adlockwood

50 pounds in 90 days is unrealistic and a set up for failure. I joined Medical Weight Loss Clinic and work out with Jillian Michaels DVDs 4-5 days a week and have lost 36 pounds in almost 7 months. That is a healthy average of 5 pounds a month of consistent weight loss with 14 more to go. I have gone from size 16 to a size 10-12. It is about 1350 calories a day with higher protein and unprocessed foods. Rapid loss causes a rebound effect that is very demoralizing. Workouts made all the difference and it must be forever. By the way, I am 57, was pre-diabetic and overweight for 20 years. If you wear off the fat, and exercise, the insulin resistance problem goes away.

Hear hear! It is about time someone talked about boundaries. You have a right to a break. As a professional, you do what needs to be done but stop whining about it. If you are unhappy in your current role, MOVE ON! Your co-workers will appreciate it, believe me. A bad attitude is contagious I have been a nurse for 34 years, and held at least a dozen roles that taught me something in every one. I work very hard, but I feel honored to be where I am now.

The liability insurance is the same as your malpractice insurance - it is cheaper for case managers because you are not hands on. Get it thru Nurse Service Organization

Which is exactly why it is impossible to send someone to rehab who needs 6 weeks of Mycofungin at $15,000 - so they sit in a hospital bored to death and killing our LOS, and risking hospital acquired pneumonia. Let's face it - acute care hospitals are not rehab, it seems there are no alternatives for a medicare patient.

I don't mind sending my resume to anyone who is interested - unless you plan on ripping it:) Annette By the way, Tampa - I don't think you have much to worry about with that background - it is similar to mine. I was out of CM for 15 years, and my UM from BCBS was back in 1985, and they still liked it. Some things don't really change much.

I followed up on this today, and it turns out our onc case managers do this frequently and unless the chemo drug is a carve out and billed by rehab in spite of the patient already having it, it's not fraud. Besides, it's not us comitting fraud, it would be the rehab. So, my initial instincts were correct when I questioned the premise that it was fraud in the first place.

I appreciate your answers - there is always new twists and situations to learn in the world of medicine, insurance and money!

You should write a letter to your manager and let them know of your change of position and end date. You can mail it if you don't want to make a special trip in. Email is not really a classy way to quit.

For the sake of further discussion, I assume the facility doesn't want the patient NOT because he needs the medication, but because they don't want to have the cost in their case mix. My assumption is that SARs have a set reimbursement based on diagnosis, and they avoid the costly patients. Of course the fact the patient has cancer would not be hidden, but if Medicare is billed for an outpatient med, doesn't this save the SAR from bearing it? This is not my case, and as an inpt planner, this is a serious issue if a patient needs rehab but we can't place them unless the Dr stops his medication. We often have pt's on chemo incidental to the reason for admission. I am reasonably new to inpt case management and finding ways to get folks on to the next level of care is full of barriers. Chemo shouldn't be one of them (it may just be palliative chemo) and sometimes they can't go straight home.

It is an oral med, not IV, and it is still prescribed by a Dr. So, I would like to know exactly WHY it is fraud.

I posted on the case management forum, but thought maybe someone here would know. If you know a sub acute rehab will not take a patient on an expensive chemo drug, is it fraud to have the patient fill the script on the way to rehab through a pharmacy, and treat it like a home med? Some of our inpt case managers think it is, but I can't see how it would be, and may be the only alternative if the patient needs placement and is being turned down due to expensive meds.

I have worked in all of it - from floor nursing to Blue Cross, to Insurance CM, to home care, and now inpatient CM. I agree with those that vote for home care, or if you could get in to a medical home primary care provider office, that would be great. Inpatient CM is the most exhausting and unsatisfactory form of nursing in my opinion. I needed the job, but I really have to say being free and on the road was much better = whether that is home care or for outside CM.

If you send your email address to me, I will forward you a copy of my resume. Forget about my educational background, because that is not a key issue - but do look at the way I describe my experience. I did work on key words when I wrote this for my last job, which I identified by doing some research in to the job descriptions of the jobs I wanted. Make sure you mention allnurses in your subject line in your email Annette Lockwood [email protected]

One of our staff wants to know if it is considered fraud to send a patient to a facility with a script for an expensive chemo drug to fill himself through Medicare and bring it to the facility as a home med, knowing that the sub acute rehab would not accept him if they had to pay for the med themselves as part of a capitated payment?

