Hospital setting frustrations

[Somethingsgottagive]

Working in a job where no one understands your role~ Case Manager, RN To the doctor who shouts in my face, before I ask my question, "No that patient is not ready to go home".

-- umm thanks I wanted to ask you about the plan for a different patient, the one whose family is trying to figure if they can afford the care you prescribed for them. I need to clarify your orders because you didn't give enough information in your neatly hand written note. It would be really helpfu to be able to tell her daughter if we are talking about 100$ for the treatment or 1,000$

The nurse who thinks I work for the VNA "you don't need to see them, they are independent"

Your right he is independent, hasn't seen a doctor in five years, newly diagnosed diabetic -- definitely wouldn't benefit from getting any services set up by me in the community.

The nurse who thinks I am a cold hearted b#*$~h. I get your intention as a patient advocate, would love to have you if I was a patient... But your not seeing the big picture. Going to the doctor who is one his first day with this patient and telling him how much pain you patient is in... Can they please increase the patients pain medicine... When I chime in and say that patient has a substance abuse history and every study have been negative. getting them Set up with a detox program like their mother helped convince that patient is really hard after you convinced the doc to increase methadone they were put on this admission to wean off herion. You know since they have to be off narcotics to get in the program.

The Team leader that doesn't get the involvement in each patients care, "that provider isn't here for rounds so the patient doesn't need to discussed in rounds"

Sure lets not go over their plan of care. The patient has had a different nurse every day, today's nurse got a great head to assessment in hand off but has no idea that, Mr. M is going to be going home on two weeks of lovenix injections and no one has showed him how to self administer. And that wound vac for home will probably order itself.

The patients daughter who thinks i should be able to fix her mothers years worth of problems in a two day stay.

I am sorry your mother is requiring 24 hr supervision, that's not covered by insurance. No she is not a candidate for short term rehab- she transfers and ambulates completely independently... This is on you & your family not me. When this situation happened to my husbands grandmother we moved in with her & nasty sundowning rants & all.

The patient who wants my name to report to the CEO of the hospital because I am the first person to inform the the are observation level of care & what that means.

So sorry that your provider didn't take 5 minutes to explain that there wasn't any indications to admit you inpatient into the hospital. That They would plan on observing you for another 23 hrs or so to see if something changed or a test resulted warranted further treatment. So sorry that your going to have to pay 20% of the thousands of dollars in tests that are being ordered. I am sure if you had know that up front you might have declined that MRI. For the patient that thought they where on their way one night down to a qualifying stay-- no observations doesn't count but if you yell at me long enough maybe I can convince one of the hospitalist to commit Medicare fraud.

[n2biology, ADN, BSN, RN]

Thank you for adding insight on what a case manager has to consider when preparing a patient for discharge.

[NRSKarenRN, BSN, RN]

I spent 14 years as Central intake Manager in a home health agency responsible for 3,000+ referrals/month interacting with 100's case managers over the years. You eloquently painted the daily picture of a case manager. With the increased focus on reimbursement tied to safe, effective discharge planning, many hospitals in my area have provided intense staff education regarding discharge planning process and case management role with Case Mgr's rounding daily with physicians.

Kudos for your keen assessment of patient needs and recomending homecare when warrented for those "independent" patients newly dX with Diabetes who haven't seen a doc in years...they are the first ones back in the ER within 48 hr's cause they never got their meds filled or took double the dose resulting in hypoglycemia.

:)

[lauramswrn]

OMG this is my day totally. And to the resident who does not want me to have the attending's cell phone number to tell him of his planned dc for tonight needs to leave. Due to her not needing that beautiful swallow eval when she's not dysphagic and tolerating PO and . Send her home, we could do this PO." Patient had commercial insurance.

OMG what we do daily.

[SummerGarden, BSN, MSN, RN]

So far the poll does not show us feeling supported by administration or coworkers the most. :)

[cbperrine]

One of the best descriptions of my day ever! Completely accurate. I do love my job though, the good still outweighs the bad (and it doesn't hurt that I love a challenge)