Lucy4

Yes - the interview was prior to admission to the program. I don't know if it is still part of the procedure. The questions included what qualities do you feel are important for a CM to possess, what qualities do you possess that could be valuable in a CM position, etc.

Kaplan has a number of programs including the case management program - open to nurses and social workers. Check on-line for more info. I had to do a phone interview also.

I completed the Kaplan program about 6 years ago. I work in acute care and wanted a CM job and no one would hire me due to lack of experience. My thinking was if I completed this program that I would have an edge - and I did. When I enrolled in the program it was a total of 8 classes and covered all aspects of CM - CM models, CM of special populations - geriatrics, pediatrics, Workman's Comp, disability, types of reimbursement, etc. Requires ALOT of reading from tests and articles that are assigned. Tuition included a subscription in an on-line library. Each class had an exam at the end and done on-line. You can retake if didn't pass. The classes were $400 each at that time and you do have to buy books. My employer (hospital) reimbursed me for the classes. Took me a year to complete the program. Hope this helps.

I am a discharge planner and occassionally discharge a patient with a Pleurex catheter. The patients where I work are sent home with 3 kits and then I order kits to be delivered to their home. Pleurex catheter kits can be ordered thru Edgepark Medical Supply Company - google for website. I set my patients up with home care initially. Home care may be able to order for Medicare recipients - paid at 80% and patient is billed for 20%. The agencies do not supply the kits themselves. Same with VACs - KCI has a script form that is completed by MD and I fax to company. KCI obtains insurance/medicare auth and sends VAC and supplies to patient's home or the hospital for homegoing.

Sorry you are having such a difficult time and hope things improve for you. I like to think the great majority of CMs are fair and interested in good outcomes over making referrals to a facility just because they are friends with the liasons. One suggestion I have is to have an open house and inviting the CMs to tour your facility and emphasize the specialized care that can be offered. Marketing to physician groups may be another way to go. Where I work the orthopedic surgeons are very particular about where their patients go for rehab and have personally toured some of the facilities, met with the therapists and discussed what they want for their patients. Market what your facility does best. Several facilities in my city - owned by the same corporation - offers some type of specialized care at each SNf. One has a program for bariatric patients and has staff trained in how to care for them and obtains the necessary beds and equipment. Another has a CHF program. One facility is located across from a community hospital and marketed to the ortho surgeons at this hospital. Now the ortho MDs at this particular hospital send their patients (S/P total joint replacements) there for rehab. Think of what your facility can market and offer that the others do not have. Just a couple ideas. Good luck and keep us posted as to how things continue for you.

I am a DCP at a tertiary medical center and discharge many patients to SNFs, LTACs and acute rehabs - more SNFs than the others. Medicare requires that patients are offered freedom of choice and I, as well as all DCPs, are required to give patients a list of providers within their geographic area. I print a list of providers from ECIN and give to the patients, regardless of their payor source. I encourage families to visit their facilities of choice. Many of my patients are from out of town and have come for specialized care (solid organ transplants) and most are required to remain in town after surgery - unless they live less than one hour from the hospital. Sometimes patients are readmitted for one reason or another some time after transplants and can go near home for rehab. Though patients are given FOC, I admit I guide them to facilities that can best meet their needs and have experience with medically complex patients. I have indicated to patients which facilities have accepted transplant patients with good outcomes. A couple of the services outright forbid transfer of their patients to one particular hospital based SNF. Overall though, I have found hospital based SNFs to meet the needs of my patients most reliably. A couple other nursing homes with SNFs in town have accepted transplant patients and provided good care and have good outcomes. Have had good luck with one particular corporate facilities outside of town and state. Whenever I have contact with a patient whom I have discharged to a facility - readmit, phone contact or visiting -I talk with them and ask them about their experiences and whether they would recommend to others. I have found that patients are candid with good and bad experiences. If I consistently get negative feedback from a facility, I do relay that information to the liason. Recently I sent a patient to a corporate LTAC - patient's families choice due to close proximity to their home. The liason from this LTAC stops by regularly and provides small gifts, brochures, etc and promotes her facilities. The patient who was discharged to this LTAC was the first patient I have sent to this facility. The day after discharge I recieved a call from one of the social workers at my hospital who is a good friend with this patient's wife. She wanted to know what happened on discharge that upset her friend so badly. On investigation, I found out the liason called the wife and wanted to send her husband to the corporate LTAC on the other side of town because the census is down at that location. When the patient's wife said NO, the liason persisted and offered gas cards to assist her with travel experiences. I contacted the admissions office for the LTAC and expressed that I was angry and very disappointed at what happened and now very hesitant to give them any other referrals - also expected that his care be stellar and that I would follow up on his progress. After talking to some of the other CMs, found out they have had similar experiences and the LTACs this liason represents is not their first choice of facilities. Also care issues. I agree with Ingy on all of the points in her post. Satisfactory patient outcomes are a top priority. Good Luck!

