Nurse Case Management

[bestm]

I work in a hospital on a med surg floor, we recently changed our model from discharge planning/ UR( I worked discharge planning for 8 years and UR for 4 years) to Nurse Case Management with social workers. We are now without a director and have a Interim director who is a nurse with 5 years experience in nursing, three as a discharge planner, so no one in our dept has a working knowledge of the new model. I have 25-28 patients on my unit. I do all Interqual and insurance reviews, Nursing home returns, DME, Home healthcare, dialysis and all difficult placements, financial included. I am expected to open everyone and speak with them within 24 hours, then chart on them every three days. The Observations we follow daily. We do the Interqual on the unit we are on, which is very challenging as there are so many interruptions. We have a social worker who covers two to three units and they stay in the office to do the New Nursing Home Placements, so there is not a lot of "teamwork" with them. Their main responsibility is New Nursing home placements only, they will get involved if a pt is homeless and will refer to shelters in town, but the nurse case manager will assess and speak to the patient before Social Work is involved, so the Social workers do placement to shelters only, at times they do not talk to patient as they do not have time.

We do have a clerical person who also does Observation charges, ULTCs for social workers and will fax for us if there is time, they are based in the office with the social workers, and they need to be paged each time you have something to fax. Is this the norm in other places? I am salaried for a 40 hour week and usually spend 10-12 hour days and take call on the weekend with no compensation. I love my job, but this is not good for my family life, so just need to know if this gets better after time or is this the norm. Any ideas, thoughts or suggestion that could make this work better?

[SummerGarden, BSN, MSN, RN]

Sadly, I worked in one hospital that follows the same model and had big caseloads too (20-40 patients per Nurse CM inpatient). Nurse case managers and social workers were completely dissatisfied with the job and the turnover rate for that hospital is high! Another hospital allows nurse case managers to work on the clinical aspects of discharge planning and UR, while the social workers are available to counsel patients, assess for safety issues and family dynamics, and work on custodial placement that are short and long-term in nature.

The work for hospital number 1 has not gotten better and I do not think it ever will. On the other hand, hospital 2 is more rewarding because the nurse CMs have time to get stuff done and only work as a nurse with a reasonable caseload inpatient (less than 20 patients per Nurse CM). Thus, it is no surprise that hospital number 2 has a low turnover rate! My advice to you is to start looking for another job, especially if you have at least 6 months to 1 year of work experience in your current position. Good luck.