Crux1024

I am allowed to call my manager in the middle of the night when I cant figure things out. Everyone else on the team has also offered to be available for 3am calls. I hope I dont have to make too many. I am already trying to sift out priorities and on Friday I had literally 5 things to do at once. My preceptor stopped for one minute and she had me go over what was most important and we started to tick things off in order. You are right about the MDs and other RNs not knowing the job. I dont think I had a clear idea before I started. There are only 2 shelters in my county and both of them accept middle of the night referrals thankfully. But learning the resources is something that I am worried about. I want to be able to offer the patients the best and most appropriate resources like DME or HH as soon as I am aware of their need. Supposedly, DME can be delivered in the middle of the night but often the people delivering are sometimes not local to the area so it can take hours. But i appreciate the encouraging words and advice. Its obvious you and Grntea are filled with knowledge and I am grateful for the advice. It really does help. Thats ridiculous. I dont think (or at least hope) we will have that issue. Security and staff have a good relationship and they are called as needed. I have never heard that administration didn't want us calling security. I would also hope that those RNs who I have hung in the trenches with would not put me in that kind of position. But you never know. I have never heard of the MD or RN asking the patients if they minded a CM speaking to them but you bring up a very good point. I know that the CMs have had some issue with those who are frequent fliers or have chronic problems they don't attend to correctly. Its never gotten to shouting matches that I know of, but I know that some patients don't want to have particular conversations with us. Ill have to keep that in mind. Also, funny you should bring up Social Workers. About one year prior to now, SW and CM merged and everyone is now a considered a case manager. So SW is to do what the RN CMs do and the RN CMs are to do what the SWs do. That being said, the ER has one social worker who hangs tightly to her role (though she is now a CM) and does a very good SW job. She leaves at 4:30 every day though. So referrals to SW are not possible as I am now technically a SW too (makes learning the job slightly more interesting/difficult). Day shift ER has an RN CM and CM/SW on every day except weekends. CMs then continue the coverage through the evening and night. What are your thoughts on that? I read another thread of yours where you very strongly advocated for SW to be in league with CMs. What happens if this is not possible? Also, have you heard of this happening before? Merged job roles?

There is a report sheet that goes from CM to CM, fresh one in the AM. I had a very busy day on Friday and It was good for me to see how crazy it could get. I was assessing someone for HH and got 3 calls about consults and one for a physician to speak to me regarding OBS status rules. The focus on tasks. I think the understanding and anticipating will come with time. Thank you for the advice.

Hello all. Two weeks ago I jumped ship from bedside (in the ER) to ER Case Management. I have to say, its more overwhelming than I would have thought. The other CMs I am training with are so full of knowledge, I have no idea how I will ever equal up to them or what they know. I will be a night shift CM once I am off orientation, so helping with d/c planning as well as UR in my off time, setting up home health or outpatient services as needed, averting admissions when possible and sharing resources with those those who need it while in the ER. Any tips on staying organized or anything you can think of that would help a newbie out? I have no previous CM experience, but for the position I filled I was told they wanted someone with ER experience over CM experience just due to the ever changing environment that we have to work in. Cant deny Im a bit nervous about filling such big shoes on my own when Im off orientation.

I am grateful that generally when someone appears to doctor/ER shop and comes to the ER with results from another nearby hospital with the same or similar complaint, they get a lecture from the MD about staying at the same hospital for continuity of care. then case management gets to go in and lecture them as well. I don't think they like it much but it gets the point across.

Finally registered for classes. It looks like the NURS 500 class has one synchronous class time. Just sharing in case any one has to consider this in your schedule. Our schedule at work already goes out to mid October. :/ it luckily worked out for me. But there's plenty of time to try and switch of necessary.

Tibby, Care to share?

I will be on vacation in Florida while the Accepted Students day is going on, or i would have tried to make it. I also missed the online Orientation they had this past Tuesday b/c I had to work @ 1900 (It was scheduled from 1800 - 2000) Did anyone else "attend" the online program? The advisor said they will be posting a link next week for those who missed it to watch the video and gather info.

Irish, thanks for all your insight and advice. You have been extremely helpful. I hope classes are going well for you.

Curriculum - Division of Graduate Nursing Thats the Plan of Study for the program (click "Plan of Study") . Just keep in mind that to qualify for Financial Aid you have to have 4.5 credits a quarter. I emailed my assigned advisor and she recommends looking into the certificate programs and earning one concurrently with the FNP. Using the certificate classes to fill in the semesters where the normal plan is not enough to qualify for aid. Im excited to start. I know September will be here before we know it.

