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Joe NightingMale BSN, RN

Med surg, cardiac, case management
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Joe NightingMale has 4 years experience as a BSN, RN and specializes in Med surg, cardiac, case management.

Male nursing student

Joe NightingMale's Latest Activity

  1. Joe NightingMale

    Is managed Medicaid the worst of CM?

    Thanks everyone for responding. My opinion of this field has actually shifted quite a bit. Still a lot of chaos, a fair amount of stress, and lots of clerical work and complaints. But I've come to realize I seem to be quite good at this. I seem to have the talents for this position, in a way I did not with floor nursing. My co-workers and supervisors seem to agree. And I'm feeling more positive towards even the difficult days. Yes, it is more like social work or psych nursing than medical floor nursing. But I'm finding I'm starting to like the social service aspects. And I'm getting more interested in and more comfortable with the psych aspects. It will be interesting to see how I feel in a few months...
  2. Joe NightingMale

    Is managed Medicaid the worst of CM?

    I'm starting to wonder. I work for a major insurance company that manages a state Medicaid program. It's my first CM job, and I have to say, I hope the whole field isn't like this. Our members are hard to find, the majority of them have mental illness, oftentimes very serious. We only have telephonic contact, which is good as I've been shouted at and cursed and even had to call the police when an deranged member threatened to come to the office and kill me. And did I mention...I have no mental health experience? I'm all med-surg and cardiac ICU. Doctors seem to dislike us, finding specialists for our members is next to impossible, as is home health, and I can never seem to get accurate information about who our in-network providers are. Things are highly disorganized, with heavy turnover and frequent changes to policies and procedures and poor interdepartmental cooperation. I never seem to use my nursing skills, mostly what I'm doing is finding doctors for people and helping get medications and medical equipment. And also assisting with getting procedures authorized, that's big. Which is funny because here UM is completely separate from CM. So authorizations shouldn't even involve me. Really, a social worker assisted by a secretary could do my job. I'm not using my clinical skills at all or my teaching skills all that much. Is this just the company I work for, or is it just managed Medicaid, or is this kind of thing found everywhere and it's just the luck of the draw depending upon the position?
  3. Joe NightingMale

    Thinking about OR nursing

    I presently work in a tele/cardiac stepdown unit, having previously worked med-surg. I'm considering a different specialty, haven't really cared for med-surg or stepdown. I think I need something more specialized, more technical, and less people-oriented than what I have been doing. I've considered a variety of roles, and one of them is OR. But of course I'm a little hesitant. It'd be a fairly big step from floor nursing, lots of new stuff to learn. Some of the surgeries can be very long, such as transplants. And surgeons have a reputation for being unpleasant...on TV they're always yelling at the RN for a scapel or something. But it would involve more tech and less people contact--something that is better for me. I'd be more specialized, and I do better with positions that have a narrow focus. And I know a fellow nurse who really likes being an OR nurse. So I wonder what people here thought. OR isn't the only possibility, there are several other specializations I'm considering. But this is the one that would probably be the biggest change and the one that I'm most hesitant about.
  4. Joe NightingMale

    Where to look?

    I had asked this question before the upgrade, but then it disappeared. I know that contract research organizations are a good place to look. I've looked at some of the local teaching universities, but only found one or two positions. Granted I've only looked at three so far. Are there any other places that use research nurses? Thanks
  5. Joe NightingMale

    What job titles do research nurses have?

    I posted this earlier, but with the updates it disappeared. I've been looking a research nurse jobs, been using LinkedIn to identify possible positions. But I'm not sure what job titles in research apply to nurses. Also, I'm not entirely sure where to look. I know universities are a possibility, as well as hospitals and contract research organizations.
  6. Joe NightingMale

    Looking for part time/PRN work

    I was planning to keep working for my employer part time/PRN when I leave, just to make some extra money. I had figured that it would be like I do now: Pick up an extra shift once or twice a month. However, I heard that a former co-worker tried to do that same thing and found that they were expecting her to work all kinds of extra shifts and holidays. I'm going to try to reach her via Facebook to get the whole story. It's strange, because I know there is at least one nurse who drops in every month or two to work. Obviously I can't ask my manager about this without letting her know that I'm looking for another job... Which kind of throws a kink in my plans. I was hoping to have the PRN work to add to my full time work to provide a little more flexibility. So I was wondering if any of you out there know positions where one can work PRN with relatively few restrictions as to the number of days. I'm not looking for something like our hospital float pool, which requires 4 shifts per month including one weekend. I'm looking more for something that would be once or twice a month. I guess I've kind of got used to working the extra shift once every month or two at my present place. I'm not sure I'm going to have that option somewhere else.
  7. Joe NightingMale

    Those of you in inpatient/specialty practices...

