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Med Surg, Case Management, OR
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NurseRoRo has 16 years experience and specializes in Med Surg, Case Management, OR.

Conspiracy Theorist at Heart

NurseRoRo's Latest Activity

  1. NurseRoRo

    No creativity in nursing? Hah!

    I once used a home care patient's Thera-Band from physical therapy as a tourniquet for a blood draw. It was the super flexible one (yellow, I think). A band-aid can be used to secure the extra strength of a foley g-tube (instead of medical tape if there is a sensitivity and it's also cheaper).
  2. I have been a nurse for ten years. I loved nursing school and all the clinical areas that I was exposed to. I have a broad background in nursing, ranging from inpatient to home care, OR to the insurance industry. I've cared for NICU babies, 100 year old patients actively dying, and every dynamic and age group in between. I helped develop a palliative care program and have educated coworkers on palliative/hospice practices. I currently work in the insurance industry, doing case management. It's challenging only because it's all about making quotas and metrics. The salary for this job is the most I have ever made, I never work weekends or holidays. And the health benefits are awesome. I pride myself on the fact that I got this job on my own merit, and did not know anyone in the industry or any "connections" on the inside. I struggled with people saying I'm "not really a nurse" since I'm doing telephonic case management and not out in the trenches. (I recently talked myself out of grad school to advance my education because if I'm going to stay in the insurance industry, it doesn't do me any good to pursue an advanced clinical degree). A previous supervisor/mentor of mine recently reached out to me about a job opportunity for a team lead position at a local branch of a home care agency. I'm not too sure what all the exact details are (on-call, holiday requirements), but I know the salary is competitive and they have a thorough training program. The commute is way better, too with this position. I'd be getting back into clinical issues/teaching. (Let's also remember that I still have to apply/interview for this position, but I'm being very optimistic...) My siblings and I are all nurses. There was a time where my "job-hopping" was a joke. I know that all my jobs have lead me to where I am today...I have no regrets about any of my jobs or leaving them when I did. However, this one opportunity is causing friction with me and my husband. He is of the school of thought that all the "job-hopping" is not a good thing and that I am running away from any commitment and that I should just stay where I'm at because it's good pay, a good company that will not go away anytime soon, and it's not hard work. He knows I've wanted to do clinical management/education, but says at this point in my career I should just be happy with what I have. Is job-hopping really bad in the nursing field?
  3. I should explain that prior to my current job of telephonic case management, I was doing field work and doing case management visits. I left that job after the home care program I helped develop was taking a different direction by upper management. I was gearing up for a position in management with the program and then they eliminated the position. Though I enjoy the $$ and life/work balance with my current job, I do not have the opportunity to do the teaching, leadership and staff development that I did in my previous job. I don't want to be a job-hopper. So I feel like I've settled...b/c I can do a non-challenging job and get paid realllly well by a huge company, or I can enter the world of clinical management and feel uncomfortable entering a world I have always thought I'd be (though with quite a learning curve), probably making less money but with likelihood that it is what I want to do in my heart. I hate that money is such a factor...and hubby isn't happy that I'm "giving up" on my current job.
  4. I have a broad range of nursing experience, and have found my job as a home care nurse the most fulfilling as well as draining job ever. I left the field work after a lot of drastic changes in the agency. I stayed in case management, and am working for an insurance company doing telephonic case management. I have an opportunity to interview for a position with Gentiva, for Manager of Clinical Practice. It is a team-lead sort of position. I have held several jobs in many areas in my 10 years as a nurse and I think every job has helped me with the jobs that came after it. I got a good endorsement from a previous supervisor (who now works at Gentiva). I would like to see if anyone has worked with Gentiva on a management level, and share their experience? I can tell you in my current case management job, I am staying because I am getting paid the most I've made. But on some level, I feel like I've settled....
  5. NurseRoRo

    What's the difference betw case manager and UR?

    In the company that I work for, a Case Manager may be expected to do some UM things, but UM nurses are not expected to do CM duties. UM nurses do not interact directly with the patients/families, rather they deal with hospital Utilization Review nurses and doctor's offices. They deal with authorization/review of days the patient stays in the hospital, as well some prior authorization of services to those inpatients. Case management nurses in my company also do discharge planning for people in the hospital. We can do auths for home health services, DME, etc. And when they get home we do a case management assessment and enroll them to case management, which means assisting with coordination of care, doing med/disease education, linking them to community services that may assist them, etc. This requires a license in whatever state you get assigned to. Some companies require nurses to have a license in every state.
  6. NurseRoRo

    Telephonic Case Management

    All big name insurance companies have Case Management nurses. It does help to have a broad spectrum of experience, and also home care, as you can better understand what patients may be going back home to and anticipate their needs better. I really enjoy building relationships with the patients I care for, and am starting to find telephonic case management not as fufilling. It's not to say I'm bored, I am busy all day. But sometimes I feel like a salesman, calling people who have just returned home from the hospital to get them into case management. It's also all about a numbers game. Insurance companies require quotas, or a goal of however many cases are opened to case management each month. Your livelihood depends on this. Sometimes you get caught up in quantity vs. quality. I'm a huge patient advocate, but sometimes I feel that I'm pushing myself onto these patients so I can meet my quota. But I left home care because I was burned out on the feeling of being constantly behind in charting, doing work outside of work!! So I'm in a little dilemma myself!
  7. NurseRoRo

    What do you eat while on the road?

