Any cons toward accepting a UR position and leaving bedside?

nursingosaurus · Dec 12, 2011

GOOD QUESTION! I completely HATE bedside nursing....I work in day surgery now, and people sometimes are so freaking gross that I can barely stand it. I know that sounds really awful but...I just am burnt out on direct patient care. Maybe after a break from it I will feel differently. I have asked some people how they feel about case management and they have turned their noses up at it....discouraging, but, the people that turned their noses up at it are the people who truly enjoy direct patient care, so that might have something to do with it. I hope you (and I) both are able to get some answers. I am looking at CM as well as UR, too. Best of luck to you!

SummerGarden, BSN, MSN, RN · Dec 13, 2011

the only two cons i have found of working as a cm vs. working as a bedside nurse are these:

1.) if you want to be a bedside nurse again (i do not), you may have trouble returning... i have not met nurses who work as cms for years who have returned. of course, i have also not met cms who want to return.

2.) direct patient care interactions (if you also are a discharge planner): staff by the bedside is under the wrong impression that cms are msws and/or are able to solve the problems of every patient that enters the acute care system. thus, you will spend a great deal of time explaining your job function and that you are there as a resource (like them) and will not be able to solve people's problems. for example, staff forget that patients have the right to make poor decisions unless he/she no longer has legal rights to make decisions on his/her behalf. they also forget that if the md and/or primary nurse was not able to convince a patient of something, you will not magically change the mind of the patient either. plus it is not your responsibility to save the world just like it is not the responsibly of the md or primary staff to save the world.

pros: just about everything opposite of bedside nursing….. most of what you hate about bedside nursing is a pro of being a cm. for instance, i take breaks and i eat lunch without permission. i also go home on time and have good shifts much more often than not. gl!

christiern619 · Jan 21, 2012

the only two cons i have found of working as a cm vs. working as a bedside nurse are these:
1.) if you want to be a bedside nurse again (i do not), you may have trouble returning... i have not met nurses who work as cms for years who have returned. of course, i have also not met cms who want to return.
2.) direct patient care interactions (if you also are a discharge planner): staff by the bedside is under the wrong impression that cms are msws and/or are able to solve the problems of every patient that enters the acute care system. thus, you will spend a great deal of time explaining your job function and that you are there as a resource (like them) and will not be able to solve people's problems. for example, staff forget that patients have the right to make poor decisions unless he/she no longer has legal rights to make decisions on his/her behalf. they also forget that if the md and/or primary nurse was not able to convince a patient of something, you will not magically change the mind of the patient either. plus it is not your responsibility to save the world just like it is not the responsibly of the md or primary staff to save the world.
pros: just about everything opposite of bedside nursing..... most of what you hate about bedside nursing is a pro of being a cm. for instance, i take breaks and i eat lunch without permission. i also go home on time and have good shifts much more often than not. gl!

i am interested in taking a change in career direction towards becoming a cm. i currently am an rn working in acute care and am wondering what you would suggest to someone who wants to take this career path? what prior experience is required/preferred? what are the steps i need to take? any information would be much appreciated :)

Mandi3020 · Jan 23, 2012

I left bedside nursing years ago in favor of case management (one job was doing home visits and the current job is in the acute/hospital setting) and I NEVER want to go back to bedside nursing. Having said that though, I know it would be really difficult for me to be comfortable at the bedside again. So, if you ever want to do that type of nursing again, don't go exclusively into CM. Also, I agree with the poster that says the floor nurses think that CM are MSW; I get very tired of being expected to fix every patient's problems. One nurse even wanted me to do a mental health eval on a patient that needed IVC'd! We just about came to blows on that one--NO WAY am I putting my liscense in jeopardy by going outside my scope of practice.

clahoney7 · May 15, 2012

I think having the hospital experience is what you need to be a CM in a hosptial. I started in UM at an insurance company as I have no hosptial experience and moved to CM, got my CCM after working a year.

the pros are for me: holidays and weekends off. A steady 8-5 for the most part with no OT. A lot to be said about not being called in.

cons: sitting long periods at a desk and getting carpal tunnel, back problems, risk for clots, risk for obesity and heart disease due to being sedintary. It is easy to get caught up in the daily and forget to take rest breaks.

