Wren

I can't answer your question about WHY Medicare won't pay for home IV antibiotics but I can tell you one solution I use when possible. If a patient can get to an infusion center 3x a week, then they may be able to get their abx in an infusion pump for continuous infusion. Depends on the med and dosing schedule of course but we have an infectious disease doc who rounds in our hospital and he has an infusion suite in his office that does this for us. Medicare will apparently pay for the pt to get IV ABX in the provider's office up to 3x a week. This only works if your pt isn't home bound and has transportation to get to the office. They need to to have a PICC or something similar. Check with the infectious disease docs in your area.

Moondancer, Another RN Case Manager & I share a 36 bed floor, mainly oncology & ortho patients plus we are responsible for a women's health unit that has beds for up to 20 pts. The women's health unit rarely has any discharge planning though as most admits are young, relatively healthy pregnant women admitted for PIH or pre-term labor, stuff like that. Our main responsibilities there are doing new patient admit notes and continuing stay reviews. Typically we just divide our main floor and each take 18 patients but we help each other a lot. I never, ever tell a doctor or staff nurse that "that's not my patient". We both print out the census for the whole floor and we step in to assist each other as needed and neither of us leave for the day unless we are both done. The Case Management Department has a couple of social workers who do discharge planning for all of the unfunded patients. We don't do insurance reviews generally as we have an administrative assistant who takes calls and faxes clinical information as requested. She will occasionally (maybe once a week) ask me to take a call from an insurance case manager when it just isn't clear what is going on from the notes. I admit this seems very cushy to me as any other hospital case management job that I have had required we also do the insurance reviews. Finally, we do an initial admit note within 24 hours of admission and do concurrent reviews q3 days for pt's who are in in-pt status. If someone is in observation status we review them every 24 hours. Good luck with your new role!

LPN1997, This post is probably too late for your interview....sorry! Did it go well and are you still interested in the job?

Hi SanFran Nurse, I am a hospital case manager and probably 50% of my job entails discharge planning. The other 50% or so involves what I think of as regulatory compliance.....making sure that new admits meet criteria to be in inpt status and doing continuing stay reviews. The posters below have done a good job of outlining some of the real challenges of the job but I have to say that I still love my job a lot. I have done insurance case management and hospital case management and I far prefer hospital case management. One BIG advantage that we have at my hospital though is that we have social workers who manage all of the uninsured patients. So I am never scrounging for resources for someone who doesn't have insurance or is homeless. It is hard to set up IV ABX for a guy who lives under a bridge! I'd have second thoughts about this job if I had to do that. We still have patients who have poor insurance that while they theoretically have a home health benefit, in reality no home health company will take the business because the pay is crummy. Yes...some families and patients are difficult and present with their list of demands and entitlements but still at the end of they day I am very happy with my work. For every difficult patient I seem to have 10 that I genuinely help and are grateful. I am also blessed that I have a good relationship with the staff nurses, techs and charge nurses on my units and don't catch flack from them. I know how hard their jobs are and they appreciate the complexities of mine. So....my long winded advice to you if you decide to look closer at hospital case management is to ask a LOT of questions during your interview. Find out exactly what you will be responsible for. I am on call about once every 6 weeks and usually work about 8-5 and I rarely miss lunch!! My case load is sharing a 36 bed ortho & chemo floor and a 12-20 bed women's health floor with another case manager. Our floors turn over fast and I typically have 10-12 new admits a day and that many discharges....just to give you an idea. Good luck!

Have someone look over your resume or have it professionally revised to give yourself the best possible resume. Then I'd call the human resources department of the hospital and ask if they have a job fair coming up soon that you can attend. If not, you can ask if you can schedule an appointment with an RN Recruiter and you might get lucky and actually get an interview!! Probably not but it has worked for a few people that I know. Be sure and tell them that you have PICU experience. Once I put on my best suit and went to the personnel office of a hospital in a town I was thinking of moving to and they interviewed me right then! I later got a call offering to set up a second interview in the department I was interested in. I don't think I would have gotten past the receptionist if I had shown up in jeans and a t-shirt. Good luck!

Tiffy, I am sorry but I laughed out loud when I read your post! :chuckle Were we nervous...are you kidding??? I'd be worried about you if you WEREN'T nervous!! Yep...I think I can speak for the great majority of nurses in that many of us weren't just nervous but completely scared to death. It is natural to feel that way and honestly, you'll probably be on and off nervous for awhile...it takes some time to feel comfortable with all of the new skills you will be learning. You are correct too that the 2 yr programs or 4 yr programs don't really prepare you for this job. They teach you the vocabulary, the basic skills and how to THINK like a nurse but then you just have to wade into the deep water and learn the craft of nursing. Being a nurse is a wonderful thing and I personally wouldn't trade it for any other career but it takes time to learn it. Give yourself permission to be clumsy and slow and know that every single one of us was where you are now! You will be fine. Good luck!

