Inexperienced nurse in a more critical role

[marilynaalvarez]

I graduated nursing school in 2015 and went into Psych Nursing then Utilization Review for behavioral health. I'm in a new position titled "Palliative RN Case Manager." I was hired by an interim manager who was under the impression that it was mostly a palliative nurse position, offering hospice, etc. However, I've come to find that this is not the expectation of my position.

I'm expected to be more of a hybrid nurse that will see very critically ill patients in the home, provide wound care when necessary, help manage them without the need of contacting the doctors and without relying on home health to be called for minor issues, and yes, determine if they meet necessity for hospice. I don't remember lab values anymore, I don't remember cardiac info, kidney info, wound stages, cancer stages, copd, nothing. I feel so stupid, I don't even know how to use a manual bp monitor anymore or listen to heart and lung sounds. Where do I start?! I can't quit my job, I'm supporting my family myself.

I asked the physician I work with (who was under the impression that I had critical care experience and she is the director of home health) and she will be setting me up to shadow a home health nurse and also a cardiac nurse. I do not want to present myself not knowing anything though. How do I teach myself this info again? what is the important stuff to know? I need all the help I can get.

[CharleeFoxtrot, BSN, RN]

You probably don't want my advice as it's isn't something you want to hear I am sure. I kept typing a response, then erasing it as no matter how I tried to look at this you are in over your head and I can't think of a subtle way to say that. Please don't mistake my words for snarkiness as that's not my intent but having done the job you describe I can't see how you can suceed without the relevant experience.

You've forgotten lab values? Meh not a huge issue as there is a reference for that. But the job you describe is being out in the field and expected to be able to put the pieces together quickly and with autonomy. A missed sign/symptom can result in a preventable hospitalization or worse. Your description of the job notes that you are supposed to handle things with minimal supervision.

A few hours of job shadowing can't fill the gaps in your knowledge or the insight and experience that a few years at bedside/critical care provides. Do I think you can't acquire insight and learn to do this job? Of course not, that isn't the issue.

The issue is there is no room for a learning curve in the job you describe, and a lack of knowledge could have a really bad outcome for your patients. I feel like you are setting yourself up for failure and it worries me.

[Cowboyardee]

Bite the bullet and tell your boss you don't have the skill set your role requires. Maybe they'll find a way to orient you at length, or maybe they'll find another role for you.

I know you have a family to support, but you can't weigh that against your patients' lives. And there's no book to read on your off time that will take you from a nurse who can't use a BP cuff to a nurse with extensive bedside experience. You dont need to shadow. You need a new position.

[Susie2310]

For the patients' sake and for your sake, this does not sound like a position for an inexperienced nurse.

[Workitinurfava, BSN, RN]

Try another CM position.

[hppygr8ful, ASN, RN, EMT-I]

I have to say I concur with the above poster's. You are simply in over your head and to continue puts vulnerable patients at risk. You can learn skills but their is no substitute for the kind of hands on training you get at the beside.

Hppy

[Kallie3006, ADN]

Is this position worth your license? More pressing, is it worth a patients life? It seems like it would be a losing battle where you had no leg to stand on if something was to happen and you had to face the BON. Practicing outside of your scope is not taken lightly.

[Been there,done that, ASN, RN]

"How do I teach myself this info again? what is the important stuff to know? "

We cannot do that for you. In order to practice in your current setting, you need a refresher course and lengthy orientation. You are putting your patients and your license at risk... for the pay check???

[CharleeFoxtrot, BSN, RN]

Another thing to consider as the internet is forever...OP, you also might ask the Mods to change your user name.

[FolksBtrippin, BSN, RN]

I don't know how much of this is anxiety and how much is really you not being adequately prepared. I worked inpatient psych too, but I am confident with heart and lung sounds, taking blood pressures, COPD. Our patients have a lot of comorbidities in inpatient psych. You probably saw a lot of brittle, non adherent diabetics. You probably had a lot of patients withdrawing from drugs/alcohol. That's useful.

Are you sure that some of this isn't nerves? I think you should do the shadowing. You may find out you know more than you think.

Not to say you don't have real deficits. We don't see dying patients in psych. You will need to learn a lot about that. But yout experience with UR will make certain things easier as a case manager. You will have strengths that a nurse coming from critical care will not have.

I would think that shadowing a person who does the same job as you will be doing would be better for you than just shadowing home health and cardiac. Will you get a long orientation with another case manager?

Find out if other nurses were hired into this position with a similar background as you.