I was out of nursing completely for over 8 years, and here is how I got back in: I started working for a home care company that was not certified and needed an RN for supervising the aides and setting up medications for the elderly in their homes. Through that, I found an additional job working part time at a day center in mental health, because several of the home care clients were also in the community mental health program. I needed full time, so I got a job as a hospital based case manager, but after 6 months, I am high tailing it back to mental health now that they have a full time opening combining my old job with part time at the mental health clinic. Hospital work is nuts, plus our facility is starting to add weekend and holiday rotations too for the case managers. One thing about being out of it for a while - I don't want to go back to working 7 days a week! And why for the love of Pete would you need a case manager on Christmas Day???? I don't even care about the money - I need a life

I agree with most of the posts here, however I think it would be good to tell your supervisor you have suddenly experienced anxiety/panic attacks in the past 2 weeks, and that this has never happened to you before. Let her know this was the cause of the absences, and that you have an appointment with a Dr find out why. Panic attacks are just as real a condition as an asthma attack, and need a combination of medication and work with a licensed counselor to over come them. As long as you clearly state you are working to handle the problem, and that this is a recent development, I would think they would be willing to work with you for a bit. Saying that stressful conditions causes them is too easy - many people are under stress but don't have panic attacks. There are ways to handle them, strategies to stop them, but there is no one answer why they suddenly start. Treat it like a health problem, because that is what it is. I work with a nurse who is very open about suffering with depression, and she uses it as a learning opportunity for others.

I am sure they will still have a "40 hour" week, but still - that schedule is not a "normal" life. So, if you had an opportunity to work a county job that is truly M-F, no weekends and no holidays, maybe less money - would you do it? I just feel like a quitter, after working so hard to get that job. It just seems to me to be unfair to expect folks to work weekends and holidays without any kind of shift differential. Or is that the norm in hospitals' management staff?

It's legal, it is the same as floor nurses work - rotating thru weekends, only this is for salary. We have already been reminded twice by email our company policy for exempt staff is regular pay for weekends and holidays. We should be hourly with that type of schedule, but of course they would like to change all the case management dept to salary, including resource, float and utilization management folks. It is a sneaky way to get rid of overtime pay. Many companies want to do it. My ex told me if you are expected to report at a set time, and work a set shift, you are considered non-exempt. Management staff usually have more flexibility, but it also means they may work 12 hour days if needed. And that is the policy - "if you are needed for weekend coverage, you work it at regular pay" All the supervisors have that policy too. Don't forget legal only counts for unions and federal employees, not private industry "at will" employees. I am really rethinking this job - too stressful and fast paced for too little money to tolerate 7 day a week scheduling. At 51, I feel I have earned a more predictable job at a higher salary, now I feel I am getting thrown right back to the days when I was in my 20's and 30's and I was trying to advance my career. Why get 30 years experience and a masters degree when you can be scheduled with this life at only $59,000 a year?????? No wonder nurses leave the profession. I just jumped back in to it, and I made $55,000 back in 1991 with a company car. I feel terrible I have only been there 90 days and already I am regretting it. It is not the job - half of it is real case management. the rest is bull. They try to have case managers wear too many hats and they are effective at none of it.

I am thinking the best way to do that is to become a certified diabetic educator. I am leaning that way myself, or I was until I found out my old job in mental health is available full time. I like to specialize in something, and inpt cm doesn't allow the time to specialize or teach, even though they say you can. 25% of adults in this country are diabetic, and with the focus on prevention - diabetic teaching and self management is essential

