field nurse with offer for clinical manager position

  1. I am currently a field nurse and have just been given the opportunity to take a position as a clinical manager as one of the two managers is moving out of state. I really enjoy QAPI projects, mentoring newer nurses, diffusing situations, improving processes etc. I did a fair amount of that as a RN supervisor in a SNF. It's M-F 8-5pm salaried. My earning potential out on the field is might be greater but obviously it depends on census and a whole lot of other variables (cancelations, no one is home, wear and tear on car, time consuming visits etc). Knowing I was going to make the same amount every paycheck would be such a relief, plus no weekends and holidays.

    The trouble is I have 3 young boys (ages 6,4,3). I already have fulltime preschool for the youngest and after school care for the other two. As a case managing field nurse I'm able to schedule my first patient at 9am so that I can help my husband walk out three rugrats to school in the morning (a couple blocks down a busy road). I see patients until about 3pm, come home, start dinner and finish whatever charting I couldn't do in my patients house. Husband meets me at home about 5pm and then we pick them up and have a family meal (precious time). My husband then leaves again around 6:30pm and I manage the bedtime routine solo and finish my charting after they go to bed if I need to.

    With an 8-5pm my husband will have to solo it in the morning, make dinner and probably feed them dinner as well since they come home starving and realistically I won't be back by 6pm. He is supportive but it's heartbreaking to think of losing that time with my family. It's kind of why I went into home health in the first place. I wanted flexibility. What I lost was consistent income. Now I have an opportunity to advance my career and have consistent income but I'm going to lose all that flexibility. Sigh.

    No easy answer but I'm really curious about what some of you who have done both jobs with a family might have to say.

    I really need to make up my mind over the weekend so very appreciative of timely response
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    About PCH85

    Joined: Aug '18; Posts: 5


  3. by   caliotter3
    I do not envy your situation. You have everything well-planned at this time. Frankly, won't there be case mgmt opportunities in the future? If it were me, I would go with things as they are until the children are old enough to factor into the equation to relieve some of the stress. If you need some more consistent income, you can always pick up an extended care shift with another agency on one of your off-days, maybe even just a six hour shift. That situation would be easy to quit or rearrange should the need arise, whereas a FT position as you described, has little, if any, flexibility.
  4. by   PCH85
    Thanks Caliotter, you always have good things to say on this forum (been reading HH posts for awhile, always learn something interesting).

    My family could REALLY benefit from increased income and that's what makes this such a difficult decision. I have thought of staying full-time where I'm at and going per diem with a different agency just to ensure I have enough patients each day but I kind of hate the idea of balancing two employers. I know you have done well with extended care shifts, I'll look into that in my area. Do they hire RN's as well as LVN's? How's the hourly rate? This Clinical Manager position doesn't come around that often, there's only two at my agency. Also a chance for some career development but at the sake of my family schedule? This is the age-old working mom problem, the sacrifices we make!
  5. by   caliotter3
    The problem with extended care for an RN is that not all agencies will pay an RN their RN rate for an LPN/LVN level case, and most extended care is just that, LPN level. I've noticed that the clinical supervisor/case manager positions are fairly revolving door in my area. Realize this may not be the same everywhere.
  6. by   Libby1987
    I've done both, twice over (not clinical manager but management nonetheless). I've loved them both but stayed in the field when I needed flexibility for the kids.

    The clinical manager position is not 8-5 and it's so much more than the fun stuff like mentoring and education, it's very much about staffing, scheduling, performance mgmt (writing up staff). 20% of the staff will take up much of your time, and no matter how much you like them now, on the other side you will deal with performance and attendance issues. Speaking of attendance, sick call/LOAs are a frequent occurrence and a challenge. You can spend all day and feel like you got nothing done. I like mgmt as much as liked the field but I believe in going in eyes wide open.

    If you're willing to leave house before 8 (I don't know your commute, and there won't be mileage) and get home after 5, not necessarily leaving at 5, you could probably pick up more work in the field for extra money on days you choose to work longer.

    I worked a schedule like yours when my kids were in school and I never missed a thing of theirs because of the flexibility. And the mgmt positions were always there when I was ready for them.

    That said, you'd probably be able to return to your field position if you determine it's not the right fit/right time.
  7. by   PCH85
    Hi Libby1987,

    I REALLY appreciate your response. At what point did in your family life did you take the management position the first time? How was that transition? What made you go back to the field?

    All those long hours inside an office dealing with things like staffing and performance mgmt (like your mentioned) does make me cringe a little. At the same time, I have a fabulous administrator who is completely engaged and loves to share her passion for HH. If I'm going to ease into management this would be a good place to do it. But again, if it's not the right time then it's just not the right time.