RNSAC, MSN · Dec 17, 2012

I have a semester left of school and will be looking for jobs shortly. I just wanted to know if there are people who work as a case manager and as a bedside nurse. I initially wanted to be a bedside nurse but i ended up specializing in case management so now i want to do both. I understand that if i choose to go into case management, it'll be hard to find a job as a bedside nurse later down the road. So i'm hoping to find a job in both areas. From my understanding, it is easier to find a job as a case manager than a registered nurse, at least in northern california.

I received a RN license earlier this year and after 3 months of looking for a job, i gave up. I believe being a full time student may have been a reason for the rejection letters but who knows. At this rate, i might just go straight into case management.

Mijourney · Dec 23, 2012

RNSAC, congratulations on getting your RN license. I would spend more time trying to get that first clinical job. IMO, it's important to have clinical experience before taking on the responsiblity of becoming a CM or UM. My observation is that those nurses who have had minimal clinical experience are not as effective overall as those who have had at least several years of direct bedside care experience. It's great to have knowledge and skills from your school days. But, that does not equate with real-life autonomous experiences in bedside or administrative nursing. Autonomy, advanced critical thinking, and resourcefulness are very important in CM. You need strong critical thinking and autonomy skills as well as resourcefulness to be effective in meeting the goals of your employer, your client, and yourself. I've written a similar sentiment before under another thread: you need to crawl before you walk in the nursing profession otherwise you may end up cutting yourself and your client short. Best wishes.

nurseprnRN, BSN, RN · Dec 24, 2012

I can't see how you could possibly be a case manager without solid bedside experience. Remember, the definition of case management includes influencing the course of medical care, and how could you have a clue about that without knowing how medical and nursing care works in a variety of conditions and settings? Don't make the mistake of thinking that case management is somehow nursing lite or not real nursing. Nothing could be farther from the truth.

Also, be sure you know the difference between a discharge planner and a case manager. Many people employed as "case managers" in "case management departments" are not qualified to sit for the CCM examination because their job descriptions do not meet that standard. They do discharge planning. Only. Check the CMSA, Case Management Society of America for links to the certification to see what it's really about.

That said, I was a critical care clinical specialist and found myself doing work comp case management all of a sudden, and haven't been back to the bedside in almost 20 years. Not one iota of regret.

Patience.

Nurserton · Dec 29, 2012

I have a semester left of school and will be looking for jobs shortly. I just wanted to know if there are people who work as a case manager and as a bedside nurse. I initially wanted to be a bedside nurse but i ended up specializing in case management so now i want to do both. I understand that if i choose to go into case management, it'll be hard to find a job as a bedside nurse later down the road. So i'm hoping to find a job in both areas. From my understanding, it is easier to find a job as a case manager than a registered nurse, at least in northern california.
I received a RN license earlier this year and after 3 months of looking for a job, i gave up. I believe being a full time student may have been a reason for the rejection letters but who knows. At this rate, i might just go straight into case management.

I work with a nurse at an insurance company now who used to work inthe hospital as a Care Coordinator and pick up shifts on the floor also. So, yes, it can be done, bur probably only if you're doing CM/UR in a hospital, otherwise the hours at an office wouldn't allow it. Many hospitals employ CMs on night shifts or second shifts and the like. Also, it probably would be a bit much for a new grad. You should focus on building your patient care foundation for a little while first and then talk to the CM dept at your hospital.

Orion81RN · Jan 11, 2013

Case management can be done by a third party company working with insursnce companies, with assessments being done via telephone. I just learned of this. One company is RSA. Im just now learning about case management being a new grad. I have a former classmate who works there as a new grad. I only want to keep this in my back pocket though while looking for clinical nursing to get that experience.

nurseprnRN, BSN, RN · Jan 17, 2013

Yes, to be a case manager you need clinical experience on which to base your management decisions.