eevie3940

Hi GoNightingale! I did my case management job in a small hospital about 201 beds. I also used to work at United Healthcare for about 2 years before going into hospital case management. But, my typical hospital case management day began at 8 am. I usually covered the med-surg wing. I would review ALL the charts for inpatient criteria (there is a book Milliman that the hospital provided for reference). We then would send that information to the insurance company (if they had one). Depending on the census, that would take about 2.5 hours. We would have a meeting at 11 am to discuss why the patient was in the hospital to the ceo, cfo, nursing management, etc. After lunch was dc planning. Patients that had total knees would knee lovenox, walkers, bedside commode etc to go home with, or if they needed inpatient skilled care we would arrange that. Seems easy typing it, however we had a large indigent & medicaid population, and finding resources for these people was draining. There would be indigent people who would come in that had a stroke with no insurance needing inpatient rehab and you would have no place to send them, because of no insurance. I could tell you countless stories, but i won't bore you with that. Advice: Try doing your dc planning early in the week if you know they need home health services b/c by the weekend, the agencies are full and cannot take admissions. Also, detach yourself and try not to carry the day home with you like I did, I got burned out. As far as United Healthcare, I worked in a cubicle, on a phone, for 8 hours, with people yelling at me as to why this and that service isn't covered. I got some of the WORST cases. If you want the hairy details, just send me an email. I can understand that you want to shift gears. Nursing is very tiring, and emotionally exhausting at times, but there are silver lining moments. I have gotten many thank yous, flowers, etc, and I save those things to remind me that I am a good nurse. I genuinely care about people and their well-being, and I give 100% everyday. Good luck to you and if you have any questions feel free to ask!

At our hospital, full time we take about 24 hours of weekday call, and about 24 hours of weekend call. I don't like taking call, so if someone is willing to take it they can have it. Part time people usually take half of the full time people. Being called in depends on the surgeon. Some of them don't like to get up in the middle of the night for an appy, so they book it early at 5 am and have the call team come in before scheduled cases.

I came into OR nursing b/c I was burnt out on Case managment. I have experienced alot of different areas of nursing in my 16 years. I must say, transitioning from case management, (a position of autonomy), to OR nurse (nurse fetch-it) was highly difficult. My brain had to switch gears. It is alot of information to learn. Unfortunately, I wasn't a scrub tech before I came into the OR, and I think that makes you better prepared. I do like it, and I learn new things every day. I have been in the OR going on 3 years now, and its now just perfecting the things I know. We don't do trauma at our hospital and I work 3-11. We take call about 24 weekday and 24 weekend. I say, go for it, you may like it.

Hi! I am responding to your post b/c I did leave case management. I did the job for about 4 years, and I was emotionally drained. We did both UR and social service dc planning. It was very stressful, and I began to hate it, and by the end, I hated the job. I went into the OR and I like it there.

I've been in hospital case management for 3 years now, and previously, I worked at United Healthcare doing UR/DC planning for a year and a half. My day typically goes like this: We have a case manager that is an early bird, so she usually picks up from registration face sheets of all admits. We have folders for each wing, so she does the admit-discharge-and transfer paperwork. She places all new admits to corresponding folders, takes out discharges, and patients who've transferred to/from icu, places them in the appropriate folder. I take my folder and my list of patients on my side and review the chart for appropriateness, quality and continued stay criteria and enter the review in the computer for our admissions person to send it to the insurance carrier (if they have one). This usually takes me about 2 hours. My load is running about 25 since we have a case manager that is out. I then report to a 45 min. meeting to discuss clinical update as to why the patient is still in the hospital. This meeting is attended by the CFO, CNO, directors, accounting, coding, etc.... After the meeting, I start rounding for discharge planning, assessing patients 80>, chf, diabetic, copd, people who are from SNF's, ALF, receiving HH services, etc... We do not have a social worker. The case manager is the social worker. Some days are really bad, having to do the job of 2 people, but we have 201 beds in our hospital. :madface: I interview the patient/family for dc planning. Some families can be really aggressive and want things done their way, or they want their family member in the hospital when they don't meet criteria. I don't have a favorite part in the day- usually when its over I guess. The hardest part of the job is when you have a self pay patient that needs large amounts of care. Resources are very limited here in Florida, and usually you end up begging providers for home care visits, etc... The activity most often performed in the day will be chart review. We review the chart every day. We know more about the patient than the primary care nurses, b/c nurses typically do 12/hrs and we do 8, so we are there 5 days a week as opposed to 3. We provide continuity, whether I see the patient everyday, I do know what is happening in their case. I hope this helps. I am going to take my CCM in less than a week, and I'm nervous!

