Cg-RN

I've had two interviews for a Transition Nurse Case Management role (hospital based) and will be shadowing a nurse on Friday. I was wondering if those of you that have similar experience could suggest questions to ask, or provide any advice for the job or shadowing? My job will be to "ensure an efficient and coordinated hospital discharge and transition process for patients recently hospitalized or treated in the emergency room that are at high risk for increased use of healthcare resources." In our program we will identify these high risk patients and follow them for 30 days post discharge. I feel that I would really thrive in this position but would just like some pointers and advice. Thank you!

I could really use some advice from some fellow nurses. I work on a cardiac telemetry unit. The last shift I worked I had a disagreement with my CNS about a patient who was refusing to be turned. My CNS stated that the pt could not refuse to be turned as turning q2hrs is a "nursing standard." To that I replied, regardless if it is a nursing standard or not, the pt is of sound mind and has the right to refuse any or all cares. I stated that is is in fact against the law to force the cares on him. I stated that I would teach him the importance of turning and chart the teaching and refusal if he continued to do so. She was obviously very miffed that I disagreed with her. Today I happened to check my work email and I found that she had written me about a pt I had discharged home that day. This pt was a heart failure pt with a low EF. The standard for that is that the pt will be discharged home on either an ACE or ARB. If not, the MD must state a contraindication. Well this pt was sent home without one. I know what the standard is. He had discharge orders waiting when I started my shift. I was also trying to deal with some other difficult pts including the one who was refusing care. I was drowning. It was more than two and a half hours before I actually got to assess some of my patients. She stated in the email that she wants me to reply in writing "how I will be more vigilant in the future to make sure the heart failure measures are adhered to." First of all, I know she is digging up things because she is annoyed with the talk we had that day. I admit, I totally forget to check his EF before discharge. I agree I "dropped the ball." On the other hand, I am so frustrated with her and my manager. We have 5-6 patients who can be very critical. Our case manager has been arguing for years that our unit needs to be classified as a specialty unit to deaf ears. It is normal to have two discharges and one admission on your shift. We have so many forms to check. I's to dot....T's to cross. It is IMPOSSIBLE to be perfect. At our last staff meeting our manager said that if anyone can't handle our unit then they will find us a unit that we can handle. Are you kidding me? We have the full range of nurses.....from 23 year old new grads to 60 year old nurses who have been practicing for 30 some years. None of us can handle all the total nonsense which nursing has become. It is more about making sure we get that compensation for care and patient satisfaction scores than real pt care. I feel like they want us to be little robots who do not think for ourselves or have any limits on our capacity to get things done. We are human for pity sake. Whew....that was a lot. Anyway, what I would like to know is how should I respond in this email? Being overwhelmed or circumstances is not an excuse in her eyes. I really don't know what to say. Could someone please suggest something. I am at my whits end. I don't know if I should look for a different job? I work for a huge company which is known for being quite cut throat. I am really feeling demoralized. I want nothing but the BEST outcomes for my patients. It frustrates me that I am not given the tools to give them that care which they deserve. Thanks for listening everyone. :heartbeat

Hi Southernbelle, I am in the same boat as you! I just accepted a position in the cardiac medical floor yesterday. All the patients there are on some sort of cardiac drip. To be honest I am very nervous. I will have only 8 weeks of training....nearly two of which are not on the floor. My sister is a RN and suggested I read Cardiac Care Made Incredibly Easy. She is going to let me borrow her copy. On the positive side, the nurses on the floor seemed very cheerful and helpful. The nurse who gave me the tour of the floor said that everyone was more than happy to answer any questions she had as a newbie. Since we will be starting near the same time we might be able to be a resource for each other. I would love to bounce things off you if you are up for it. Contrats on the new job and keep me posted on how things are going!