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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.

A couple of the discharge planners at my hospital (including me) realize that we are interpreting some of the IQ criteria differently. Would someone give me their take on this? For example, using the CNS/MS subset, (pg 86 in the 2008 book), for the Severity of Illness under imaging findings....Fracture/Dislocation of cervical/thoracic spine. Do you interpret this criteria to be related ONLY to the dislocation or fracture of the cervical or thoracic spine OR as someone said today....ANY fracture? The argument was made that because the Fracture is capitalized and it is followed by another capitalized word that they stand alone. This is a new job for me and most of my previous IQ work has been computerized so I've been dependent on the "green light" :chuckle to tell me if a patient met criteria. Anyone want to enlighten me!! Thanks!! :loveya:

Csunkis, Welcome! I see from your profile that you are in high school and it is wonderful that you are considering nursing as a career goal. :balloons: The good news is that you don't really have to decide anything right now. In fact, I'd encourage you NOT to decide what area of nursing that you want to specialize in because it is hard to make those decisions until you have a chance to try them out. You can find some nurses who absolutely love and some nurses who absolutely hate every nursing specialty. I remember HATING my ob/gyn rotation....couldn't get out of there fast enough, but guess where my RN daughter practices??? Yep...OB/GYN and she loves it! I've spent a big chunk of time in hospice and she can't image that. So try to go in with a open mind and see what moves you. Good luck!

Faith08, My experience couldn't be more different than that described by the commuter. I am an RN and have been for many years and can't think of a career that I'd rather have. I came to nursing with another degree and a whole different career path and I have never regretted changing to nursing for a moment. Can doctors, families or co-workers be jerks? Of course, but you can run into jerks in any work environment... business, in law, in retail....where ever you go. Fortunately, they are in the minority and I certainly wouldn't let that discourage me. Overwhelmingly I have found my colleagues (doctors, nurses, CNAs, etc) to be good people to work with and we are united in the goal of taking care of the patients. Nursing gives you the opportunity to work in many, many different types of settings so if you find one that doesn't suit you then there is sure to be another that will. It is natural to be scared but you have the science background and you will feel better once you get started. You can certainly do this if you want! Good luck!

I totally ditto what the other posters said! I've been an RN for a long time and I look up diseases, new meds, new treatments, etc. all the time. Thank goodness for the internet! (It wasn't around when I went to nursing school......) Nursing and medicine in general is a dynamic changing field and you will never stop learning! :)

Great idea to start reading now! You might consider subscribing to a basic nursing journal like Nursing 2007 or American Journal of Nursing. The student rates are VERY affordable and it will introduce you to the issues of nursing plus give you a head start on reading your clinical material! Good luck....

MaggieMay....sorry for the delay. I've been on vacation and refuse to TOUCH a computer while I am off work! :typing I don't think having only an associates degree will keep you from many research jobs. The hardest thing is to get your first job but after that you have the ever valued EXPERIENCE and it will get progressively easier. If you decide on research nursing you might start by joining the Association of Clinical Research Professionals (ACRP) or Society of Clinical Research Associates (SoCra) and then go to the local meetings. Check before joining to make sure that they actually have meetings in your area if networking is your primary goal. It is still probably worth it to join because you will learn a lot and as a member you will be able to see who else in your area is in the association and perhaps contact that person so see if they have openings. Persistence is the key but I suspect you can find something if research appeals to you. Good luck!

I second the comments of Daytonite...great post! :) In my nursing school class we also "practiced" on each other although not foleys and NG tubes! Many years later working as a nursing supervisor I've even had nurses start an IV on me for training. I quit doing that though after enough painful jabs :smackingf! There is a long history of nursing and medical students using each other for guinea pigs to learn techniques so you are in good company. :) Good luck with your training!

RN2B2010 I totally agree with the advice that Aspiring Nurse offers. If you can't get in the front door...use the back! Consider getting your LPN/LVN degree....usually less than a year and way less competitive. Once you are licensed and employed as an LPN then many, many employers will pay YOU to get your RN degree and assist you. I am partial to nursing and think it is unequaled as dynamic field to work in but here ARE other health care fields that you might find rewarding and can get into more easily. I've worked with many a nurse who started out as a sonographer, radiology technologist, respiratory therapist, etc but I've never worked with a nurse who was changing to any of those career paths! It probably happens though. Still....there are many good jobs in healthcare that might meet your needs if the path to nursing is too long. Good luck!

Julesradio, I always encourage people to go ahead and get yourself in a healthcare environment as soon as you can because you learn so much that way. Not only will you learn a lot and that will help you during your nursing school days but you will be a better nurse later because you've been in the trenches. You also have the opportunity to work in hospitals or other facilities and you will make contacts (networking baby!). You have to evaluate your personal situation and determine how much of a financial hit you will take and can tolerate. Its the real world out there and you have to pay your bills but I think it is an excellent plan if you can swing it. Good luck!

RN Pursuit...there is no "right" answer and I'd never encourage anyone to take a pay cut....but, there is definitely value in working in a health care environment. You will learn things and have a better foundation than some other students. You won't be doing the same work as a nurse of course but it helps to work with them to see what you like (and don't like) about nursing. It DOES take a long time to get that degree but it is so worth it. :) Good luck with whatever you choose.