    What is your training? I'm bouncing back and forth between FNP and ACNP. I'm pretty sure I don't want to do a high-volume primary care practice. I'd like fewer patients and I'd like to specialize. Specialize in what, I don't know. Cardio has been interesting to me, as well as emergency medicine, but for some reason dermatology has caught my eye as well... That could obviously be an ACNP, who primarily do inpatient stuff. Be a bit trickier education-wise...there are fewer ACNP programs than FNP programs...but I could manage it. However, I know that FNPs also work in specialty practices, and even in inpatient settings like the ER. And it'd be easier to obtain the degree. Or I could start in FNP and then switch to ACNP, if I desired. I guess I could even become a PA, although since I already have an MSN the NP role would probably be the more logical one... So I'm a little lost here. I was hoping that those of you who do inpatient or specialty practice could inform me as to how you got to where you are. Thanks!
  8. Joe NightingMale

    Which NPs don't deal with dozens of patient per day?

    And that's my other big concern about primary care: Some of the patients may have serious medical conditions that aren't obvious. I shudder to think of the liability, really would like to avoid being sued. And then there's the other side of the coin: Most conditions seen in primary care aren't that serious or that interesting. I don't want to spend my days handing out Z-packs for otitis media. The only positive to primary care is that I've heard that doctors are abandoning the field, which suggests to me that it'll be wide open for NPs and PAs. Real easy to get a job. But is it a job worth getting? Another question I have to consider...
  9. Joe NightingMale

    Which NPs don't deal with dozens of patient per day?

    So, procedure bring in more money than exams, and you have fewer patients in inpatient, whereas in outpatient you need either high acuity or high volume. That's good, I need to understand the business aspects of NPs. I actually have a pretty good head for figures and budgets. Though I find high acuity tiring as a bedside RN, I might not feel that way as an NP as I won't be providing bedside care. In fact, it might be more interesting. One concern I have about primary care NP is dealing with vast amounts of boring minor illnesses. Been thinking about this, I don't mind teaching but wouldn't want to have to do a ton of it, so I might skip endocrinology. I'll think about primary care...I know it'll be in demand, the docs don't want to do it anymore...but it would depend upon how much teaching I'd be doing.
  10. Joe NightingMale

    Which NPs don't deal with dozens of patient per day?

    Really don't care that much for kids, but as long as it was older kids I wouldn't mind. Don't want to do psych, that's for sure. Don't think OB is a good match either. Not really that big into the elderly, but not a major drawback either.
  11. Joe NightingMale

    How to evaluate NP programs

    An informal advisor of mine suggested that I investigate the reputations of various NP programs before considering any of them. Which is a good suggestion, except that I'm not sure where to look for that information. I know US News and World Report does ratings of schools, but I've heard that is a questionable source of information. Is there anywhere else I should look, or anyone else I should ask? Thanks.
  12. Joe NightingMale

    Which NPs don't deal with dozens of patient per day?

    That's a good point, I hadn't considered that specifically. Although I have wondered if it wouldn't be better to see more healthy patients. My med-surg floor is high acuity, with many nursing home patients, and it gets tiring.
  13. Joe NightingMale

    Which NPs don't deal with dozens of patient per day?

    I figured that acute care would probably see fewer patients than primary care. Not sure I want to spend so much time in hospitals, though. I do enough of that now. I know it also varies on what specialty/sub-specialty you're part of, and the individual practices.
  14. Joe NightingMale

    Which NPs don't deal with dozens of patient per day?

    Naw, not much money in teaching. And that can be exhausting too! Just imagine lecturing in front of a big class for 3 to 4 hours... I'm glad that there are practices where you aren't scheduling patients in 15 minute intervals. Don't think you can get much done that way
  15. Joe NightingMale

    Which NPs don't deal with dozens of patient per day?

    I've been advised to go on for my NP. I tend to agree that's a good decision, but I have a few hesitations. One is that I know that many NPs deal with loads of patients, sometimes 30 or more per day. Which doesn't strike me as much of an improvement over my present med-surg position. While I interact well with people (and have lots of patience with them), I tend to prefer to deal with ideas. The idea of walking into a clinic with dozen of people waiting seems fairly exhausting, especially if they need extensive teaching about their conditions. Trying to explain things to my half dozen med-surg patients is pretty time-consuming and at times frustrating; I can only imagine what it would be like to have to do that with 5 times as many people per day. I've been told that not all NPs deal with high patient loads, and I'm curious as to who those NPs are. I don't mind working hard or under difficult conditions...I do night shift at an inner-city charity hospital. But people can tire me out, and if I can limit the number I work with, or not work directly with the patients, that might be better.
  16. Joe NightingMale

    How does HH compare with floor nursing?

    For those of you that have had the chance to experience both.