B52HOLYTRINITY

UPDATE: I moved to a med-surg unit not terribly long after my last post (so maybe on Ortho for 1.5 months). We had a gal go to home infusion, and I was able to switch floors. I like med-surg way more (more variety than Ortho), and the unit had only 15 beds (so I took extra for the split every morning, depending on who was out, but it was maybe 25 beds instead of 40). Since then, our department has implemented a new model and gone through some process changes, and SW is taking more of an active role in discharge planning within their scope, hopefully making "the towers", as we call them (like Ortho), more manageable. Then COVID happened, and my unit expanded to about 24 beds, and that is plenty for me:) I'll be moving to Dallas, TX soon and will start at UTSW. I think their model is 2 CMRNs to 1SW on a 36 bed unit, so that sounds awesome.

Oh man, I thought I was busy in the ICU. I have a 40 bed Ortho floor where everyone needs something and is very case management heavy. I deal with discharging to skilled rehab/skilled nursing facilities, home health (nursing/PT/OT), home infusion, hospice, and ordering DME. Doctors will tell family members that we know if x,y,z is covered by their insurance and will be able to answer all of their questions, and we don't. We only deal with the insurance if it pertains to the aforementioned areas that I described. Family members don't like to hear that the information they are seeking can only be answered by their insurance company (1) because every insurance is different, and there are a lot of types out there, so it would be impossible for us to keep track of every one (2) We do not have the staff or the resources to be calling for all of the patients in this hospital that we are responsible for, and (3) Calling me 2 hours before your family member goes off to surgery to see if everything is going to be covered seems like something you should have figured out a while ago before an elective procedure, Karen. Long story short, doctors have a vague idea of what we do and say things that are inaccurate or make promises they can't keep to patients and their families, and they get mad at us. Also, people are idiots. Oh, and you get snide comments from the bedside crew when you can't drop everything and attend to something they think is important. If they aren't discharging today, it's not my priority. I'll get to it if I can. You have 6 beds, and I have 40. Generally, it's pretty routine, and you know what they need, but the volume is overwhelming for someone new. And the phone calls. I get so many phone calls. A 30 min lunch break where I am not working or taking calls happens very rarely. I am all about taking 30 mins for yourself, especially when I was bedside, but in this job, it can be discharge pending. If they are here past a certain length of time, the patient's insurance can stop paying for unnecessary inpatient days as soon as the patient is medically ready to discharge, so that means that the hospital potentially loses money if the patient cannot afford to those extra expenses. Hospital throughput is also important because you don't want to have to divert patients to other hospitals because you aren't using your resources effectively and discharging people in a timely manner. You also get to hear about it and explain what's going on in an extended stay meeting that happens weekly. Many things are outside your control, like a patient getting denied from ECF because they only have Medicaid-pending, or they're a sex offender/felon, and those are hard to place. Frequently, the patient is just not medically ready, or you're waiting on family to decide whether they can afford to send their loved one to ECF on hospice or do home hospice. (By the way, Medicare will pay for hospice, but not room and board at a facility, and they also won't pay for 24 hour caregivers at home. So it becomes a private pay situation to some extent, and a lot of people aren't prepared for that. The only program I know of that will pay for room and board at ECF on hospice is Medicaid, and many people don't qualify for that. I do like that this job isn't life and death, but to say that it is less stressful is not true. It's a different kind of stress, and it can be a lot. I have to admit that I miss working 3 days a week. Working your a s s off 5 days a week only to have 2 days off is a bummer, but I do like that I have set hours and a good routine. I've even started regularly working out and have lost almost 10lb. So there's good and bad. I know it will get better. Just rough being new, but we all know these things get better with time and experience, so I'm hangin' in there.

CVICU nurse here with background in ED as well. Just accepted a position in Inpatient Care Coordination. Start date is 1/19/20, so I'll come back here and let ya know how it goes. Excited for something new!