New Hospital Case Manager/UM & I am overwhelmed..............

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I just started a new case manager job in a hospital. I will be floating to several different medical floors. In addition, I have about one year in community health case management which I feel has not really prepared me for this job. Btw, I have not worked on an acute care floor before. Frankly, I think I am in sensory overload and this is around my 5th shift.

How long should orientation be on an acute care floor and how long does it usually take to feel half way proficient?

Thanks for reading this and for any advice you might have for me.

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Specializes in Tele.

I just started a new job as a Hospital Case Manager this week. I have both Acute Care experience and Case Management experience for an insurance company. Both are helpful, but I don't have any direct inpatient case management experience. I was a bit overwhelmed as well, but I think with time and patience it will all work out. There is so much to learn and the only way to learn it is to experience it. I think what is most important is being able to prioritize your work and making sure the patient has everything he/she needs as they progress through their admission. I'm approaching my responsibilities the same way I did for my floor assignment, and at the core is the nursing process. Maybe you could apply this process to your previous experience. I'm also expecting it's going to take at least a couple months to feel comfortable. I'm open to suggestions as well!

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Specializes in ED, ICU, MS/MT, PCU, CM, House Sup, Frontline mgr.

I am told by more experienced nurses then myself that it can take 1-2 years of fulltime work experience to be comfortable in the acute care setting as a New Nurse CM no matter your clinical nursing background. The burn-out and turnover rate for New Nurse CMs is high. In fact, I just finished my first year in an acute care setting as a Nurse CM. I started feeling comfortable only a few months ago despite having an MBA, an acute care clinical nursing background, and a social work CM background. On the other hand, a few other nurses that started with me (also new Nurse CMs) quit and returned to bedside nursing. Thus, do not mentally put yourself down; because you are in for a long year and the last thing you need to do is be your own worst enemy. Talk to the experienced nurse CMs in your department for guidance and motivation. Others have made very good nursing careers out of this specialty, we can too! Good luck!

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EllbellRN and MBarnBSN,

Thank you for replying. I really needed to hear from someone who has experienced what I am talking about. I don't have alot of confidence and I think that this does not help the situation. We also meet with the HAT doctors and that is quite intimidating, because I don't feel I can really give much input at this point. It seems like they really value the CM's and their knowledge, and I feel like a dumb rock in those meetings. Thanks again and keep the advice coming please.

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Specializes in Tele.

I know exactly what you mean about feeling dumb with the docs. I never had a problem calling docs when I was a nurse on the acute care floor, and I have a lot of personal experience dealing with docs 1:1. But for some reason last week, I felt tounge tied and completely lost all confidence! I honestly think the more you work, the more comfortable you will become. I'm only per diem, so I will have a difficult time coming up to speed, but I signed up to work every weekend once I'm off orientation, so I'm forcing myself to get right in there and learn the job! Good luck!

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Specializes in Med Surg, Tele, PH, CM.

I really feel that the hospital did you a disservice by hiring you with only one year of CM experience and no acute care. Not only have they set you up for burnout, but are playing with your self-confidence. Many hospitals will not hire CMs without lengthy clinical and CM experience. Stand your ground if you like this job. Talk to he head of CM, this is not fair. Don't worry about the docs, don't take it personally. Docs resent CMs because, in your role as a patient advocate, you often look like you are telling them how to treat their patients. I have experienced this over the years, and after many years as a CM, I rarely back down. The ability to manipulate docs will come with exerience. You have to learn how to make them feel as if the idea was theirs - I hate these games, but I have become good at it. One suggestion - spend as much time as you can reading patient records - reports, assessments, etc.

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I too thought it was unfair for the supervisor to hire me with no acute care experience. I really need to work and quitting is not an option, unless something else comes available. I am going to try to give it my best; however, I am not sure if it is the right place for me.

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Specializes in Med Surg, Tele, PH, CM.
, I am not sure if it is the right place for me.

Give it a chance, you are just a bit overwhelmed right now. Case management is going to be in big demand in the future. Spend a couple of years to get your feet wet and get some good experience, then perhaps find a non-hospital position that you may find a little less stressful. In the meantime, read, read, read... Admission summaries, discharge summaries, and consult reports will really help you get a feel for what's going on...

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This thread could not have come at a more opportune time. I have been given the opportunity to work as a case manager and stay local (CA) making the same salary as I did on the med surg floor or moving out of state for an OR RN residency making almost 45% less. The cost of living is less but not by that much. I have been debating whether or not I should take the CM position or OR - wondering what the future holds for either of them. I worry if I choose to go back into clinical nursing will being a CM for 2 yrs stifle those chances? What I do like is there are certifications for CM and programs in Health Advocacy. My patients will be members of the military. Reading these posts have really helped. I've been doing a lot of research about both positions and other RNs opinions of them. I spent 12 yrs filing government healthcare reports for hospitals throughout CA and my Letters of Recommendation commend my critical thinking skills, which I think will be helpful in CM.

Thanks again for posting your thoughts, advice and opinions. Truly appreciated.

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Specializes in ED, ICU, MS/MT, PCU, CM, House Sup, Frontline mgr.

RNJen2011, Case Management in Nursing is a specialty and a career choice. Nurse Case Management is very diverse and will not be going anywhere because we are attached to advocating for patients while saving and making money for our employers. There are no limits in this specialty that I have seen except for those without a clinical nursing background.

Specifically, I have read job postings that require a clinical nursing background and proof of such prior to employment. If you fear not being able to return (I don't since I do not want to be a bedside nurse ever again), I suggest that you take a bedside nursing position part-time and work as a CM either part-time or full-time. Many CM positions are way more flexible then bedside nursing positions. BTW, you are not alone.

Many new nurse CMs are afraid to make 100% commitment to becoming a Nurse CM full-time for fear of wishing to return to bedside nursing. Some will keep a bedside position (Per Diem or PT) and slowly but surely wean themselves away from bedside nursing as they work their new Nurse CM position. Others like myself will quit bedside all together and put 100% in learning and growing within this specialty. In any case, you have options no matter which route you choose. Good luck.

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