    Thanks for the tips peeps! I'm gonna try some of these tips...especially the sun tea while in the car!! I'm in the habit of freezing part of my tea in my Rubbermaid 100ml bottle the night before and then filling it up the rest of the way in the morning. I'm tired of carrying meal bars and carrots. I finally started feeding the bag of baby carrots to my dog! I'm also currently hooked on PBJ sandwiches.
  8. NurseRoRo

    10 Tips for Home Health Nursing

    Great Post! I've spent almost 10 years in the medical field and have survived my first year in HH. I think it's one of the industry's best kept secrets! I feel that all my jobs in the hospital (Peds, Inpt Rehab, OR) have given me skills that I can bring to my patients in the home.
  9. I made the switch to HH after spending almost 10 years in the hospital. I started out in General Peds and then went to a free standing inpatient Peds Rehab facility. I then went to the Operating Room and stayed there for about 3.5 years. I found that I work well in a team but not as a supervisor of a team. In the OR the team has to be work in synch and I had to poke or prod those that were not working up to speed with the rest of what was going on. As a case manager, I work in a team but am independent in my field. I work with other disciplines and maintain great communication with them but for the most part I am responsible for my part of the care and I facilitate more than supervise. I love the independence. I love the lack of noise pollution so I can think in the car between visits. Long gone are the days of simultaneous phone ringing, people standing around talking while you're running around like a crazy person without them asking if they could do anything to help you, the call light going off, the unit rep telling you that family is on the other phone, and a resident following you around to ask you a question about how to arrange for discharge. I have crazy busy days, but I create my own chaos. I like to call it controlled chaos. A typical day for me is: 5 patients, or maybe 3 or 4 regular visits and an admission. My patient load consists of PICC line/CADD pump patients, COPD/CHF patients, cancer patients still seeking last ditch effort treatment before deciding on hospice. I tell my patients I am great at playing Devil's advocate, I ask difficult questions to see where they are emotionally with their disease process and poor prognosis. Sometimes I chart in the home. Sometimes I save it all up for home. I am never on the computer for more than 2 hours at home. And I start my day as late or early as I want to depending on what I have going on. One of my patients works and gets home at 5pm. Those days I start later...
  10. NurseRoRo

    How do you get paid for mileage?

    Greetings, I am still in orientation with my agency and don't know the "norm" of this industry yet. How do you start your day and get paid for mileage? If I leave my house and go to my first visit (even if it's 40 miles away), I do not get mileage for that; mileage starts from my first patient's house to the second patient's house. However, if I stop off at the office for supplies, turn in something, etc, then I would get mileage from the office to my first patient. At the end of the day, I would not get mileage from my last patient back to my house. Just curious because my average mileage will be 80 miles a day. And the average distance from my house to the towns I am assigned is 40 miles...and at 48 cents per mile...it adds up in what I don't get paid. Thanks guys!
  11. NurseRoRo

    Surgeons "go ahead" problem ?

    I came from a facility that would page the doc right before we went to see the patient in holding to see where they were, and if they need to see the patient, etc. Then I went to another OR where every doctor sees their patient before the circulator takes the patient anywhere. However, we do have a few docs who like to A: see the patient in the OR and ask them if there are questions (this usually happens when they're on the table, being preoxygenated with a mask over their face...I'd freak if I were the patient!). And then there's scenario B: One of our docs insists that his cut time be exact, so he insists that all his first patients of the day be in the room, asleep, prepped and draped before he makes his grand appearance. Granted, he may have seen them the day before, or early in the AM, but either way, you'll never see me in his office! If he doesn't see the pt that day, how does he know who's under the drape? And like everyone else has said, what if he gets into an accident right outside the hospital and the patient is asleep and ready just to be awakened to a cancelled case? And yes, he is usually late, so his exact cut time isn't exact, and he complains about turnover time...TO YOUR FACE AS YOU ARE TRYING TO CLEAN AS FAST AS YOU CAN. Then he goes wherever he goes and by the time the next patient is on the table and ready, you have to page him...he shows up 10 minutes later.
  12. NurseRoRo

    Just venting

    I have been there! Fortunately, I now work in a smaller OR setting with less drama kings and queens. I've said it before, the OR is like high school lunch or study hall!! When I work with doctors for the first time, I always say, "I'm NurseRoRo, I don't think I've ever worked with you before" or "I've not seen this procedure done before because I'm still new to the OR" That usually gets the surgeon's attention and they have always looked me in the eye to say something or introduce themselves. I assume it's because they want the case to go well, and if I've never done one, they either A: want to know who it is so they can blame you later, or B: they want their case to go smoothly, so they'll be nice from the start. Either way, I always admit, "I've never seen/done this case with you" so they know that if they yell at me, hey, I've not done this before!!

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