Job Decision: Psych CM Management vs. Acute care?

[ivyleaf]

I'm looking for advice/ideas about a job I am deciding whether or not to take. I haven't had a formal offer, but am expecting one later this wk.

The job is a Nurse manager/team leader position for a new case management program working to integrate primary care and behavioral health In Medicaid pts with mental illness. I would have a small caseload of clients and would supervise 1-3 nurses and 2-6 community health workers.

My background is mostly in psych (8 years); I have been doing outpatient clinic (mostly primary care) for the past 2.5 years.

The main hesitancy I have is that for years I have been thinking about doing acute care (medical) nursing and it would make the most sense to try it now, as my current job has direct pt care and is not psych. However, long term, I am not sure if hospital nursing would be a great fit for me; and I have read a lot of horror stories on here.

Long term I *think* I would like to go into quality management, patient safety or risk management. However, I have always wanted to try the ED and think I would enjoy the mental challenge of critical care. I am afraid I will always regret it if I don't try it now, and taking this job would make me less desirable for a hospital job.

Biggest Pros : I have worked for the agency before and really like it, I really like the woman who would be my manager/the program director; I would get exp w management and the opportunity for some exposure to data reporting/analysis, quality measures, and contract negotiation; it's a unique opportunity, lots of autonomy

Biggest Cons: a lot of unknowns (it's a brand new program), I find case management somewhat boring, benefits are not as good as my current company (have been with them for almost 6 yrs), a lot more responsibility than my current job for only a little more pay (probably 2-5k more, although schedule is flexible and time off would likely be better), I'm not sure I will like management, I'm a bit jaded when it comes to the population

This job would be a great opportunity to really give a lot of my input and co-develop a new program, which I am definitely interested in; but I am afraid of closing the door on acute care, since I've wanted to do it for the past few years

However, I am afraid of passing up a unique opportunity like this when I don't even have another job offer to compare it to. I think I have a good chance of getting hired into either the ED or one of the tele units at the 2 hospitals that are attached to our clinic (I currently work per diem on the psych floor in one of them); but complicating this, I got a written warning for a med error almost 6 months ago, and that may make them less likely to hire me.

Also, I have felt more burnt out working with patients off and on over the past few years, which Is why I've held off from applying to acute care positions. I find I have less tolerance for stupidity, noncompliance, and entitlement (which I've heard there can be a lot of in the hospital).

My personality doesn't scream "caretaker" and although I know patient care is the most important part of nursing, I think it is the science and pathophys that draws me most to acute care.

Sorry this is so long; any thoughts or advice would be much appreciated

[Eris Discordia BSN, RN]

I worked acute care medical for 16 years and am now in psych. All I can say is that I, in no way shape or form, envy our psych case managers. Those people have such a difficult, crazy busy job. All I could say is for me, personally, I couldn't do their job. Ever. Never ever. Yikes.

I would rather be back working the worst throw-down, poorly staffed shift in the PICU under a full moon than do the job of our amazing psych case managers. Those people have halos and are saints for what they have to deal with and the amazing work they do. They work with patients, families, providers, facilities, UM, insurance, shelters, police, the government, and ever other challenging situation you can think of.

Just my non-expert two cents there. I would pick acute care and scratch that itch first.