mclennan, BSN 15,420 Views
Joined Sep 25, '06.
Posts: 747 (58% Liked)
Powerlessness. Some is perpetuated by the systematic forces, and unfortunately, some is perpetuated by nurses themselves.
I am a case manager RN. I also have a good relationship with my hiring manager and know why she hired me so here ya go:
1. BSN. Most medical groups, insurance co.s, hospitals get better reimbursement and accreditation if CMs have BSN.
2. Some experience in Public Health, health teaching, discharge planning, chronic condition management or something along those lines. Lots of states offer PHN licensure to BSNs whose program curriculum included community/public health that meets requirements. If you can get it, get it. My hiring manager, and 3 or 4 other CMs in my department were PHNs for some years before becoming CMs - she says that pretty much nailed why they hired me. Highlight any nursing experience in which you developed therapeutic, long term relationships with patients and followed them through chronic illness. Any telephone triage expertise or training is valuable too.
3. Get certified as a CM either by the Commission for Case Manager Certification or the ANCC Case Manager Board Certification. I cannot emphasize this enough.
4. Be prepared to sit in a cubicle all day calling patients, to wear business clothes, to earn salary instead of hourly, and go to lots of meetings. It is a far cry from working the floor, the clinic, or 12 hours in scrubs. And it's not always better, it can be just as crazy busy, complicated, stressful and the grind of 9-5, M-F isn't the paradise you might think. We have had a couple of CMs who came straight from inpatient, bedside shift work nursing leave after 5 or 6 months because they missed working with patients and having those 3 or 4 days off a week. And, they missed overtime pay.
5. On the upside, it's very autonomous, independent work that actually uses nursing theory heavily, and really sharpens your critical thinking skills. Docs love us. Patients love that they don't have to come to as many appointments and have a go-to advocate. Case management is gonna be a big thing, it saves everyone money and increases patient satisfaction scores big time. And, the pay is great IF you have the experience and certification!
Hope that helps and good luck!
Reminds me of when I volunteered at an AIDS hospice (well it was a group home, but in the 90s we didn't call it a hospice even though that's what it was) and cared for this wonderful man. He was 6'4 and near the end, he wasted away to only 100lbs. or so. He spent a lot of hours sitting in a deep bathtub of warm water, nothing else was very comfortable for him. One night I asked him if he'd like anything to eat or drink and out of the blue he said, "you know what I'm craving? A big, day-glow fruity island cocktail. In a big glass, with the little umbrella and garnishes and a straw. Ice cold. I miss sipping drinks like that on vacation."
Well, of course there were several men in recovery at this place and alcohol was banned. At first I thought, I'll figure out how to make a virgin drink like that for him. I called my uncle who was an ex-bartender in his 60s. I'll never forget it. He said "to heck with that. Let's make this man a proper drink." I stopped by his house the next day and there he had a whole setup, a Thermos with the drink in it, and a hurricane glass packed with fruit, umbrella and straw. He even wrapped it all up in a box so I could smuggle it in.
I did. I arrived & found my patient in his bath, candles lit & music playing as usual. Got a huge container of ice from the machine, and locked the door behind us. I took out the glass, iced it and poured the drink. It was a hideous bright blue and loaded with rum. I fixed up the garnishes and umbrella and gave it to him. I have NEVER seen such a blessed out look on a human being's face!
After only 5 or 10 minutes I could see the blue drink coming out of him in the bath water. His GI was so destroyed that almost anything he consumed was passed so quickly he couldn't absorb it. I didn't say anything. I let him enjoy the cocktail. He finished about half, then handed it to me and said "you finish it. I insist." (I was not a nurse then and an off-duty volunteer). I pulled up a chair next to the tub and settled in. We sat there a long time, talking about our favorite vacations and wild times. I very stealthily changed the bathwater until it was clear again.
He died about a month later. At the visitation I tucked the little cocktail umbrella in his suit pocket and kissed him goodbye.