We do this, have been for about a year. The process for us is called Bypass Rapid Assessment Triage (BRAT). When there are at least 2 available beds, patients are met at the front by a triage nurse and registration person. They come up, state their complaint, get registered by the clerk. While that's happening, the nurse is looking for an appropriate bed according to their complaint and calling the nurse to let them know. There was some pushback when it first started, and with times of high census, we are unable to do it. Its mostly accepted now. Generally we are able to BRAT for several hours, tapering to normal triage in the afternoon and evening. Obviously, this will require communication with the charge nurse and floor nurses and everyone has to be on board. We room them as soon as we can in the system and I remember being told we have significantly reduced our door to doctor time.

Not at all. Your success in the ER depends entirely on the person you are. The rhythm of the ER is definitely different from floor nursing but it is doable. I came from a Cardiac/tele floor that mostly held M/S patients and I transitioned well. Ive been there almost 2.5 years now. Listen, look and ask questions. There will be patient populations and procedures that are entirely new to you and thats ok! Your success will be up to you. If you interview for a position ask about their orientation process: how long, if there are dedicated preceptors etc.

I was sad I missed the GWU deadline....I accepted and sent $ for an alternate program (the program is good, but GWU was my first choice). And now I hear they extended the deadline.. I just cant win. :/ Was the deadline extended for FNP as well?

Just cwondering if anyone else has a CNS that works with them in their ER. We have one starting in the ED soon, told by management her job role "is yet to be defined". This is new for the whole hospital, they have several CNS starting in different areas throughout. Just curious if anyone has experience with a CNS and what they do in your facility. Thanks.

Have you noticed the physiology exam that is suuposed to happen during our first semester according to the Plan of Study ( http://www.drexel.edu/~/media/Files/gradnursing/MSN/080913_PlanofStudy_MSN%20Family%20Nurse%20Practitioner%20AY%202013-2014.ashx ) . That makes me nervous. Like I should be studying right now! I think im ok with science classes starting a little later. Id like to be sure I can handle the workload of the masters classes before I get into the harder material.

Good idea on starting the thread. Myself and a coworker have been accepted to the fall FNP program. I'm about an hours train ride away from Philly which is one of the reasons I really hoped to get into the program. I'm currently an ER nurse and have almost 5 years experience as an RN. I spent 7 years as a Surgical Tech before I graduated with my ASN. I'm nervous but think I'm ready.

The acceptance letters state we have 45 days after the date of the letter to make a decision on whether we will join the class. Id assume you'd have a better picture of whether or not you'll be getting in, after the 45 days pass. This was 45 days from March 7th. Hopefully you can get some good news next month . Good Luck

I was also accepted for the 2014 Fall FNP program. Im looking forward to it though I am nervous. I applied before Christmas and a coworker applied in November. I wonder if the waitlist has to do with the time that they received your application.

I have some questions I'm just curious about, Looking for responses from people that are working in acute care settings. Does your hospital require cardiac telemetry nurses to have ACLS? If they dont, what's their reasoning? Has it always been that way? If they do require them to have it, do you agree with them having that training? Does your hospital have a specialty code response team? Do your MS Tele floors have ACLS nurses? Thanks for any input. A local facility is changing their policy so that Cardiac tele floors do not have to have ACLS certified nurses. The nurses are allowed to have ACLS, but the hospital will no longer be paying for the training unless they are in specific areas (IICU, ICU, ER, OR, TRAUMA serv.) I can't really understand why. Wondering what others view points are.

If your long term goal is to work in research why do you feel you need to go for NP now? You could always get a post masters certificate for NP should you decide that is what you want to do. Good Luck with your decisions.

Love.

Hi Tasha! I'm stalking your postings as I figure out what I want to be when I grow up and thinking about applying to FNP schools for a Fall 2014 start date. Your thought processes are very similar to mine and at this point I'm gathering info on schools. You're full of good info! GL and I hope you hear from Simmons soon!

So, have you all started classes at Maryville and what do you think of them? I'm looking at multiple schools and just trying to gather good information.

I do SANE through my ER and get paid to be on call with 1.5 times my hourly if I get called in. I've heard of ind. contractors but they're generally (in my experience) run by private organizations. The woman who did our SANE classes works in this way but she's in California and I in Pennsylvania. There's a center that's basically rape crisis center and they are called when a patient shows up to the hospital or police station. They have their own offices and exam rooms and don't need hospital space which I found interesting. She's also been doing this since the 80s.

Our hospital had some pamphlets printed about the heart center...only the EKG they used as part of the background print was running backwards, (as if you'd be reading a normal EKG from right to left) A minor flaw and you won't notice unless you can read EKGs, but damn, it still bothers me to this day.

Thanks for reading my novel post. I hadn't considered CNS. Im not sure I quite understand the role. Ill have to look into it a bit more.