NurseRoRo

*Deeb Breaths* Make sure you have something in your down time that you enjoy so you can take care of yourself. Even if you don't think things are getting to you on a recognizable level, they're obviously festering inside if you find yourself bursting into tears. That being said, I am the worst person to give advice about this. I am a people pleaser, and I like working in stressful environment and kicking a** at it. But when I am stressed or more likely....super peeved at something, it all comes out as a giant episode of sobbing. I've sadly sobbed at work from sheer frustration and exhaustion. It's embarrassing and I am sure I looked like a total nut. My coworkers were toxic and the entire situation turned out better once I left that job. However, it made me realize what I wasn't doing as far as caring for myself. I think in the work we do, it's sometimes hard not to have stuff pull at your heartstrings or for you to get fired up about something that someone may not feel the same way about it, etc. I enjoyed volunteering at the humane society on my days off. However, I ended up bringing a dog home the first week.

Good to hear you're having a good experience! I am currently awating the outcome of my transcript evaluation, with anticipated start date of January 2018. I'm hoping this will go quickly for me, too!

I have worked in the OR but not the other two, so I would still say, OR. I know for my personality and learning style, I don't think I can handle the amount of adrenaline, focus, and multi-tasking in the ER or ICU. I loved working in the OR because yes, there was multi-tasking and limited time to turnover rooms, but there was also time to take a breath and watch surgery. I loved watching how surgeons worked, like artists, almost.

That sounds like a sticky situation that honestly, if I were the RN that you reference, I would not take on that sort of liability to jeopardize my license. As loyal as I am to my employer, I know that if there were ever a lawsuit, my employer's best interest is not me. They would say I should know my scope of practice and yet I allowed a non-licensed person assume duties of a RN. If you are permitted to call doctors, do assessments, pass meds, how do you sign off on all those documents? If you get a telephone order, do you sign the order F.Lastname,RN? If so you are practicing illegally. If there were questions or suspicions during a board of health survey, it would be very easy for them to look at employee records to verify who is licensed, etc. If the facility is allowing this to happen and they take federal funds (Medicare, Medicaid), they are commiting a federal offense which is absolutely illegal.

I have never been sent home from clinical, but I have been made to burst into tears during a clinical day. TWICE. We had a tough professor who also happened to be the onsite clinical instructor at the hospital where I did clinicals. I was chosen to review my careplan with her before I walked into the patient's room. Of course I missed a nursing diagnosis b/c I spent all night doing dosage calculations for titrating heparin drips. The patient pushed the call light and we went inside, flipped on the lights, and her face was covered in blood. Turns out she had a nosebleed from non-humidified O2. The instructor pulled me aside and pretty much said, "THIS is why I ask about your careplan....you do not want a patient covered in blood who is on a heparin drip." 17 yrs later, I know she would not have bled to death from dry nasal passages....but that was so crushing at the time. A few weeks later, I got yelled at by the nurse of my patient in progressive cardiac care because he was quizzing me about various drips the patient had going. Apparently I answered the question wrong because he said loudly in front of the patient and family, "I am not going to risk my license for you to potentially overdose and kill my patient."

I am in the process of applying to WGU for RN-BSN program. The info I read and the enrollment counselor I spoke with both stated the requirement of having an active RN license and working a minimum of 20 hrs in a job as a RN. I am planning to use my employer's school reimbursement benefit, too, which requires a minimum of 6 months of employment with them, a minimum of 20 hrs per week active work, as well as having no write-ups before or during the time I'm asking to be reimbursed.

I'm not sure if I'm horrified or impressed that she apparently thought this was a logical thing to do. Yikes.

@ TheMoonisMyLantern, ADN, RNre: bologna sandwich No. Please no, I didn't read this correctly!?? I used to work in a women's hospital in the operating room.....I took those 2 minute lady partsl preps very seriously sometimes....even when masked, there are some scents that seep into your nostrils.

In life, I am an introvert. In nursing, I am considered an exrovert. Coworkers don't believe that I could "possibly" be an introvert because I'm so bubbly and talkative. But man, it's extremely exhausting day after day. I spend my days talking to patients, educating them and collaborating with teammates, etc. I love what I do. I feel like I throw everything out there to get the job done, to be the patient advocate, etc. On my days off, I am a total sloth. It is my time to rest, reset, and gear up for another week.

