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Ambulatory Case Management, Clinic, Psychiatry
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ivyleaf has 12 years experience and specializes in Ambulatory Case Management, Clinic, Psychiatry.

ivyleaf's Latest Activity

  1. ivyleaf

    How to become a case manager

    I think so- never hurts to apply!
  2. ivyleaf

    Help w/job decision?

    Thanks LibraSun; I appreciate your response. I am leaning towards not taking it. The combo of the loan repayment and commute (I feel like I am already @ my max with slightly under an hour), combined w/ the pros of my current job; is making me feel like it is not worth the move. I am going to try to take more advantage of the flexible scheduling and time off @ my current job to make it more palatable.
  3. ivyleaf

    Home Health Nurse Out of Nursing School?

    I would suggest getting a year of med/surg now. The longer you wait to try it (if you try it), the harder it will be to give up your more flexible schedule/etc, and you won't do it. It does open up a lot of doors. This is from a nurse who started in psych and regrets not doing med/surg earlier for the experience. After having a m-f 9-5 outpatient job, the idea of med surg is much less appealing. But, this is me and may not be you. Some home health agencies do hire new grads, but I would be sure they offer a thorough orientation. As a home health nurse, you dont have anyone to cast a 2nd set of eyes on the patient, no doctor to see the patient; it's all you and your judgment/experience. Which, as a new grad, is probably going to be somewhat lacking (no offense, this is a generalization).
  4. ivyleaf

    Job change?

    I would apply! I totally identify with being comfortable somewhere, even if you're not happy. But doesnt sound like youve got anything to lose by applying.
  5. ivyleaf

    Help w/job decision?

    I posted a while back about a potential job offer, and now I have been offered the position. The position is as an inpatient case manager on a med/surg floor, mostly discharge planning. I am currently working as an outpatient case manager/manager (1/2 caseload, 1/2 management) for medicaid patients at a behavioral health agency. We do medical and psych CM. My background is in psych and clinic (float, mostly primary care - case management and direct patient care), so this is a unique opportunity since most postings I see require med/surg experience. Long term I am interested in UR and CDI. This job would expose me to UR although I wouldnt be doing a lot of it. I am torn between staying at my old job and taking the new position, mainly because 1) I have received $21,000 in loan repayment through my current job; I would need to pay back about $15,000 of it if I left before 4 years (I am at 1.5 years). On the other hand, the new job pays 7500 more a year and has yearly cost of living raises which my current job does not. I would borrow 1/2 the $ from my retirement w/the plan to pay it back to myself within a year. 2) My current job offers a lot of flexibility w/scheduling (leaving early/using vacation time fairly regularly as long as I ask ahead) and I have a lot of time off (4 weeks vacation + sick time + holidays). My main passion is the outdoors, and I like to go away weekends/up north as much as possible. On the other hand I dont really take advantage of the time off. 3) Current job has a fair amount of autonomy and I have my own office. Besides client needs that come up and staff needs/their client crises, I have a lot of control over my schedule/day 4) Commute to new job is about 10-15 minutes longer than my current commute, which is a little under an hour (45min to an hour). Have to park off site and take a shuttle. Schedule is also earlier so would be getting up an hour earlier, although I get out 1/2 hr earlier. 5) have to get BSN w/in the next 5 years. I have a BA in another field so shouldnt be extremely time consuming, but it wasnt in my 5 year plan and is more $$ However, there are definite pros to the new job: 1) Career stepping stone, getting back to the "medical" side of nursing, which I miss (The knowledge/theory part, not the hands on) 2) New position/job is exciting. I am feeling burnt out at my current position, mainly due to a combo of staff performance issues, bureaucratic/programmatic issues I have little control over, and poor communication between other teams we work closely with. Plus having a lot to do and never feeling like I can get it done, which I know is the case at most nursing jobs. 3) After 2 years I would make up the loan repayment and w/ cost of living increases, be at almost 10k/year higher salary than I am now. 4) I have a hard few months coming up w/onboarding a new nursing staff while covering my usual job duties. I have hemmed and hawed and made lots of lists; just looking for some outside thoughts. I am really anxious about the possibility of giving notice since I'm friendly with my boss/she worked hard w me to negotiate my current job package, and it's not a great time to quit (other manager is transitioning out and only working part time remotely, we are down a nurse- although hopefully going to hire one this week, and down outreach workers as usual). thanks!
  6. ivyleaf

    Feeling lost in my nursing career

    stick it out a year, it will open doors. not all unit culture are the same, although i think ICU does attract competitive personalities
  7. ivyleaf

    Can I be a successful Occupational Nurse?

