nursechris1

So it has been a year since I posted on this thread. I can genuinely say case management is the worst job I have had in my nursing career. It is probably one of the least appreciated jobs. I don't feel good about what I do. I am the mean one who has to walk in the patient room and tell them they no longer meet criteria to stay, that they don't meet inpatient criteria or the 3 night stay needed to go to rehab. Sorry, you will have to private pay for rehab. We are the ones who go in after the doctor admits them to the hospital for placement and has to tell them that's not how it works under Medicare. Or the when doctor tells them they will get a 3 night stay for ankle surgery. We are the nurses who struggle to find placement for the underinsured homeless alcoholic and get the heat when the patient is still in the hospital a week later. We get to tell patients or their families that they are no longer safe to return home. We have to tell families of dying patients, I am sorry your loved one can't die here, we have to transfer him somewhere else (unless they might die on route). Now the hospital system is cutting staff. People are quitting. At least 10 people have quit our department in the 17 months that I have been there. Several of those positions have not been replaced. Staff call in sick frequently. I really thought it would be a job that would be low stress, boy was I wrong!!

Regarding the IV comments, as a diploma trained RN, we had a great deal of experience starting IV's in nursing school.

Catherine, our expected caseload during the week is 1:25. On the weekends, it's closer to 1:40. The thought is that there is less to do on the weekends, HAHA. The only thing we don't do on the weekends is fax clinicals to insurance companies. We have people in our department called Case Manager Associates, but it appears they are phasing them out. The do a lot of the discharge work, making the referrals to facilities, agencies, etc. The nurses do the initial face to face on every new patient along with doing UR , ULTCs PASRRs and when we have time, review the chart to make sure the patient meets criteria to stay. Some days the job is good, other days it's hell. I work on Neuro, and we frequently have patients who are difficult to place. Otherwise, we deal with the same things the floor nurses do: working with difficult families, difficult doctors. For me, I don't feel like I make a difference. I used to be a hospice nurse, and I really felt I was doing something to make a difference. I did that for about 10 years. It was an emotionally taxing job though.

This is frustrating for me also. I have a Bachelor's in Psych, RN diploma, and a Master's in Health Administration. I have been a nurse for 20 years. I don't feel that another year of school and $15,000 of debt is going to make me a better nurse. (The hospital will only pay $3000 of that.) Part of the problem is the hospitals that are Magnet. There are no exceptions for the BSN. I have already had the classes or classes very similar to those in the BSN program. I am 48 years old. I don't want to go back to school.

I was a correctional nurse for a year and a half. I really enjoyed it. I left because I was the only RN working there, on call 24/7, and I was working all the time. I worked 8 hour days, and if I didn't have an EMT or CNA to pass meds in the evening, then I had to go in.( I was salaried so I didn't get one extra penny). I worked for a contract company, and they just didn't seem to care. I liked the fact that I didn't have to take crap from patients. I could be blunt with them. I didn't have to worry about patient satisfaction surveys. I wasn't mean to the inmates, but I didn't give in to every little thing they wanted. I did have a problem with some inmates, especially the females, who were very manipulative and persistent. I worked with a great jail captain who was very supportive. This was a county jail, so the inmates were usually there less than a year. I don't think I could work in a prison where the inmates are in for longer sentences. If I could have worked my hours and gone home, no call, no extra hours, I would probably still be there. I loved the deputies, they treated me like family.

Where I work, the nurse case managers don't do any patient teaching. We do initial assessments to find out what the patient's support systems are, what their baseline was at home for ADLs. We coordinate with the therapists and the physicians to determine what the person's discharge needs are. We don't always have a SW working with us, so we also set up discharge referrals. We fax clinicals to insurance companies. We are supposed to be looking at the pt status, inpatient or observation, make sure they are in the right status. We are supposed to review the chart to make sure they meet inpatient criteria upon admission and ongoing. I have found most of our day is spent doing initial assessments and discharges. Some patients are easy, you walk in, they need home health, you find out who they want to use, then you set it up. Other situations are complex. We had one patient that needed to be placed. She had behavioural issues. We called 44 facilities, nobody would take her. She was with us for 3 months. Finally discharged her to the homeless shelter.

I work in a county jail. I love the job. It is very challenging. My biggest stressors are the fact that I am the only nurse working there and I am on call 24/7. I have EMTs and CNAs working for me but if I am short staffed I have to cover their shifts. The other difficult part is that I HATE being manipulated. Where I work the deputies are great. We are like family. They appreciate me and take care of me. The jail captain demands respect from the inmates. Disrespectful behavior results in loss of privileges and possible lock down. The jail is small, 70-80 inmates. Most are not sentenced yet and most are with us less than one year. You definitely have to have med-surg experience before going into a job like this. We have a PA who does clinic 1/2 day a week and is on call for questions. Otherwise it's up to me to assess and determine if there is a real medical issue or if they are faking.