I worked for Anthem un the past as a telephonuc case manager. i had a caseload of approx 65 members. They were a mix of short term and long term complex members either recently discharged or about to discharge from inpatient. My job was 100% from home. I attended rounds for the states in which I had members, presented those that are extra challenging or at the repquest of the medical director. I work 8a to 5p Mon thru Fri. My coworker communication is thru instant meaaaging and phone calls. Must know lots of community resources and be able to build rapport with members.

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).

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?

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.

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....

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.

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!

@joanski, I'm still a newbie at my job but so far it's going well. My job required a minimum of 3 years of home care experience as a nurse case manager and experience with chronic disease management (CHF, COPD, cancers, etc). Honestly I was surprised to find that I had those qualifications...and for a job in the insurance industry, no less. I didn't have any preauthorization or utilization management experience, but am learning to do those tasks. At this time I am still working in the office, working 8a-5p, and on occasion, 9a-6p when I am scheduled to work late since some of our states are in a different time zone. I get an hour for lunch, which is nice, since I'm not used to having time devoted to lunch! Working from home can start as early as 8 months after being hired, or as late as 1-1.5 years. It depends on a lot of factors (whether or not there's been a flood of others going home, if I get good scores on audits or can keep up with the pace of the caseloads, etc). Until I get to start working from home, I feel like I'm at school, all over again! Though I have an hour for lunch and can run out to run errands or meet someone for lunch, or get a hair cut. But considering I live an hour away from the office, I have to factor in what's nearby, travel time, parking logistics. Like in nursing school, it's just easier to stay on campus and grab a sandwich! LOL Keep your eyes peeled on sites like CareerBuilder. There are always jobs posted for insurance companies and since managed care is needed more now than ever, you might find something that you can do with your ER background. As far as your experience, you never know...if your app and resume catches a recruiter's attention, you can always explain your experiences and assets for the job at hand. Good luck!!

Thanks for the info! I accepted the job offer from Wellpoint and will be doing telephonic case management for members in 3 states. I am nervous about this because it is a different kind of nursing but excited because after 10 years, I finally get holidays and weekends off!

Evening, all nurses! My background in nursing is eclectic. I have spent the last 4 years in home care case management. I initially applied with Wellpoint six months ago for a Telephone Case Management position but didn't get past the resume/application process. Evidently they kept me on file because I got a phone call today. I have an interview with the Precertification dept manager at Wellpoint next week in Indianapolis. I'm excited because of this is an area of nursing that I want to learn about and excel at. I also would like the M-F schedule. I'm also very nervous because I don't have any UR experience. This job will involve doing pre-cert paperwork, chart reviews, etc. Anyone have any experience in this? I'm just nervous because I don't know anyone who has done this kind of nursing. I also don't know what to expect from this industry. Any insight is appreciated! Thanks!!

I recently interviewed for an office job a a nurse for a Rehab/Neurodevelopment doc in a Peds clinic. I have previous Peds rehab experience but it's been a little while. This would be my first job in an ambulatory setting. Just wondering if anyone has any insight into specialty clinics.

Don't tell your children that if they cry/act out that the nurse is going to give them a shot. It only makes them freak out more.

I am an emotional overeater. I know I am and I know I have a problem. I just don't know what to do about it. It's pretty sad that I sit here and read this thread and I'm getting "hungry" just reading everyone's comments. For me, it's the sweet/salty, crunchy/soft foods. All the comfort and control foods. I have thought about and keep looking at OA and FAA sites, but can't seem to push myself to go. Of course my husband tells me he loves me no matter what, and it's not a big deal to him. Of course not, it's happening to me! BLARGHHH! Thanks for being there, guys. I'm glad I'm not alone.

Ditto about FMLA. It is meant to protect your job and they cannot drop you when you are on medical leave. FMLA was granted to me the day I inquired to HR about it and then they sent me paperwork for my Docs to fill out and I had three weeks to send it back to HR. It's a lifesaver. Good luck. We're all here for you.

I'm not sure how our agency calculates the exact usage of cell phones but they supply us with cell phones. Most staff actually use this for their personal use as well. We were using Verizon but switched to Sprint because the coverage is better in the rural areas we go into. I think they dole out the same amt of minutes per person and if we go over it (I've worked there for 2 years and never got charged), we pay 35 cents per minute we're over.

our agency matches the government mileage amount. i drive a company car, so i don't get mileage. like another nurse on here, the company pays for the gas/maintenance/insurance on the company car. i am hourly, but i did take a pay cut for leaving the hospital. i average 4 to 5 patients per 10 hour day. i also drive around 100 miles a day. my visits are on average an hour or an hour and a half. i do a lot of counseling and end of life teaching.