Amber, Your interviewer KNOWS that you can't know much about Maternity...you are a new graduate!! They expect to train you so relax about getting too many clinical questions. What they WILL want to know is what kind of work ethic you have, will you "fit" with the team, can you ask for help when you need it, will you work hard, will you be a team player? You can best address those things by being calm, friendly, smiling...make it easy to interview you. Give examples of how you have been a valuable employee in the past even if it is not nursing. If you were the evening shift manager at McDonalds...mention it as an example of accepting responsibility. Never, ever (as in never) complain about an old boss, old co-workers! No one wants to hire a future unhappy or pot-stirring employee!! The interview is NOT the time to ask if you have to work Christmas or in any way complain about your potential schedule. Your interview is for selling yourself...you can hash out the details with the HR Department later when they call to make you an offer. That is the time to tell them that you have take off a week for your Aunt Trudy's wedding in August. :chuckle Tell the interviewer how excited you are to be starting your career and why this specialty is your chosen one (practice a few lines to summarize that). Let them know that you realize you have a lot to learn but you will be reading/studying on your own and look forward to learning on the job. It is fine to ask about their training/orientation program and it shows interest on your part. Impress your interviewer by sending a handwritten thank you note as soon as you leave...be sure to get his/her card so you can spell the name correctly! Good luck with your interviews and please let us know when you get a job...and you will!!

Des...it is too late for this interview but each interview that you have prepares you for the next. The interviewer might have been looking to see if you knew how to ask for help or knew how to work together. If you are working on a floor as an RN you will still be part of a team but you do much of your work independently. So one example could be how you identified a patient who had psycho-social needs and you brought in a social worker to consult on the patient or...you and a colleague teamed up during your time on a floor to safely move the patient in bed. If you asked your preceptor for more experience (learning to start IVs for instance) you could describe how you initiated that training, helped the IV nurse and gained valuable experience...etc. If you can't think of something from the clinical environment, you could offer how you organized a group of students to study together on the weekend in preparation for a test. Obviously you will have to pick things that you actually did but I bet if you think back over your preceptor time, you will be able to identify times where you initiated team work! Good luck on your next interview!

This is a REALLY interesting admissions question! I am not sure how I would answer it either but I'd probably dodge the "conservative" part of the statement and focus more my high standards. Nursing requires high standards because we can literally KILL the patient with some errors. It is a huge responsibility to be in a position to adversely affect (or positively affect) someone's life as part of your daily job duties. The conservative part is what throws me. Yes...nurses used to be all female and considered to be personal servants of the doctors (who were male). They certainly didn't question the doctor. We've come a long way from that (we aren't completely there yet of course) but most of the doctors that I work with treat me like valued colleague, not a handmaiden! Good luck with the question but again I think I'd focus on my personal value system and a recognition of how important nursing is to the safety and well being of the patient.

Good catch! You have to wonder how many people read the wrong weight without even thinking about it. :chuckle I've seen a fair number of errors myself but my most recent one was of a WOMAN whose prostrate problems were described thoroughly. :roll It was obviously a transcription error that got two patients confused but I got a giggle reading about it.

I think being terrified is realistic! :chuckle You don't yet whether this is the career for you and trust me, even seasoned nurses have occasional moments of heart stopping anxiety! But...I wouldn't change this career for the world. Your fear is probably of the unknown so take a few steps toward the goal and see if you like it. Do some volunteer work or get a job in a hospital or other health care environment to be around nurses. Go to your library and spend a few hours reading basic nursing journals ....you won't understand a lot of it but it will give you an idea of the kinds of things you will be doing in nursing. Good luck!

Great work!!! Enjoy your fellowship.

bwb22...I agree with llg...follow your heart but be prepared to detour if needed! I've worked in a number of clinical areas and I found that what I THOUGHT about a particular area was not always correct. I discovered too that I liked specialties that I never expected to like! :chuckle The good news about nursing is that you can work in a specialty area for awhile and transfer to a new area (and learn new skills) if it isn't the best fit for you...you are not necessarily making a forever commitment. Good luck!

ASHJ5153...I did an accelerated program for a BSN like you are describing and it was wonderful. I too had a non-nursing bachelors and didn't need to repeat a lot of the classes I took toward that degree. The Accelerated program lets you focus on the nursing components. I had the option of going on for my MSN after completing the BSN but I chose to go to work and haven't regretted it. You will have a VERY busy time during the program but it is so worth it!

I've known a couple of nurses who have done health coaching and it was totally telephonic at the company they worked at. (I am blanking on the name of the company) It might be different somewhere else. The company had contracts with big employers or other groups and the nurses followed up with specific health issues. So if you were a newly diagnosed diabetic, your insurance company might contract with the health coaching company...you as the nurse would do telephonic education and support. They used "scripts" that guided them through approved educational programs. It might be a good job if you have physical limitations and need to be more office bound. It might also be boring as all get out too though! :yawn:Only you know whether you'd enjoy that kind of thing..... good luck! Hope someone answers you who has actually done this type work.