The Medicaid CM I have spoken with RE patients are somewhat helpful. Often their hands are tied. Not long ago I requested assistance in SNF placement for an in state patient (Medicaid HMO). Several facilities were willing to take him but had to decline as reimbursement is $240/day and meds almost $100/day - not much left for therapies and incidentals. After multiple conversations between M/C CM and facilities, I told the M/C CM that there were 2 options - #1 carve out rate that is acceptable or #2 M/C will pay the hospital to rehab him in hospital (after DRG is paid - M/C pays by the day). In a hour she called me back - offered a special rate to the choice facility which was acceptable to them. One particular border state sends patients to my hospital for highly specialized care. Many are state medicaid. When these patients require rehab or LTAC placements - their home state has very few facilities that will accept. Finding a facility in my state that will accept these patients at out of state medicaid rates in nearly impossible. The out of state medicaid CMs are happy to have to not have to deal with these patients and their assistance, in my experience have been nil. At age 21 these patients have no SNF benefits. I asked what happens to these patients if hospitalized at home and was told they rehab in the hospital. Commercial insurance case managers that CM this specific patient population have more bargaining power and the great majority call me offering assistance before I have a chance to call them. I know I am off track here - just blowing some steam.

Hi everyone! Went to internist on May 12th. Had labs drawn late last week. HgA1c was 7.3 (last done a year ago and then was 6.9). I have been non-compliant with diet and just in last 3-4 months started watching and have lost 20 pounds. I asked about starting Byetta and my doctor said he does prescribe Byetta but at this point wants be to try metformin first. Now I am on a taper schedule and in 6 weeks will be at 1000 mg BID. Said he prescibes Lantus at HS for patients that do not have good control with the metformin. I am continuing the Amaryl 2 mg daily. I had increased this dose on my own to 3-4mg but didn't make much of a difference. Also, my doctor said in a study it was found that in lowering blood glucose levels too quickly - associated with higher mortality rate. I go back in 3 months and will have labs done at that time. My AM B/S has been 150s to 200 range. Before dinner I am usually 100-130s, occassionally in 90s. This AM was 142 and 120 at 6PM (nothing to eat since lunch). I need to drop 80-100 pounds. Also exercising would help and I am bad about that. Anyways, talked to the diabetic educator at work and she was very surprised he didn't prescribe Byetta and that the endocrinologists where we work treat much more aggressively. Takes 6 months to get an appointment. Said the study he was talking about - was referring to one arm of study and sounded like was misinterpreted. Anyone have any insight. Not looking for advice but interested in knowing what others have experienced. I am tempted to make an appt with an independent practice endocrinologist that I know from my old job. My former internist who I fully trusted took another job. then one I chose and saw once took another ob, hence the new MD.

I am a case manager at a major tertiary medical center and my primary responsibility is discharge planning. UR is separate. Some case managers do reviews and have a smaller case load but those hired as discharge planners in past 3-4 years are responsible for discharge planning. I prescreen all patients for potential needs - targeting those with readmissions within 30 days, age 75 or greater, no insurance (need to get immediate SW consult). The floor I case manage has many readmits due to nature of patient population. Also write reports for patients with 20 day or greater LOS each week - justify LOS and discharge plan. I facilitate placements to various levels of care - LTAC, SNF, acute rehab, home care. I set up patients with home antibiotic therapy - securing nursing agency and infusion pharmacy. Also order DME/DMR when needed. Occassionally obtain preauth for meds needed on discharge. Patients come to my hospital for highly specialized care and many from out of town/state. Also working with various payor sources when securing services/placements can be a challenge. The patient population I case manage often times has heavier care needs and med costs, therefore trying to place them with a medicaid payor source can be difficult (cost of care can easily exceed reimbursement). Private insurance will often carve out a higher reimbursement - medicare/medicaid HMOs do not - or maybe one in 1000. I enjoy the job and find it challenging. Good luck!