    Money is an issue. I'm assuming when you were on the field it was PPV? How do you ensure you make budget when you are at the mercy of your census? I shoot for 5-6 but sometimes a person can't be reached or has an appt. Sometimes I only have 3 on my schedule. Occasionally I exceed my goal but more often than not I come up short. Plus the depreciation on my car which is hard to account for. Did you ever try working for two agencies?

    The management salary would allow us to pay all our debts off in two years and save up a good down payment in another 3. That's a pretty appealing five year plan. But five years of never getting to walk my kids to school or surprising them occasionally with an early pick up and then coming home after they've all eaten after spending 45 minutes in traffic....

    Any tips on how to maximize my earning potential on the field is very appreciative!
  8. by   Libby1987
    Yes, I was PPV, my preference in fact.

    Some things to try with PPV if you're a case mgr and have some self scheduling ability:

    Good rapport, communication and coordination with your patients and your team to head off as many cancellations or contact issues as possible. Also be clear with your patients the necessity of your services, when they buy into why they need you, some will make themselves more available and accessible. Make sure they see you make calls/emails on their behalf. Patients are less likely to think they don't really need anything (treatment visits aside) when they see the care coordination. I've heard hundreds of times patients say they don't know why the nurse comes, that happens when you do all of the follow up behind the scenes.

    Ask your patients if you say schedule next visit for Wed and then Tues opens up, could you call to see about moving up their visit? Never miss an opportunity to bring visits forward, didn't get a SOC, back fill from later in the week. That opens up your end of week for those SOC and unexpected visits to occur. You don't want to have a light Tuesday then an extra SOC comes Wed or Thursday but those days are already full of originally planned visits. Are sure they know of the possibility of you moving the visit forward, otherwise they might think there's a lack of organization.

    Make sure your patients know how and when to reach you for early symptomolgy and intervention. Its best practice for the patients of course but also an opportinuty to see them to manage them at out patient setting.

    Be flexible and never miss an opportunity for low hanging fruit. Someone's patient needs a prn cath change? Grab it.

    Anyone busy and could stand a lighter day? Offer to take their SOC.

    Ask if any pending SOCs that can be brought forward. Next day SOC is the new best practice, same day SOCs are also reimbursable if the documentation is there.

    Move up any recerts that you can, you might even get an extra visit in as follow up visit.

    Extra weekends and call?

    My income always averaged higher than if I were paid at my hourly wage and it was consistent year to year, just had dips and peaks through the year.

    The first time around in Mgmt, my then husband was stay at home or I used a preschool. This was more than 20 yrs ago and things were simpler and more lucrative, I don't recall working long hours back then. These days of do more with less and budgetary pressures with reductions in Medicare reimbursement, your agency's back office support staff has seen their workloads go up and getting out at 5p sharp is not anything you can count on. It may not be a regular issue at yiur agency but I'd do some research into that.

    The 2nd go round in mgmt, my youngest was driving so I didn't have near as much pressure to get him picked from practice etc.

    The extra money you might make as a salaried manager will likely in part be used for conveniences 8-5ers often do. And no mileage. I gave up about 6K in tax free mileage reimbursement and with mgmt job I drove 48 mile trip round trip with no reimbursement.

    I'd wait until they're older but if you really want all that comes with a clinical manager position, warts and all, then you can make it work.
  9. by   PCH85
    Those are some great scheduling tips, thank you. I'm especially guilty of the "behind the scenes follow up". When you give your patient's a set schedule (and ask if it's okay to occasionally move their visit up), do you also give them a set time? Some of my patients would appreciate that but I've been reluctant because when I go to map my route it may cause unnecessary driving. Thoughts on that?

    The hourly my salary would be based on isn't much more than my base pay. I think I need to pass the mgt job for now.
  10. by   Libby1987
    In general and in advance, from the prior visit, I try to commit to am or pm and tell them I will call the afternoon before to narrow it down to no less than a 1 hr window. If they need more, to put a pet away etc or just in general, I will call when I'm headed over.

    If that doesn't work, they're a high risk cancellation regardless, your visit is either not that valued to them or they are more active than aligns with home bound.

    Exceptions for things like labs or other specific treatments that require tighter coordination or for the working adult children who have very narrow windows to leave work for your appt, I do everything to accommodate scheduling in those instances.

    When asking if the option of moving the visit up from the prior visit, I would do the same as above. If it turns out that my schedule opened up the day before then more than likely I would calling the afternoon before to ask and would be able to give them an hour window at that time. It would be their option to agree to the change at that time. Make sense?
    Last edit by Libby1987 on Sep 3
  11. by   PCH85
    Yes, that makes sense. Thanks very much for all the tips. My big take away is that I really need to sell my services, to get buy in and reduce missed visits. Appreciate your expertise.