I have done both. I worked for insurance as a case manager for worker's comp and no fault auto - those cases are long termers, meaning they are the medically complex and usually have psych components related to long term disability. It can be hard to move those folks forward and make choices, none of which are as good as they thought they had it before they got hurt. You get to know them well, but it is slow going. Often there is vocational rehabilitation and retraining planning. Inpatient is completely different. You get a case load every day, usually with 15-20 patients or more, about 30% can be new every day give or take. Every day you field pages, work on discharge planning, handle social work issues, and in my case, include insurance reviews for which you don't really have time to deal with. Much more stress, more variety, faster paced. Sometimes you feel you are drive by case managers, because you don't have time to teach or listen much. I am supposed to see every patient within 24 hours of admission, but in reality I maybe see 5 out of 18 or 20. Some days you see only 1 or 2. Some days you can see 8 if you have no insurance reviews and no one needs anything. I would be much happier if I didn't have to deal with the insurance stuff - that is a job in itself and has no place in the case manager job, in my opinion. It all depends on which pace is right for you. I like seeing patients and family, and helping with discharge planning tranfers; I don't like feeling like if you spend more than 15 minutes with a patient, you will get behind or get paged. Insurance work means complications like chronic pain, disability lawyers, entitlement attitudes, and rare successful return to productive work, but it does allow a closer working relationship with patient and families.

I started this new inpt job, and I knew they were working toward adding more weekend coverage. Now that I have been there 3 months, they added a holiday rotation, and plan on moving to a 7 day schedule in the fall. Exempt employees mean no weekend differential, and no holiday pay. Is this the norm? I am seriously thinking about leaving already as I can see burnout in my future with 20 patient caseloads, 7 days rotations, and the mandate of seeing patients within 24 hours of admission = which is impossible.

I am a float, so that means I cover for both nurses and social workers on our CM team. Here's a question - what exactly is an inpt case manager supposed to do when you get a call from a family member telling you your patient, who is an adult and lives alone, has plumbing problems and shouldn't live alone right now? Keep in mind this family member lives in another state, and her suggestion is we put him in rehab so he isn't living alone. Seems to me that would be fine in some cases, but for an oncology patient on chemo, I don't think a rehab referral is appropriate. What is our responsibility here? Does it sound callous to suggest family members need to step up and do something themselves about this? Or is SAR an appropriate place to send someone who is tired secondary to chemo?

I must say that external case managers are more involved in "real" case management. Inpatient CM is not very satisfying in that you spend 2 hours just figuring out who is on your patient lists and where they are in the process, plus the nurses do their own reviews. It is usually almost noon before I hit the floor to see patients, and out of a case load of 16-20 daily, I see 5 max. A lot of discharge tasks. And most leave at 4:30, because on salary, you don't get paid to put in 10 hour days (although some days it can't be helped) If I had my way, the utilization review would be handled by the dedicated UM staff = after all, they are nurses too. In our hospital, the social workers have their reviews done by the UM staff. I guess the theory is, nurses know their patients - but in reality if you check the charts to look at the criteria for UM, it is a waste of effort and time to go back to your computer and do the review, then see the patients (back up on the floors) By the time you meet the patient, and do the computer work both in the EMR and our Allscripts web based referral/review program, you may spent 45-60 minutes on a patient. That means you see 4-6! And we are reminded we have rules that state you must do your initial assessment in 24-48 hours of admission. When you get 6 new patients a day to your roster, that is impossible. Like trying to pay off a credit card while still using it. There are some days 1 or 2 take all day. And don't forget the constant pages. Way too much time sitting in front of a computer - thank goodness I didn't take the telephonic CM job :) On the good side, the day flys by. On the less than satisfactory side, there is no time to teach, which I like doing. My latest thought is to try working on being a certified diabetic educator, so I can at least work with one group of patients and teach. Our staff gets alerted on EVERY diabetic, and yet all we have time to do it hand them the phone number to the DSME classes. The drawback to insurance CM is some of those folks are so entrenched with their disability, you can't move them forward and spend months trying. There are pitfalls to all of these jobs. I felt lucky just to be working days, but the weekend rotations are on the horizon, and they just put us on holiday rotation too, without the hourly bonuses that floor nurses get for working holidays because we are on salary. I guess I stepped in to this job at a point of major management changes, and they are going back to the way things were 20 years ago when schedules were dictated, not self coordinated. I am just trying to avoid the negativity, do the job, and watch for the next opportunity! Thanks for asking.....

In my opinion the question is, do you want to not see patients, and just work with computers, charts and data? That is what this would entail.

I am surprised no one answered this - you should seriously consider it. CM for hospice would primarily be a liason for the hospice, and it is a good day shift job. You would need to have superior skills in dealing with families considering hospice - it is a delicate and sensitive position to have, but it is sales, too.