I can assure you with 10000% accuracy and truth that I am a full time MSN student at WGU. The two classes I've completed both required posting to a message board as part of the class content: reflective exercises and critical thinking commentaries. My mentor has told me she and other faculty check these boards, and our participation is a small part of the overall grades. Many components of the course state: "share you thoughts on the message board & respond to at least one other student's posting." This is not the "community" boards I'm talking about. SMT2 and NFT2 both required this, in addition to the Tasksteam assessments. Which weren't hard either. And for the record, I've never even been on their Facebook page, because I don't do Facebook - period.
The course message boards are chock full of people who ramble on and on about their military service, sparkling work history, children and struggles, often more so than the course topic at hand. It gets pretty tiresome.
Overall it's a good deal for the price. I'm doing it to get the piece of paper I need to get the heck away from bedside, for the cheapest price. I am sorry so many of you can't swallow the truth: most college education, anywhere, in any form, are exercises in BS, requiring little critical thought, intellect or real pedagogy these days to pass. They want your money, you want the degree, they make their process almost impossible for that NOT to happen. Regurgitate the words they wanna hear in your little papers, use APA correctly and you'll get your Pass grade. Same thing at any school. College has been and is, pretty much a joke in this country for decades - with the rare exception here and there. Come on folks......you can't be that naive. It's all pretty meaningless hoop-jumping.
My own enrollment specialist is Mormon, and he himself told me over half the staff at HQ are Mormon. They're physically located in Salt Lake City, for crying out loud! That's not ignorance. That's the truth and I think it's great! You don't believe me? Ask them yourselves. If you have a problem with that, it is YOU who is ignorant, not me.
Funny how many get their knickers in a twist because someone thinks differently than they do. Fine nurses you must make!
Um...yeah....definitely attending WGU MSN program. Sorry it's easier for some and harder for others. I am not busting my ass or being challenged at all. Everyone is different, but seriously, if you are struggling through a program this simple, I am sorry. It requires very, VERY basic research and writing skills that any of us should have learned in high school and nursing school - and that's about it. Get real. It's not that hard.
I'm not being rude, I'm being realistic.
I am addressing both you and NurseVirgo. (And I repeat, my PM box is NOT full). I gave a lot of info in my response to help both of you and you still post questions that sound like you're very inexperienced at this.
There's nothing wrong with inexperience, but anyone - especially a traveling nurse, this day and age - should know how to use Craigslist and Google Maps. And should know what anyone means by the term "non-diverse."
I basically spelled out, step by step, how to start looking for a decent place on CL (a room rental in an upscale home in the Valley) and you STILL asked for more info about it. Come on. Ask more specific questions, not just a request for "more info."
I was more supportive and gave more info than anyone else did in response to your questions. Sorry I expect a traveling nurse (from whatever period of time) to know some BASICS. Come on guys, get with the program, everyone uses Craigslist and Google Maps, you shouldn't need to be instructed how. I'm happy to address Los Angeles-specific issues but I'm a little surprised you both act like you need such obvious things explained.
My box is not full.
I shouldn't need to say much more about the Valley being "non-diverse." What more explanation do you need than that?
Go to CL. Look at LA. Go to rooms for rent/sublets/whatever and look in the SF Valley area. Look on a map, for names of cities nearby. Specify your search and when you see posts that are well written and have pictures of fancy places at fancy addresses (use Google maps street view) follow up and check it out.
If you're smart enough to be a nurse you should not need direction like this. And if you have traveled before you should also be MUCH more resourceful than this. LA isn't any different from any other American city except, it is BIGGER.
Be VERY careful with Craigslist. Especially in L.A.
Never EVER go check out a place alone.
Ask for references and actually call them. Seriously, ASK for references of former renters or roommates.
When you do search, have upfront cash, references and all your info ready.
Remember, living in L.A. means basing your entire life - work, friends, hobbies, EVERYTHING - on traffic. Choose your location carefully and listen to locals who know what's up.
Likely the best place to find a living situation will be in the "Valley" i.e., San Fernando Valley. Look in places like Van Nuys, Simi Valley, Granada Hills or Chatsworth. MAYBE Sherman Oaks ($$$$) and MAYBE Encino ($$$$). Remember the Valley is HOT, isolated, and very, very non-diverse. It's a lot of strip malls, chain stores and beige development homes.
