Help, I'm in over my head!

[doinitall]

I am a seasoned RN, have worked in nearly every setting there is, acute, ICU, ER, flight nurisng, home care, home infusion, home hospice and managed care in disease management. I have been looking for a case management position, and have accepted a temporary position with a managed care company for IN PT CM in the SNFs. They have been so short staffed that they accepted me knowing that I hadn't done this before and said they would train me. You know where this is going, don't you! I shadowed the CM LVN for 3 days, then she wanted me to start taking over things, and she was available by phone for support. By the second week I was basically on my own. She transferred to a different office at the start of my third week so I was basically on my own, since the rest of the CM group is also short staffed. Tomorrow I start my fourth week. Part of my confusion about this job is who does what. There are LVN CMs in the SNF that I work with, but each SNF seems to have their own way of doing things. For instance, I have a 75 yr old mbr who has been taking care of his 95 yr old mother, and he sustained fxs that landed him in the SNF for OT, PT and pain control. He has some family out of state. The current situation is no longer safe for this mbr and his mother. I asked the SW to get involved, and our hospitalist wanted this mbr custodial, but he doesn't have any secondary and no funds. He plans to leave this week. I asked the CM if she had been in contact with the mbr's out of state son, and she said she would call him. Is this my job as the medical CM? I have hours of extra work each day, partly because I'm new and partly because this is a heavy load. But I can't imagine that all of the coordination with family lands on me. I want to do what is best for the mbr, and safest for my license. Can someone give me some resources so I can get up to speed quickly? I would like to be considered for this position full time, and think once I get a handle on some things I would be fine. I just don't like not knowing things. Thanks for listening!

[d'cm]

The resources available to your member are totally benefit/ State/ local specific so it is hard to offer suggestions without more detail. That being said, the facility has, by accepting them in first place, taken the responsibility of their disposition. Certainly it is not your responsibility to track down family members. I would advise you to question your definition of "safe". We can ensure people have the DME they need and the nursing for complex medical issues but we can't change their living situation, habits and life decisions. We need to let people, like your member here, be the adults they are and make their own choices. The size of the safety net has been determined by the electorate.

[SummerGarden, BSN, MSN, RN]

To answer your other question, yes we are obligated to talk to families regarding such matters although it sounds less clinical and more social. The reason being, this situation is very clinical. The patient has a medical condition that is preventing him from continuing with his original lifestyle. So now, his life is going to change dramatically.

If you have a social worker, get him/her involved. Make sure that it is a social worker is not new to this situation so you can find out about the resources to help make appropriate decisions. You will find that there may be very little you can do other than to support the social worker. Document all of your attempts at making this a safe discharge as well as contact the legal authorities, such as APS, in your state or county if needed.

If your facility does not have a social worker, then contact the former CM and ask for advice. Hopefully he/she is not new to such a situation and can do more for you than just contact the family. He/she should be able to let you know of alternate insurance options, alternative housing, and community resources that the patient can use in your area. Good luck.

[doinitall]

Thanks for your quick reply! I am working in Southern California. Another CM quit today, so we are bare bones, so I will have to continue to find things out for myself. Thanks for the support.