I have never heard of giving out gift cards to families - these places must have a big budget!!!

Not familiar with the particular Kansas facility. Select Specialty hospitals are long term acute care hospitals (LTACs). Some are free standing and some are in leased space of an acute care hospital. More and more are free standing. LTAC is a level of care (LOC) that is appropriate for medically complex patients who require a hospital LOC over a longer period of time. An example of a patient who requires an LTAC is one that has a major surgical procedure with complicated postop course. Ends up with a trach and needs vent weaning, enterals, IV antibiotics and meds, dialysis secondary to acute renal failure and wound care, along with OT,PT and ST. Rehab will be lengthy and care needs exceed what can be provided at a SNF or acute rehab, though does not need to remain in acute care. Type in Select Specialty in search engine and will bring up their website. Kindred and Regency are also corporations that own LTAC hospitals. Check out their websites for more information regarding LTAC LOC.

Thanks for your reply! I have increased Amaryl to 3mg and fasting is still 150's to 170's and occassionally higher. Today I had a meal replacement bar in AM and a light lunch. Blood glucose before dinner was 102 - usually120's - 130's. Seven day average is still 150 range because my AM B/S is high. I have lost 20 pounds and have been trying to limit the carbs. Need to take off 80-100 pounds and also excercise. I have another doctor's appointment May 12th and I am going to talk with him about options. Seems like I don't have very good control right now. Will keep you posted.

I dissected a fetal pig for anatomy class in undergraduate school - got to take it home to study.

I worked in LTC at an excellent facility a few years ago. Loved the residents but not the politics. I have felt at different times that LTC nurses are seen as second rate and not being able to get a job any place else. Not so at all. Geriatrics and LTC is a specialty in itself. So much to learn and as an above poster said, elderly can become very ill and very quickly and sharp assessment skills are necessary. I know of some very fine LTC facilities and their benefits and pay are very good. Generally LTC pays a little less than hospital nursing. When I left LTC to go to a hospital, my pay went up a dollar an hour but I cleared less as had to pay for insurance - didn't pay anything at my LTC job. Follow your heart and good luck with your career choices.

My observations are a general lack of attention to details. As I stated before, I & O is a big pet peeve of mine - especially on a cardiac floor. I have seen some of the new nurses turn off an IV pump that is beeping rather than fix the problem - leaving a PICC or central line to clot off. Leaving TED hose on for days even when they are obviously dirty - stained with blood, etc. Not changing dressing - leaving for the next shift who leaves them for the next shift and on and on.

I have some experience with working on a transplant floor and I think the experience is excellent. So much to learn and an interesting and challenging patient population. Great opportunity to build relationships with patients and also for patient teaching. I would say would offer great experiences to take with you to an ICU. Good Luck!!!

I & O. I haven't found very many that know how to calculate intake for IVFs. When I get report and ask how much is left, the response I get is "well I think...." When I ask how much they took credit for at 10PM - can't tell me. I go in and check patients with them and we look at the IVs together now. Even at that, they cannot enter the correct amounts in EMR. Asking to clear volumes on the infusion pump so I can accurately record how much I can credit - too complicated. Some will multiply the hourly rate x 8 (100/hr - 800 cc infused). Doesn't matter that the patient's IV came out and time lost in starting a new line or was recieving blood for 3 hours and IVFs were held for transfusion. Same with enterals. Clearing the pump at end of shift is too complicatd for them. No record of how much water used for meds and flushes.

Thanks for your replies. I am seriously thinking abouth the Byetta. If not I may have to go with a low dose Lantus at night. Have a doctors appt in 3 weeks so will discuss then. Will keep you posted.