If you want to live in L.A. proper, and commute up to Calabasas, live on the West side. Affordable in this area are Mar Vista, Culver City, West Hollywood. And by "affordable" I mean you can score a studio apt. for maybe $1300/mo. That price usually does not include laundry or parking. For that, make it $1500.
Look for rich people in the Valley renting rooms out in their house! That's probably your best bet.
I definitely agree with #7. I was a successful student for a lot of reasons, but looking back, I know a big part of it was the fact I didn't have kids or pets, only worked VERY part time, (a few shifts a month) and generally accepted the fact the nursing school was my "life." I watched many classmates who tried to work, who had children, who got married & had weddings to plan, who got pregnant, who had drama going on in their personal lives or were always partying FAIL.
I'm not saying it can't be done if you have family obligations or a job but it's 100000X harder. Too many people (especially females) are led to believe we're supposed to be SUPERWOMEN who must be 100% successful at everything and overachieving perfectionists every minute. There is no better recipe for failure than believing that. Just set your life up so you can focus exclusively on nursing school. Don't whine about it, because it is what it is.
Also, figure out what works for YOU. Lots of people say don't cram, don't procrastinate. Well, some of my best A grade papers were written all night before the 8am deadline, smashed on vodka & Red Bull. Cramming worked for me. Figure out your quirks and don't always follow the rules.
I'm working on my Master's in Nursing Education for the very reason that *I* had a horrific substandard clinical experience in nursing school and feel a drive to be part of the solution.
I can understand some reasons why you wrote this. Dealing with student nurses all day would get to anyone. But you really could have made your point in about 10 fewer paragraphs. And honestly, it is WAY over the top. I finally just shut down and laughed at your paragraph describing health care as a jungle of predators or whatever. Come on: lighten up.
And, frankly, it is exactly this mentality that is part of the problem plaguing nursing these days. This whole old school, break-their-spirit, chew 'em up & spit 'em out boot camp garbage is just embarrassing and outdated. Nursing school doesn't have to be some survival of the fittest death race to glory. It is not the military. I beg you, stop perpetuating negative stereotypes! Express your feelings but be aware of their destructive influence.
I had good and bad preceptors. The bad had personal issues that had long since become demons bigger and more important to them than their reasons for teaching any more; 6 years later, I look back and can see that's really what the problem was. They were bitter and angry about the healthcare system and took it out on their students. The really awful ones enjoyed doing so, and saw preceptorship as a blood sport. Stupid. All they managed to do was make everyone as miserable as they were. No one learned anything.
The good ones were relaxed but firm, kind but stern, supportive but not coddling, realistic but not threatening. They treated me like a human being, not an enlisted soldier. They had a sense of humor. They didn't think or behave like paranoid, predatory prowlers with a chip on their shoulder. They were just people who shared their knowledge and acted as mentors and that was IT. No overthinking it beyond that. They also seemed to be less "over involved" in the job and had healthy lives and interests outside of work.
You sound like you are up all night licking your chops and plotting your students' demise.
I know precepting has its frustrations but jeez. You're a terrific writer and I think it would be put to better use on something more constructive and realistic.
Yo! OP! I STRONGLY recommend you shadow a nurse working a med/surg floor/LTC/trenches for a good week. Not one DAY - a week. Preferably somewhere understaffed, under-budgeted, overloaded with noncompliant patients and undergoing an accreditation or state survey. Oh wait, WHOOPS, that's EVERYWHERE!
Seriously, arrange it. Run alongside a busy as heck RN on a couple different shifts and see for yourself what the daily grind is really like. For good measure do a few hours in ED, too, maybe on a full moon or Thanksgiving. And really, TRULY shadow her - don't eat if she doesn't, don't pee if she doesn't, don't take a break if she doesn't. Don't be her gopher (she'll want to use you as that). Run WITH her to the stat lab when their delivery system breaks down, run WITH her 2 floors up to the nearest working ice machine because her units' machine just died, run WITH her to Central Supply 2 buildings away to grab a debridement tray for the doc because the one on unit expired 3 days ago. Go WITH her to meet with her manager to get yelled at & written up because she refused to let a family member drink the patient's Ensure the other night.