Thanksgiving has always been my favorite holiday. I grew up close to extended family. Spending time with my cousins was always so much fun. Also, I love to eat. :) I don't care for Christmas so much. It's the pressure of finding the perfect present. I was married for 15 years, and I can't think of a present that I gave him that he really liked. It was always something. Wrong color, wrong brand, etc. My mom and I exchange presents and it gets more difficulty every year trying to find something for her. I actually start getting depressed this time of the year, which lasts until the day after Christmas.

We have a 37 yo inmate who had a cardiac event (after running from police) 2 days prior to entering our facility. Troponin levels elevated. Tox screen negative. Heart cath negative. He has been with us 5 weeks and we have sent him out twice with c/o chest and left arm pain. He returned both times within hours with the ER doc stating nothing was wrong with him. I noticed on his mar that the day before his last episode was his last dose of tranxene. I realized I hadn't had a complaint in days from him while on the tranxene. His bp is always low, so I don't take much stock in that. The other night he said he had a severe headache, he was having dry heaves. Chest pain. We gave him tylenol, something for nausea, and put on oxygen. I had him see mental health earlier that day and was instructed on deep breathing. We practiced that with him. He recovered quickly. So hard to know the right thing to do. Like others have said, I can't keep sending him to the ER.

Are the inmates charged for each sick call? That seems to be a deterrent. Not that we want them to avoid seeing us if they aren't sick. But they are not going to turn in a kite every time they have a hangnail. Also they have to turn in the kites before I get there in the morning. If not it goes to the pm shift. Unless of course it is an emergency.

What is it about this country and the work expectations. we are expected to put work before our personal life. That just isn't healthy. it's as if my boss says: 'she was able to get that assignment done in 8 hours, lets give her more work tomorrow and tell her she can't have overtime". I am so worried that I am going to accidentally harm a patient. I used to like to give my patients extra TLC, foot rubs, back rubs, just spend time talking to them, etc. I have such terrible compassion fatigue right now, it's all I can do to go in and do my job. Plus, we are always worried that we are going to be fired for whatever reason they decide.

I can't believe the patient safety issues that are created in health care. I work in an outpatient infusion center. Our administration has decided that we can reduce to 1 nurse and a med tech in the infusion area. we have been slow, but it varies from 4-8 patients/day lately. Point is, that it is unsafe to have only one nurse working. When I need someone to double check chemo or blood, I am going to have to call the nurse from the clinic side to help me. If she is doing a new patient assessment, I could have to wait a long time. I was really mad the other day and had a melt down. I hope I don't get fired. I got to work and didn't think we were starting this 1 nurse thing yet. I found out I was working alone, I had 5 chemo infusions and a blood transfusion before noon. They ended up calling in our only pool nurse, thankfully she was available. I would like to find another job, but I live in an area where there is one hospital here and one in the next county. I have worked home health/hospice and oncology for a large portion of my 18 year career, so it's been a long time since working acute care. I love where I live, and I would be very sad if I had to leave the area.

I work in a cancer center, and am a certified oncology nurse. We have done this procedure several times in the last year. You should go through a chemo/biotherapy course so that you know how to handle the chemo, how to handle spills, etc.

I too have weekends where I just sleep the weekend away. No motivation to do anything. Right now, I force myself to go to the gym right after work (I work 8 hour shifts). I don't go home first, I keep my bag in the car and go directly to the gym. I work with 2 other nurses, all 3 of us are on antidepressants. Our pharmacist started on antidepressants before she quit. Most nurses I have known were taking antidepressants. You should rule out physical causes first, but like others have said, you don't necessarily have to feel sad, the other symptoms you have are signs of depression

I have little compassion these days. Partially because of the type of work I have done over the last 12 or so years. I was a hospice nurse for most of that time and now an oncology nurse. The type of work is emotionally stressful by itself. Then add a hospital system that is really messed up. Every now and then, they will just up and fire people and cut hours. The last round they let 22 people go. If we aren't busy, we have to take turns leaving early or taking the whole day off. There are only 3 nurses, so we each taking time off frequently. While that sounds appealing, it's stressful when it comes to paying the bills. I am not sure what I would do for a career if it wasn't in nursing. I live in a resort community. Our hospital is the only one in the county. The next county has a hospital, but the drive in the winter could be a little dicey. I can't afford to take a pay cut, and there aren't many jobs where I would make enough money to continue to live here. Anyone have thoughts of what they would do for a career if not in nursing.?