clhankin67

I left hospital nursing out of frustration of being pulled from the bedside with all of the bright ideas everyone came up with. Additional forms, more frequent computer charting, with computers only at the desk available, nothing near the patient rooms. Add to that the new medication dispensing system (6 nurses getting meds for 6 patients each, all due at 0900), a system that will only allow you to pull your meds in a 30 minute window of time to be given to prevent med errors, otherwise it will not allow you to dispense without an override by pharmacy. But wait, there were still errors, so they added to that a little hand scanner with additional documentation that you had to use to scan the patient, scan the mar, and scan the med before dispensing each med after you stood in line to get the med out of the machine..... but had to get everything done within the 30 minute window or you had a med error to address. Updated skin forms q shift, med rec q shift, updated report and med rec done every time the patient left the floor for testing or procedures and repeat upon the patients return. Review the Care Plan at the beginning of the shift, and at the end of the shift as something may have changed. Q 2 hour pain assesments, q 1 hour repositioning, hourly nurses note entries. Add to that report to the charge nurse at the beginning of shift, report to the nurse manager when she arrived, discuss with the nurse manager her findings after she did quality rounds with each patient (Ms. Jones in 12 is upset she hasn't had her icewater refreshed in 2 hours) Admits, discharges, transfers in and out and all of the paper work associated with. Wound care, foley care, NG care, trach care, assist Docs with rounds, review reports, call Docs..... and remember, no overtime allowed! How can you effectively teach patients about their illnesses, treatments, tests and meds? How can you assist with AM care so that you get a complete look at their skin. How do you fit in the time to hold their hands and LISTEN to your patients? Administration needs to comprehend what their nurses do, experience several shifts, prior to adding, adding, adding while taking away staff..........

I am a manager for a Managed Care Company. Per the Medicare Benefit Policy Manual, Chaper 6, Section 20.6, Outpatient Observation Services Effective 07/01/09 : "Observation care is a well-defined set of specific, clinically appropriate services, which include ongoing short term treatment, assessment, and reassessment before a decision can be made regarding whether patients will require further treatment as hospital inpatients or if they are able to be discharged from the hospital. Observation services are commonly ordered for patients who present to the emergency department and who then require a significant period of treatment or monitoring in order to make a decision concerning their admission or discharge." "When a physician orders that a patient receive observation care, the patient's status is that of an outpatient." A Medicare FFS member will be required to pay outpatient co-pays, and will need to pay for those meds that do not need to be administered by skilled nursing (such as PO meds). This can be very confusing as the member does not understand that they are not "admitted" to the hospital and can be cost prohibitive for those on a fixed income. This may also apply to Commercial insurance, Medicare Advantage and HMO plan rules. I see certain hospital's that will keep a patient in OBS status for DAYS in fear of being audited by RAC for incorrectly flipping to In. I have other facilities that want 100% of cases flipped to In, and have seen IQ stretched to meet either criteria. We forget that IQ and Milliman's is considered a guideline by CMS, but they do not recognize either as the "law". At the end of the day, we are professionals and need to utilize effective assesment of the individual in the bed, their testing results, and our clinical judgement to assure that the member is in the correct level of care.

You are truly in a difficult situation. I agree that Standards of Care should be universal, and I find this LVN's appalling. I was an LPN for many years before becoming an RN. I took every CE opp that presented itself, knew all of the Unit and Facility Policy and Procedures by heart. I was the Unit Preceptor for the Med/Surg/Tele unit I worked on and precepted both RN's and LPN's. New grads require experience in caring for a full assignment of patients including assesment, med admin, reviewing tests, calling physicians, assisting physicians at bedside, and receiving/giving report on this assignment. A little different from school where most students are not given this experience. Once they were proficient in these skills, they would then transition to their own assignment. Once they were proficient in their skills and multi-tasking, they would then add the skills that were RN specific such as Blood Product Infusion and signing off assesments with another RN. Experienced nurses would typically only be with me for a few shifts to learn the process at our unit, location of items, etc. The nurses that could not look past my license, were quickly educated by the Nurse Manager that Quality and Competent Nursing is not based on amount of time spent in a classroom. Everyone that you meet, Unit Secretary, Monitor Tech, CNA, LPN, RN, MD, etc all have something to teach us. Use common sense to weed out the information or practice which is substandard. If you feel that the Nurse you are precepting with is risking patient care, perhaps go to the Charge Nurse with your concerns prior to going to the Nurse Manager. I wish you many happy and successful years of nursing!

Sorry to hear that. Having been blind sided myself in the past I can understand how you are feeling. I agree with the filing of unemployment and clarifying your severence pay and benefits. I also recommend networking, post your resume on Monster, Career Builder, and put out feelers on LinkedIn. I would also look at Insurance Company's individual career links, your city/county/state career links, and the local colleges/university's. As a NP, you have a multitude of directions you can go. Try to look at this as an opportunity, or just a speed bump in your career instead of a dead end or a road block. Best of luck, and keep us posted on your success!

