But I am a nurse!

  1. I have been in case management for about 6 years and have worked in various areas from county indigent programs to insurance company to acute care hospitals. I currently work in a small, rural hospital. I like it okay, but my position involves UR (which is my "specialty"), discharge planning and all the social situations that come with it. My areas are ER and ICU, and I check all admissions coming in to ensure appropriateness. The part I have a problem with is the social issues, the disfunctional families, death and dying situations. It really is draining and I sometimes feel that "I am not a social worker". Does anyone else do the same thing and feel the same way? Any advice?
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  2. 5 Comments

  3. by   MollyJ
    (care of) The dysfunctional family is part and parcel of the CM role. You can argue that the dysfunctional family needs CM services because they are dysfunctional OR you can say that the illness contributes to the dysfunctionality and go from there. Sometimes meeting CM needs will increase family function but chronic illness puts full time stress on families and some of them just don't have many coping mechanisms.

    It is hard to NOT get sucked up in their dramas and you have to avoid that as much as possible. Also, focus on the idea that few of these families will be permanently fixed.

    UR (which I am not an expert in) is one of those "clean" paper work exercises [and I really apologize for writing that] that creates a lot of dissonance when you try to match what you are to do in that role with the real life problems of a family. When I was a CM, I had UR coordinator call me and point out that one of my cases had way overstayed his dx. However, going home to his burned out family was not an option (they would literally try to kill him again) and we were scrambling to get his foster care situation lined up. I knew the UR coordinator was right, no argument, but I also knew we didn't have a safe discharge if my client went to his home. He HAD to go to his foster care setting and those foster parents were doing LICENSING procedures.

    In my CM role, my bosses were saying, "Minimize hospital days." The UR coordinator's role was, "minimize hospital days." But I had to live with myself, so I took care of the patient. This is the dissonance you may experience at times.

    It's not easy. I couldn't do it. That's why I sign myself as I do. I now do drug prevention in a school setting.
  4. by   GBOTTOMLEY
    Hello, I was very interested in your ideas about case management. I have been thinking about furthering my education in that field. The U of AL has a new program with a MS in CM. AS a home health psych RN iwth certification in psych, I act as the case manager for 30 patients. My job includes it all!!!!!! Thank goodness that I have the back up of MSW to guide me sometimes. Besides going into the home, we manage meds, teach ALL DAY LONG, report, work closely with MD's, and provide social, emotional, spiritual support. Our main goal is to keep the patient out of the hospital. We have to use ICD-M codes for all procedures, but don't get reimbursed for the procedures. The labs get that. The physician gets paid to manage the patient, and we do all the paperwork!!!!!!! As psych nurses, we are approved by HCVA in Washington. Require certification in the field in order to make home visits. As a CM, I manage the PT, OT, ST, MSW, community services, and everything ELSE the patient or family needs. I think I may have a good start into the field. I would lilke t hear from others who may be thinking about the transitiion .
    Thanks.....Georgia
  5. by   bernarma
    Anyone ever done case management in a clinic setting?? If so curous how it differs or how it may be similar to hospital or insurance cm.

    Thanks.
  6. by   2amigos
    Awesome! I am just starting in school getting my prerequisites done. I've been trying to figure out what avenue of Nursing really appeals to me and I'd come up with HH and Hospice. I had always wanted to become a MSW, but in our state, it's not possible due to campuses where the program is offered, so I decided on Nursing. I am so happy to see someplace where my "social worker tendicies" would/could be an asset.
    Please tell me what is the best way to enter the field. I am going to graduate with an ADN and am looking at bridging to BSN. Help please! This is so exciting!!!!!!!!!!!! THANK YOU!!!!!!!!!!
  7. by   Anaclaire
    To 2amigos:

    I don't know much about case management and was simply browsing on this board... so I'm not going to have fantastic information for you... hopefully someone else will.

    I will, however, say that as Gbottomley mentioned in her post, that the University of Alabama in Tuscaloosa, Alabama offers a Master's Degree in Case Management. To be admitted into any Master's program, you generally need a BSN unless you can find an ADN to Masters program. There are soooo many new ways to obtain advanced degrees these days!

    This is a great web site for networking and finding out information, isn't it?

    I sure hope you find out the information you need to puruse a Case Management line of work because it sounds PERFECT for you! Boy I love it when we can be excited about our work!! Yippee!

    Good luck and best wishes!
    Last edit by Anaclaire on Aug 19, '02

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