ACT Registered Nurse

Title: ACT Team Lead

Qualifications:

• Licensed Registered Nurse in Idaho as defined by Idaho Code 54-1408 or state licensure as a Registered Nurse pursuant to the Nurse Licensure Compact Code 54-1418
• A minimum of one year experience working with adults with SPMI, including medical knowledge of techniques and procedures used in evaluating, modifying, and motivating human behavior
• Familiarity with Motivational Interviewing (MI) preferred but not required
• Has skills and competence to establish supportive and trusting relationships with persons with severe mental illness
• Respect for client rights and personal preferences in treatment are essential
• Can work in a team setting as well as individually
• Must be amenable to travel for community visits and outreach and able to work non- conforming hours to meet with clients/provide services

Department: TACT (Tueller Assertive Community Treatment)

Supervised by: TACT Team Lead

Positions supervised: None

Location: Idaho Falls office, Rigby office, Rexburg office, client home (as assigned or agreed upon at time of hire)

Role Overview

Working as a Registered Nurse (RN) or Licensed Practical Nurse (LPN) on an Assertive Community Treatment (ACT) team is vastly different from working on an inpatient psychiatric floor or in a traditional outpatient clinic. Rather than patients coming to you, you bring healthcare to them.

Under the Tool for Measurement of Assertive Community Treatment (TMACT), the nursing staff serves as the critical bridge between severe mental illness and physical healthcare. Here is a summary of your responsibilities and what to expect on an Idaho-based ACT team.

Core TMACT Expectations for the Nurse

The TMACT fidelity scale heavily scrutinizes the nursing role (specifically under the Core Team subscale). To meet the high-contact, high-fidelity standards required by Idaho Medicaid, your role will be structured around these pillars:

• Community-Based Medical Care: You will not spend your day behind a clinic glass window. You will spend a significant portion of your time (often 50% to 80%) in the field, administering medications and checking vitals in clients' homes, at shelters, or in the community.
• The "Health Literacy" Lead: You are not just a medication dispenser; you are the team’s primary medical educator. You will teach clients about their diagnoses, the metabolic side effects of psychiatric medications, and basic wellness practices (like diet and diabetes management).
• Shared Caseload & Daily Meetings: Like the rest of the team, you share responsibility for every client on the roster. You will attend the daily morning meeting to provide medical updates, flag clients who are decompensating, and coordinate who needs a nursing visit that day.
• Proactive, Not Reactive: Traditional nursing often waits for a medical crisis to intervene. ACT nursing is about aggressive preventative care—tracking down a client who missed a dose of their medication before it leads to a psychiatric hospitalization.

Daily and Weekly Tasks Checklist

• Medication Room Management: Oversee the secure medication room, ensuring compliance with the Idaho Board of Pharmacy and DEA regulations. You will manage pill boxes, coordinate with local pharmacies, and track refills.
• Morning Team Huddle: Brief the multidisciplinary team on any medication changes made by the psychiatric provider and assign field staff to deliver daily medications to high-risk clients.
• Field Administration: Administer Long-Acting Injectable (LAI) antipsychotics in the community.
• Metabolic Monitoring: Conduct routine physical health screenings. Because many ACT clients take heavy-duty antipsychotics (like Clozapine or Olanzapine), you will actively monitor weight, blood pressure, blood glucose, and coordinate routine lab draws.
• Care Coordination: Act as the liaison between the ACT team and the client's Primary Care Provider (PCP) or medical specialists. You will often attend medical appointments with the client to advocate for them and ensure they understand the doctor's instructions.
• Crisis Response: Triage physical and psychiatric medical emergencies in the field, helping the Team Leader and Psychiatric Provider determine if a client needs to be sent to the ER or an Idaho crisis center.

The Reality Check

Being an ACT nurse is incredibly autonomous and deeply impactful. You are often the single reason a client with severe schizophrenia and untreated diabetes doesn't end up in the ICU.

However, it is a gritty, boots-on-the-ground reality. You will be treating the physical toll that severe persistent mental illness (SPMI), chronic poverty, and long-term homelessness take on the human body. You will frequently encounter clients with severe metabolic syndrome, untreated wounds, or chronic respiratory issues, often complicated by active substance use.

In Idaho, this is further complicated by rural geographical challenges and a strained primary care system. You will often have to advocate fiercely to get your clients the basic medical attention they deserve from outside providers who may carry stigma against this population. You are their medical safety net, and the entire team will lean heavily on your clinical judgment.