CCL"Babe" 3,623 Views
Joined Feb 9, '03.
Posts: 309 (7% Liked)
Yes, there is a need for NP in hospice and in palliative care. My health system also uses NP for palliative care service in the hospital setting. New Medicare regulations require "face to face" meetings with physicians or mid level practitioners on a regular basis.
Think about what type of setting you eventually want to practice. There is quite a buzz in the Philadelphia area about this question. Jeff and Penn are making all their NPs have acute care certification. All their NP who do not have an acute care certificate have to go back to school to get it. The state BON has not made it a requirement to have an acute certification to work in the hospital setting, but they are "looking into it".
I feel your pain. I have a little over a semester to go and I feel like I have hit a stone wall. While talking with my cohorts I have realized that they feel the same. It has been such a long hard road- but we are almost there.
Case Management and Utilization and Review can be two very distinct jobs depending where you work. UR is evaluating people essentially for SI and IS: Severity of Illness and Intensity of Service. You are assessing to see if people meet criteria for admission to the hospital, Skilled Nursing Facility (SNF) or other type of skilled care center. If they meet that criteria you are looking to see if they are getting treatments that warrant admission to whatever level of care they are going to. Discharge Planning (DCP) is usually combined with UR. Hospitals tend to call UR & DCP case management. Managed Care companies do not consider UR & DCP case management. (they can in fact be quite snobby about the differences in my experience) Case management can also be disease management, hooking people up with community resources, health teaching among other things. I highly recommend looking at the Case Management Society of America's website: http://www.cmsa.org/
I worked for BCBS for about 4 years. I worked as a "care coordinator" or Utilization Review (UR) and Discharge Planner (DCP) for about 3 years and the last bit as a Case Manager. There is a strong delineation between the two positions. The BCBS where I worked, you had to work there full time for one year before you could apply to "go home". Applications were then evaluated for seniority and the ability to work independently and your productivity statistics. There were only a limited number of people who were allowed to work from home and the competition was tough for those positions. There were obviously benefits about working from home, but you were also expected to take more call or after time after business hours.
The company I worked for looked for a varied background in their nurses. They liked people who had worked in the Emergency Department or other specialty areas. For case management, I would think your background in pain management might be a plus since you would be working with people who have chronic illnesses as well as acute problems.
Many of the work at home people had small children, but you had to put them in day care, you were not allowed to care for them and work at the same time. the company had ways to measure your productivity and log on times. there were also surprise home visits. If you did not follow policy, you were fired.
When I worked for an insurance company they made a big distinction between case management and UR/DCP. They educated their case managers more thoroughly. We were primarily involved with disease management and counseling patients on staying healthy. We made referrals for health care information and coordinated care. We assessed for problems and assisted the patients in problem solving.
In the hospital, case management is more the UR/DCP piece; performing utilization reviews, assessing for severity of illness and intensity of service. We also do discharge planning. The hospital social workers do what we did in the way of referrals and counseling.
I prefer case management, but hospitals pay better and have better benefits.
The hospital system where I work adheres to practice of looking at GPAs of their new grads. Their thought on this is that they are hiring the cream of the crop.
In the Philadelphia region most hospitals are hiring BSN graduates. There are other jobs available out side hospitals, although the pay is usually not as good. You may want to get the diploma then work towards a bachelor degree. There are programs that will accelerate your RN to BSN once you are out and working.
Sometimes during tests such as a TEE transesophogeal ecchocardigram you purposely put bubbles into the IV line so they can watch them on the echo.
Agree with several posters: Asking questions is a way of learning. If the instructor feels threatened- find your info elsewhere-especially if you will be coming into contact with that person frequently in your job.
I have done both UR, DCP & Case Management for an insurance company & now I am Case Manager for a hospital. Hospital CM is more of the UR & DCP in my hospital. The Social Work Department performs the traditional CM role. Positives for me are: better pay, more vacation and better benefits, closer to home. Downside I am working weekends again, but thankfully no holidays. The duties are about the same for the UR & DCP portion. At least you have the charts and can get the info needed to complete the reviews. The politics are more prominant in the hospital setting. I am happier in the hospital setting.
Hospitals will often hire people with UR backgrounds to do Case Management. The pay & benefits are often better in the hospital. Hope this helps.
I loved it. Unfortunately with my health issues I am no longer active. Went through fire school and vehicle rescue, EMT & Paramedic training. Volunteered both fire and ambulance. Would still do it if I could.
The fellowhip & family is equalled no where else.
Second shift almost ruined my marriage. We never saw each other. He got lonely, started hanging with friends in bars. I stopped. It stopped. He asked that I never work second shift again- I never did. Most people have always thought that we had a great marriage & we do. Second shift was not worth it.
If you have another offer I would go with that. Starting a new job in that situation could be placing yourself in a bad situation.
Originally Posted by P_RN
A nurse with an injury or disability is a persona non grata to the human resources department. They do everything they can to APPEAR TO HELP you but in truth you are sunk.
How true. HR told me that I would probably lose my job in the Lobby of the hospital. There I was crying, the day before my back surgery. not a pretty sight. The next time we spoke I demanded to talk in privacy. I did lose my job- The first legal day they could cut my job they did. I had a lot of anger for many years.
I am considered 28% disabled, but it is more than enough at times.
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