ED case-manager as NP? Advice?

Specialties NP

Published

Does anyone have experience in Emergency Department setting with more of a non-clinical role? I am applying for a position in an ED where I would not be seeing patients. The role is being developed by the hospital, so it's not entirely formed. It seems to be a type of case management for patients who are being admitted. Instead of a bedside ED RN taking the admission orders from the admitting provider, I would be accepting and entering into the computer. I would be responsible for medication reconciliation. They are using an NP instead of an RN due to the medical decision making prompts designed by their computer system. Instead of the RN to need to call back the admitting provider for every drug interaction.

Just trying to get an idea from anyone that has experience with this type of position? What type of questions would I want to clarify in the interviewing process? What type of ideas to improve this type of position? Any advice would be helpful at this stage?

0 Votes
Specializes in Nephrology, Cardiology, ER, ICU.

Hmmm

1. Is this going to be a 24/7 positions?

2 are they hiring 3-5 NPs?

3. Since EDs are busiest from 1500-0300 usually what hours would I work?

4. Will I have full credentialing and the ability to give orders?

5. What data are they using to benchmark this position?

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Specializes in ER/Trauma.

It seems like an odd position... Why can’t the admitting provider put their own orders in? If you have no contact with the patients how do you know what orders are or are not appropriate?

2 Votes
Specializes in ACNP-BC, Adult Critical Care, Cardiology.
1 hour ago, Amber Brown said:

Does anyone have experience in Emergency Department setting with more of a non-clinical role? I am applying for a position in an ED where I would not be seeing patients...Instead of a bedside ED RN taking the admission orders from the admitting provider, I would be accepting and entering into the computer. I would be responsible for medication reconciliation.

I don't like that idea at all. You are NOT seeing patients but yet accepting and entering orders in the computer? Why can't the provider from the admitting medical or surgical service do those including "Med Rec". Med Rec is something best done with face to face patient contact and if there are further questions, a call to the patient's pharmacy. My hesitance is based on the fact that your are responsible for important orders and documentation based on chart review without having done an interview and physical assessment on a patient.

0 Votes

Admittedly without knowing what the current state of things is in your ED, this doesn't seem very well thought out on the surface of it. What is the overall goal here? To end the cumbersome practice of ED nurses entering full admission orders? If so - there's a much better way to address it.

Maybe throughput isn't great right now, but I fail to see how this will improve it. It sounds like right now you have a situation were various admitting physicians need to get in touch with various ED nurses so that the nurses can take down and then enter the orders into the computer. Now various admitting physicians will need to get in touch with you (one person) so that you can step in without knowing the patient and take down someone else's orders and enter them into the computer? Do the med rec and address decision-support items? I'm not sure you (this position) won't become a huge bottleneck.

Why aren't they first addressing the part about one person taking down someone else's orders and then sitting there entering all of them? Admitted patients need to get out of the ED, and admitting services need to enter orders in a timely manner. This position is a whole additional stop in the process. It seems like a role that should be associated with the hospitalist or admitting service, and the bulk of the duties of this role can be done upstairs.

1 Votes
1 hour ago, JKL33 said:

Why aren't they first addressing the part about one person taking down someone else's orders and then sitting there entering all of them?

That sounds like verbal orders to me and I thought they were all but verboten by TJC. What a recipe for disaster.

0 Votes
Specializes in ACNP-BC, Adult Critical Care, Cardiology.
2 minutes ago, Wuzzie said:

That sounds like verbal orders to me and I thought they were all but verboten by TJC. What a recipe for disaster.

Problem is, now they are thinking of making an NP write the orders, someone with credentials and privileges to write such orders as a licensed provider. That alone makes me shudder to think that assuming such a responsibility on patients I didn't even see is not a set up for legal disaster.

2 Votes
1 hour ago, JKL33 said:

It seems like a role that should be associated with the hospitalist or admitting service, and the bulk of the duties of this role can be done upstairs.

When I worked in the ED the ED physician wrote basic admitting orders that would at least cover the patient for a couple of hours on the floor until the admitting MD got there. At the time it was a paper form of standing orders that could be checked off with IV fluids, pain meds, antibiotics, diet and anything additional that pertained to the admitting diagnosis (nebs, lasix, etc.)It took maybe 2 minutes to fill out and seemed to work pretty well.

1 Votes
Specializes in ACNP-BC, Adult Critical Care, Cardiology.

Admittedly, the way hospitals work, a PHYSICIAN of record has to be in charge of an admitted patient per Medicare guidelines. I'm sure the role the NP is speaking of would include writing orders such as: "admit to Acute Care Medicine Unit in guarded condition under the care of Dr---, Hospitalist Service, diagnosis of Community Acquired Pneumonia".

However, I am still leery of this role because the way litigation would ensue, someone who was admitted with pneumonia for instance would have something else wrong with them during the admission which could potentially lead to a missed diagnosis so that every Tom, Dick, and Harry who ever wrote orders on the patient is being asked why "in their clinical judgement" was a test not ordered to rule out the missed condition.

0 Votes
1 hour ago, Wuzzie said:

When I worked in the ED the ED physician wrote basic admitting orders that would at least cover the patient for a couple of hours on the floor until the admitting MD got there. At the time it was a paper form of standing orders that could be checked off with IV fluids, pain meds, antibiotics, diet and anything additional that pertained to the admitting diagnosis (nebs, lasix, etc.)It took maybe 2 minutes to fill out and seemed to work pretty well.

Yes. That worked well. It's a process that can now easily be done electronically using an order set and can also just as easily be done by the admitting service, which prevents people on the outpatient (ED) side from having to write inpatient orders (which is sometimes a very legit concern depending on privileges and other concerns like what Juan mentioned).

Regardless which side is writing the orders it should be a process that is simplified as much as possible and gets the patient to the right place (upstairs) quickly. [CMS quality measure for admit decision to ED departure time].

As far as the med recs, who does them at your facility, Amber, and what is the current process for that?

0 Votes
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