for conferences. [See below for more information on how the cell phone is a tool RCM uses to deliver effective and high quality service.]

The Most Important Thing is Individualized Care
Ms. Lawler said the most important thing in caring for people with development disabilities is to care for individual needs first. ""Usually our clients are medically stable, so it's all about individual health maintenance and staying on top of any signs of trouble," she said.

She further explained how individualized care is essential, ""Take three people with the same diagnosis, diabetes. One may have other medical issues, one may have the diabetes under control, and a third may be eating whatever he or she wants." She said she relies on "diagnosis carryover", relating everything she sees or the staff reports back to the history of that particular client.

Don't Take Little Things for Granted
Ms. Lawler explained, for people with disabilities, little things aren't little things. For example, signs such as a low-grade fever, lack of appetite, or unusual behavior, can lead to rapidly deteriorating health.

Add to that the fact that many RCM clients are aging and this brings additional risks. She said a relatively simple matter of dehydration, for a person with disabilities, can require a transfusion if not attended to promptly.

Since she is responsible for new hire orientation, she always uses this opportunity to teach the nursing and direct care staff how to observe and report these signs.

[click here for a training tool to improve staff observation skills and
here for a tool on health status indicators].

In addition, she helps keep communication open among all the staff for all the clients during the weekly Grand Rounds.

She said, ""During the week, you can get pulled left and right", and in hectic situations, it can be easy to miss an emergency. That's why staff training, communication, and staying on top of the "little things" makes a difference for all her clients.

Working as a Team
Listen to Ms. Lawler describe how team work makes the difference in dealing with medical emergencies.

(please note, this may take some time to download) Listen to Ms. Lawler give an example of how she and her team responded to a client in need of health services.

Cell phone!

Ms. Lawler uses her cell phone every day to stay in touch with group home staff, nursing staff, physicians, other health providers, and the Executive Director of RCM.

In fact, RCM makes sure that all nurses, QMRPs, and managers have cell phones. In addition, they ensure that vans used to transport consumers have cell phones available to the staff.

Ms. Lawler explained that RCM staff really depend on their cell phones to stay in touch, deal with emergencies, and make best use of their time while they are out in the field. For example, because she has a cell phone, group home staff were able to reach her when she was at another group home in the same neighborhood. She was able to come right away.