Go watch the kind of people RN supervisors have to manage in LTCs & the family members they have to listen to scream at them because Grandma tossed the expensive silk blouse they bought her for her birthday into the soiled laundry bin & it got destroyed. Sit through the hours of required HIPAA, Privacy Act, Body Mechanics and Cultural Competency PowerPoint "trainings" required by law. Watch her spend the first 2 hours of her shift calling the pool/agency to send CNAs to cover the 4 who called off the Monday after payday weekend, & watch her get fired for going over budget trying to staff at safe levels.
Shadow a home health RN, ride along with her a few days and check out OASIS forms and the SOC process. Observe her buying her own supplies, dodging clients' dogs and cats and cockroaches, killing her car and having to decipher inept 'charting' done by aides who barely have a grasp of written language. Help her measure bruises from abuse with a little ruler and file an APS report that will NEVER be followed up on. Hang out with her at home at night while she frantically tries to chart all her visits and record all her mileage, and review charts for tomorrow's cases.
Seriously, I'd love if you tried this and got back to us. I wish like H-E-double hockey sticks someone had given me this advice when I was in your shoes.
Yep. It sucks. I had a cushy IT career and previous degree and decided I wanted to help people too. Off to nursing school I went. 7 years later I wish I'd just stayed in IT. This schooling and the work has aged me 20 years, made me hate people and turned me bitter.
And look for the 2014 salary survey thread here on the site. The money is NOT that great.
Nursing is a big mess these days. It's brutal and nasty and sad. I strongly suggest you find another way to help people. You seem really intelligent and sharp, which means you will have a tough time fitting in health care. Sorry but true.
I'll be the black sheep here and tell you, I was older than everyone in my class by 10+ years. 99% of them were fresh out of high school or 22-24. I was a married homeowner in my 30s working on a 2nd degree. I did NOT relate to any of my classmates at all and totally isolated myself from them whenever I could. I had a established social life outside school, and a husband & dogs, and I didn't feel it was important to hang out with a group or make friends in my program.
I was there for one reason only, to jump through the school's hoops, get my piece of paper and scram.
Honestly it was the best way for me to get through the program. I'd slip into class, sit in the back, keep my mouth shut, slip out. If I had questions I'd scribble them in the margins of my notes and email the instructor later. I did my labs when I knew no one was around. In group projects I was polite and did my share of the work but didn't go out for drinks with them or hang out.
I wasn't deliberately unfriendly - I was always nice. It afforded me a bird's eye view of others in the program and I can definitely tell you: the ones who got caught up in drama and cliques and juvenile BS were almost always 20-something women with something to prove to everyone else. And I saw many of them struggle, fail or drop out. I am certain it was because too much of their focus was on their social standing and trying to fit in, be popular or part of a group instead of on their studies. Too many young women buy into the Superwoman myth and end up sabotaging their own goals by trying to do and be everything perfectly. Eff that. I was like a ninja nursing student. No one knew I was there, and thank GOD. It's what saved my sanity.
Um. WGU is a non-profit.
They ask the same questions on assessment so many times likely because they have had to explain the same concepts about their program REPEATEDLY to so many people. People are idiots and don't listen. Simple as that. They want to make sure you really, REALLY "get" how things work. That's all.
If you're that offended by something like this so early on, and that ignorant of your school's for-profit/nonprofit status, you might want to re-evaluate your decision to do this at all. ALL of higher education is a broken, disorganized system; even these slick, polished online programs are rife with problems. If you get bent out of shape that easily, you're going to have serious problems later on. Relax and just go with the flow. No one thinks you're stupid. Put down your sword and pick up a pen.
Thanks Commuter for an excellent article.
I've made decent middle class income in my 6 years of nursing - but after all the co-pays for anti depressants, talk therapy, psychiatrists and chiropractors due to work related stress, culmulatively I'm probably just above the poverty line. Ha.
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