Thanks Dusky! I was diagnosed with Type 2 DM 2-3 years ago. My A1C was 7.1 and was started on Amaryl. Guess I was in denial and then when stressed more difficulty with diet control. have not been the most compliant person. Last A1C a year ago was 6.9. Highest my BS has been when I have checked it is 220s and that was only a couple times. Avg recently was 160-180s which I know is way too high. Hadn't been to the Dr since and went to a new Dr a couple weeks ago. I have another appt in 4 weeks and need to have labs drawn before my appt. One of the DM educators at work gave me a new meter and so for past week or so I have been checking my BS a couple times a day. Also increased the Amaryl from 2mg to 3 mg. Now I range anywhere from usually 120-150. Tonight I was 105 - 3-4 hours after eating. A times I was 120s in evening and then 160-180 in AM before eating. Anyways, the diabetes educator at work said to consider Byetta or maybe Lantus at bedtime for better control. I am 100 lbs overweight so if I could lose some weight I am certain my control would be better. I have been heavier and actually have lost 18-20 lbs in past 2-3 months with WW. Also, I am concerned about BS dropping with Byetta. I read back on an old post that had discussed the hypoglycemic episodes. Once I dropped to 20s (shortly after I started Amaryl) and did come up to 70s-80s after drinking a can of coke. Thanks for the information. I am going to talk with my Dr about the Byetta at my next appointment.

Hi everyone! I am thinking of starting Byetta and wondering if anyone has had any experiences with this drug? Thanks!

Can identify with all of the above - reason I got out of Pediatrics. Love the kids - can't stand the parents. My pet peeve was when a parent would show up with 5 other kids - let them run wild, clean out the kitchen, throw and break toys etc. Many thought the hospital was a hotel and expected premium cable TV and meal tickets to the cafeteria (no money for food but reeked of cigarette smoke). Teenage Moms are another story. Fighting over the Nintendo was common. The children's hospital I worked had no security and anyone could walk up thru the ER and anywhere in the hospital. Their boyfriends would show up at 3AM with pizza, 2 liter bottles of soda and expect to party. At that time the unit had ward rooms with four kids to a room - no regard for other kids or parents. Some parents would play one nurse against another to get what they wanted and management tolerated that behavior. Also met some wonderful families so not all bad.

I have always gotten a phone call. Nurse recruitment - in my experiences - makes the offers by phone if offering a position. A letter usually indicates a rejection. My last offer was for a position in same hospital system- case management. The director of the department told me by phone conversation she was turning my application over to human resources and that I would hear from HR. The offer came from HR and took 2-3 weeks. I would give them at least a week and if you don't hear from anyone - think about making a call or e-mail to the nurse manager indicating your continued interest in the position. I also think it is very rude for managers/HR to not send a letter or call indicating they are not offering you the position.

I wear street clothes to work now - aside from my PRN job, and bought a pair of Earth Shoes for work 2 years ago. I wear them several times a week and they are so comfortable and my feet, back and hips do not hurt. Expensive but well work the $$$. The leather has held up very well - 3rd winter and they look like new. I had a pair years ago - popular in the 70s and wore them out.

I was a peds nurse for almost 10 years and returned to caring for adults 10+ years ago. Loved peds for many years and then became very burned out - for multiple reasons. I worked at a well respected children's hospital and cared for children who were very ill (hem-onc, solid organ transplant, long term complications of prematurity, etc) with many chronic medical issues. Very easy to over step professional boundaries. Pediatric nursing is not only caring for children but for the family - family centered care concept. Just something to consider. Good Luck!

I have a wide foot and terrible time finding comfortable shoes. I bought a pair of Birkenstock shoes and didn't like them for quite some time -in fact quit wearing them for a while - took a long time to break in. I have worn Birkenstock sandles for years and expected the shoes to be the same. Now I like the shoes - only work PRN so not wearing them everyday. Not worth the $150+. My absolute favorite work shoes are the SAS walking shoe. They are not cheap - run $100+ and last 3 times as long as the other shoes. Also come in a variety of widths. If I went back to working full time in staffing - would buy a new pair. Tried Danskos and hated them - returned them. Felt like I was walking on wood. New Balance is a good shoe - but I think SAS offers best support and comfort. For non-nursing shoes - I also have a pair of black Earthshoes that I absolutely love. Don't know if they come in white or not. Hold up extremely well. Softspots are good too. Good Luck!