I am a manager for a Medicare HMO. I have 20 Nurses that are direct reports and they perform daily onsite reviews at hospitals and Skilled Nursing Facilities. They gather clinical and psychosocial information on the member's, and then give a brief telephonic report daily to a medical director. They have all been trained to give the basics of what brought the member in, symptoms, treatment and discharge plan. They all do well, except for one. Although "Suzy" is very competent and knowledgeable, her reports are painful. She will go on and on about the most inconsequential discussion she had with the member's daughter about her poodle, but fails to mention that the member is on a vent, with 3 drips, NG tube, and + MI. You want to bang your head against a hard object when listening. She has only been with us 5 months, but has been an RN for 15 years, and has extensive UR and CM experience. I have had her precept with a seasoned Field Case Manager, I have worked with her one on one. I have had her listen to everyone else give report. I have had her highlight the most pertinent part of her review so that she can focus on what to deliver, all to no avail. She does amazing documentation, and can tell you everything clinically, etc regarding her member, but cannot regurgitate it during report. I can't blame the medical director as he is extremely kind and gentle during his interactions with all of the Nurses, and will even try to redirect her during her stories by saying "OK, now in reference to the respiratory status" to which yesterday he got a response of "well I guess he was breathing OK, but you know he doesn't speak english like I said, and the wife does, but she wasn't there, so I had to find an interpreter, but if the wife had been there it would have been easier... for 5 minutes" Our reports are recorded, so I listened to the playback. All of our staff work at home through out a large geographical area, and this nurse is located 2 hours from me. I try to make regular visits to work with all of my direct reports, but typically manage only once a month working 1 on 1 with them after they have completed their 6 week training. I am at a loss and am open to any suggestions that anyone has to help redirect and focus "Suzy".

I am a Manager at a Medicare Advantage plan and we have transitioned all of our Field Nursing Staff from UR Nurses to Case Managers as we wanted them to view the members Holistically and not just view them as IQ, MR, or CMS criteria.

I want to applaud the "stare" technique. I have used it myself for most of my career. It is useful not only with obnoxious fellow nurses, but with rude physicians, patient family members, etc. Now I don't recommend the Jack Nicholson from The Shining "stare" but rather the I am waiting patiently for you to finish being rude so that I may continue "stare". You may want to add a comment at the end of your "stare" such as "if you are done, I will continue" but be sure to know your audience well. Good luck, and I apologize in advance for the rude and obnoxious nurses and physicians you will encounter during your nursing career. The interactions with their kind will be tempered by all of the kind, compassionate and eager to teach colleagues you will meet.

As a Regional Inpatient Manager who is currently reading dozens of resumes at the moment I confess that I tend to skim for key words and phrases. Bullet points make the resume too long. I want to look at one page, brief synopsis of each position, and write it to reflect the position you are applying for. You would want to highlight different points for a work at home position vs hospital based discharge planning etc. Also, place you education at the end, make your qualifications and summary shorter, no arrows. Lastly, remove any data not pertinant to the job you are applying for (CPR, IV cert, etc) and add Interqual, M&R, coding, etc. Good Luck!

I started fresh out of nursing school in a Tele/Med/Surg unit and know it was the best thing for me. I was able to get the basics, as well as Cardiac and Pulmonary. You sometimes have patients that are acutely ill, but there are no unit beds available, you have to prioritize a complex mix of patients and the labs, etc that go with that mix. Otherwise, I would recommend the wonderful world of the ER for a truly well rounded soup to nuts learning experience. Either way, Stick it out for 6 months to a year and then transfer to the unit and enjoy! As for moving, life happens. Start work locally as a GN and get as much experience as you can before relocating. Best of Luck.

Coding is very important if you are wanting to transition into UR, billing, and certain other positions. I would recommend a classroom coding class if you are unfamiliar with coding. Good luck.

I was an LPN for 16 years. I had 3 general Ed courses and 5 nursing courses. It took about 2 years including clinicals and boards, but I really had to focus.

I graduated this past year. It allowed me to be promoted to a management position within only a few months. I would recommend this program if you are disciplined, focused, and a self learner. I found many useful links here, and by googling on the Internet. Do not fall for the publishing companies that offer the teaching guides!! Use the practice exams thru Excelsior and purchase their DVD teaching the clinicals. Good luck!

I became a Case Manager in a smaller hospital while an LPN. I also went on to work at 3 seperate insurance companies as an LPN. I applied for positions that required an RN Licensure, but allowed my experience to speak for itself. I am now an RN and have been promoted to Regional Inpatient Manager with 16 direct reports for a Medicare HMO. There are many different CM certification classes out there, you will just need to clarify what specifically is the position requiring. Be proactive, talk to your facility Case Managers and ask them how they got started. Inquire if you can shadow them on your day off so that you can learn more about the job. It is easier to get into a weekend or part time position at a hospital than full time. Good luck!

How sad, the staff at York were awesome!

I have been a hospital case manager, and am now a Field case manager for an insurance company. I enjoy both sides. The challenge as a Hospital Case Manager is to understand the various insurance, medicare, and medicaid rules/regs. Also, being caught at times between Admin/Physician/Providers. Some Insurance company reps are rude and obnoxious, like the CM that yelled that the entire state budget defecit was my fault because I would not force the physician to make an ICU patient a DNR so "nature could take it's course." As a field Case Manager, my least favorite part of the job is the anger and hostility that some hospital case Manager's have towards all providers. Remember that the Field Case Manager does not approve or deny cases! That decision is per guidelines of the Company Medical Directors. All Field Case Managers are not evil, please judge each of us on our own merits.