I am not Nurse, I am: 1. A ballerina dancer 2. A computer nerd 3. A buyer/seller for the limited/macy's/dillards etc.. 4. something in crafts?:wink2:

When I read this post, it mirrored me so much. I have been in nursing for 12 years and really haven't "enjoyed" the nursing profession. I did a student nurse preceptorship one Summer & worked in the newborn-nursery/ mother baby unit and absolutely loved it. I knew when I graduated from nursing school, that's what I wanted to do! Well 12 years and 6 jobs later, I still haven't moved to mother-baby b/c there is never any openings. I've done everything (Med-surg, tele, oncology/renal, stepdown- cardiac, icu, uhc insurance), & now I'm in case management. I must say that my nursing career has been full, and I have experienced a lot. Nursing is very stressful. When I was working nightshift I would go into work a total ball of nerves b/c I used to worry about making a mistake, or doing something wrong, or fear of being yelled at by the doctor. But I grew thick skin over time and read as much as possible to educate myself wherever I went. I know where you are & how you feel. I've read many of the posts here- have you tried changing shifts? I found night shift so much easier. Even though you are in an odd ball shift, the pace is much slower, and the working group is much closer ( I thought). If you are considering a career change, do it now while you're young. No offense to the older folks! Have you thought about insurance sales? Nurse liason for a skilled nursing facility? Home health coordinator? DME/Medical equipment sales. I saw that you work in OR, some companies like Ethicon, Johnson & Johnson need reps to teach doctors new equipment/or devices in OR. I was looking into rep for KCI- wound vac, or for IV/Tube feeding pump rep. I don't know where you are located but you could certainly look around. I still haven't found my way after 12 years, but I'm still trying to find it..... Good luck to you.

hello! i absolutely loved night shift. days are crazy. nights can be crazy too but with structure. you'll get your routine down. from start of shift until about 1 am you'll be busy. quiet time for about 2 1/2 to 3 hours then about 4:30, you'll start picking up again. some nights were tough to stay awake, thats when i got addicted to mt. dew and popcorn. of course, all my time on nights were in acute care, so the routine may be different, but you'll find your way. good luck and have fun!

I have worked with Filipino nurses that were under contract when I was employed at Vencor (now Kindred hospital) many moons ago. I personally welcome any help. As far as "cliquesh"-sp?- Yes it might happen, but take the opportunity to broaden your horizons and learn a different culture, and listen to what they have to say. I've also worked with Filipino nurses at a Catholic hospital in Missouri- and from what I hear, the Filipino nursing school curricula is strikingly similar to US nursing programs, & therefore agencies use Filipino nurses to fill positions. I love food, and so I have found a good ice breaker is asking what their favorite dish is to prepare. I have worked with people from many walks of life and many cultures, so seeing new faces keeps it lively and interesting! Hope this helps.

But what kind of position are you in now? Is this a lateral move as in staff nurse in med-surg to staff nurse in OR? Or is it more like a case manager type position to staff nurse? I'm moving from case mgmt to OR.

Hello all! I have been a nurse for 12 years, and I have a background that includes med surg- little of icu, stepdown, insurance reiviewer, & dc planner. I am now looking into going into the OR at the same facility, but they want to start my pat at 24% above a new grad. Is that insane or what?? My paycut would be $2.06/hr but is negotiable (w/ approval from CNO). I'm really bummed because Ive always have been interested in OR nursing. I really can't take a $2.06 paycut, and I'm ready to move on from current position. Any advice?