Frustrated with a case manager!

You have to be very flexible to be nurse. You may have a wonderful plan and the next minute have to change your plan. This seems to be the case in hospital settings. So get over yourself discharge planner. You have a job and are there for the patients...so if their needs change you go with the flow and reformulate a new plan. Good for you for telling her exactly what you are thinking...maybe she will think twice before she dumps her issues on staff and patients. I would also write this up......especially if this is a pattern and not just someone having a bad day. That is your big clue...the offensive behavior is always there.

Hey all...I just need to vent about one of the case managers at my facility. I work in a surgical unit, a cool mixture of ortho, tele, post-op, and "typical" medical patients. I love the variety and the pace...we do a lot of admitting and discharging. I absolutely love 2 of the case managers, they are awesome at setting up home health, transferring patients to SNF, etc. But there is one case manager that is ocassionally floated up to our unit, and she just gripes to no end any time she is there. Usually I ignore her comments, and try to keep light and positive. But today I let her have it! One of my patients, an end stage renal disease patient on dialysis (obviously) and telemetry monitoring was a possible d/c, after consults with neurologist (tremors and generalized weakness), and PT/OT eval per primary md. The nephrologist wrote "pt. may be discharged home with outpatient dialysis if primary MD in agreement" at 12 noon today (Friday). Primary MD comes in at 1700 and decides that the patient would be better in a skilled nursing facility. The patient was only able to ambulate 300 feet with PT, and the family (his elderly wife) expressed their concerns with being able to care for the patient safely in his weak state. The MD was in agreement, everything beautiful. At the nurses station the doctor (one of those truly wonderful doctors!) tells the case manager and she answers in a rude obnoxious tone "Well geez Dr. X, couldn't you have decided this yesterday, its going to be really hard for me to place him somewhere now!" I couldn't resist and I snapped back at her, "No, the doctor requested a neurology consult for the patient yesterday, and just this morning was seen by the neurologist, and the patient got back from dialysis barely two hours ago, where by the way he also had blood pressure of 60/40, so it's probably a good idea that we didn't just send him home. Why don't you check the dr.'s orders and labs before you start complaining! He's not ready to go home, so if you can't find somewhere for him to go, he's staying here!" . She immediately left for backup, aka the other case managers that work all the floors ( this particular cookie is usually in ICU for discharge planning because she gets too overwhelmed otherwise). If she hates it so much, why doesn't she find another area of nursing? Sorry but she drives me insane with her attitude!

Case manager is such a multiple tasking process and it could be improved if the facility have an organized workable system. Example, the floor or unit the case manager is assigned to ,should have the copies of the doctors orders placed in a communication box for the case manager.....the order is written for the cm to follow up, instead of depending a verbal message from the nursing staff.

Secondly , the facilty should allow a comprehensive orientation of the expected process from the facility. (for profit hospital can be gnarly, for the focus is the loss of money) Of course this is understandable to a certain point since cm is for cost effective stays, but hopefully a fully thought out plan for the patients benefit. This will require cooperation among all staff involved that worked w/ the patient. But to have an effective orientation, means efficiency or no guess work and will standardize some processes, not to mention , improving the efficiency and speed, instead of trial and error.

3rdly, the supervisor is reviewing all medical reviews..she wants 100% medical payment. Is she altering information written by the case managers?

There was so much "inconsistency" . Ex. she wants reports everyday from the case managers after their work , and yet she demands not to have overtime , not thinking that she was causing the majority of the overtime becaseu of her micromanaging?

Any feed back will be appreciated.