    I would ask about what the expectations are, if there is a clear policy/procedural manual, who would orient you. Are you interested in occupational health? How frequent are accidents? what kind of supplies will you have access to in your clinic, if there is one?
  8. crappity crap crapola anyone can call 911
  9. ivyleaf

    Experience Psych RN Looking for a Change

    I was in a very similar position, doing psych for almost 10 years. I was able to get a position as a float nurse for an outpatient group (primary care, urgent care, specialty) and that opened up a lot of doors including an ER job offer. I didn't end up taking it, but I have done outpatient CM and got an interview for an inpatient med/surg CM gig as well. I also have a friend who did per diem geri psych, which helped her get a med surg job. Now she is @ a major academic medical center on a med surg floors with great ratios. She started in psych too; it is possible!
  10. ivyleaf


    What are your longer term career goals? where do you want to be 5 years from now? From someone who worked psych for almost 10 years, I would say it does pigeonhole you a bit. SNF is more transferrable and would expose you to more general medical issues
  11. ivyleaf

    Home care vs Nursing home

    Is she able to find an acute rehab position (vs. subacute/"snf")? Generalizing, I would say SNF would better prepare her
  12. Also, I forgot to mention this, but the program is for medicaid members w/behavioral health issues. We do both medical and behavioral health CM, but the nonprofit is a human services agency and run primarily by social workers vs. nurses. I like a lot of things about the agency, especially the flexibility; but they tolerate a lot of performance issues that I don't think other places necessarily would; and nursing leadership is lacking (my manager is a social worker, not a nurse). I feel a bit pigeonholed in psych still about this, but I guess if I am able to get an inpatient medical CM job interview, that is a good sign. Tried to add this to my original post but wasn't able to edit it. The flexibility and hours are the main thing, along w/the loan repayment of course, keeping me there. There isn't really anywhere to grow nursing wise in the agency. I don't think I'd get the flexibility at most other places and therefore not sure what I will do next if I don't take the position. Nursing positions, compared to academic and the business/start up world, seem pretty lacking in flexibility (besides choosing btw days/eves/nights and 3 12s).
  13. Thanks for your input. I don't really feel like I have time to add anything to my current responsibilities, but I see what you're saying. There are a lot of things that could be revamped/changed about the program; I am feeling somewhat defeated about a lot of it. We (the program director, who is a social worker, and I -- it is a behavioral health population even though we do medical CM as well) are constantly changing things up. The staff (not as much the 2 nurses I supervise, but the outreach/community health workers) are pretty overwhelmed and frustrated by lots of change. Will think about it.
  14. Looking for some outside thoughts/perspectives on potentially taking a new job. My background is mostly in psych, also outpatient clinic and case management. My long term goals (as of now), are to get into UR and possibly CDI, on the medical side. I like the idea of working for a managed care organization and having the ability to one or 2 days remotely. Currently I work in outpatient case management for medicaid patients as a manager and w/a 1/2 caseload. I work for a nonprofit. I am not getting the acute medical exposure I would like, and there are a lot of frustrations within the nonprofit world including turnover, under performing direct care staff, and unreasonable expectations from the state. I also received student loan repayment through a lottery; they state has paid off my student loans (approx $20k) with the expectation I stay there for 4 years. I have been there 1.5 so far. If I leave now, I can keep approx $6500 and will need to pay the rest back ( would need to borrow from my retirement, although I am in my 30s so that is not an acute concern). The new job would be as a hospital case manager in a community hospital on a medical floor. I don't have an official offer yet, but the rate they quoted me is about $6k more a year than I make now. Caseload would be 14-15, mostly covering 1 floor but sometimes other and occasionally ED pager coverage. Mostly discharge planning but I would learn UR/interqual and get to do some of that occasionally. I liked the manager when I met w/her, and her manager who I met briefly. Pros of taking the job: -exposure to inpatient medical (without doing med/surg direct care, which is generally a requirement to get into UR) -stepping stone to other career areas - a change (I am burnt out my current job and honestly get bored easily) -not having to manage other people -higher overall salary and likely guaranteed raises ever year (which I dont have now, raises are q 3-5 years @ the nonprofit) Cons of taking job: -having to pay back the student loan (and go through the process of figuring how to do that as far as regulations for borrowing from retirement..) -working 1 major winter holiday (now I don't have to work any holidays) -losing 4 weeks vacation (I imagine I"ll only have 2, or approx 20-25 days including sick time; they haven't sent me benefits info yet) - losing some autonomy as I will no longer be a manager (and closing the door during lunch and doing my PT exercises without having to deal with anyone most days-- I imagine I wont have this ability on floor, although they did say I would have an office) - having a different kind of unfamiliar stress (families, hospital teams vs. just dealing with my staff and sometimes needy clients, which are a known entity) - loss of flexibility (I can flex my hours now, come in 15min later just to avoid the commute, leave early some Fridays if I ask ahead of time, etc) - estimated new commute looks 10 min worse (current commute is about 45-50min each way; both jobs are only about 20 miles away but everyone is commuting those ways) -leaving my current team in a lurch since they are already short 1 nurse and our other manager has moved and is mostly working remotely and will probably find something else closer to home-- I know this shouldn't matter, but I feel guilty and am friendly w/my current manager (as in, was part of a shared friend group before she hired me) Definitely more cons than pros, but the job seems new and exciting... Maybe I should just wait for something in managed care or workers comp UR (another area of interest) to come along? The 2 managed care organizations near me have a lot of recent negative reviews from former employees, including from nurses and UR folks; I have been looking for a while. I could also try to hold out another 2.5 years until I have done my time for the full loan repayment. I have never stayed at a FT job more than 3 years. Thoughts? Thanks in advance; sorry for being so wordy
  15. ivyleaf

    Antepartum Vs multiunit acut med-surg floors

    In the antepartum unit, how often would you work with newborns? IF it is not frequently, I think the adult might be better general experience. Unless you are primarily interested in newborns/NICU