Capco56

I've been an RN CM with a major insurance company for about six months, and our team recently learned that all of our jobs are being moved to another segment of the company. The good news is we are all guaranteed placement in another position with the company and on the same pay level. We are being given several options to put in our "wish list" and one position I thought I might be interested in is the field case manager who works both out of their home and makes hospital visits to assist members with d/c planning. I currently work at home and thought this would be a good opportunity to branch out a little. Can any of the field based CM's with hospital visits let me know what I could expect? Looking for the good, the bad, and the ugly. More specifically, I work for Unitedhealth Group (Optum) so if any are with UHG that would give me even more insight. Thanks!

Congrats! UHG/Optum is a good company and with good leadership I believe. I'm glad you will like it. Welcome to our group!

Hello...did you get the job at UHC? I am on the TCM team with them. If you were hired, where will you be based out of? Greensboro NC ?

Would someone explain the difference between an Episodic Care Manager and RN Case Manager with insurance companies? I have applied to both and was wondering about the specifics of each title. Thanks!

Thanks for your prompt replies! Maybe it's just something I have to accept. It's just very difficult assessing, charting, passing meds, not to mention the "unexpected" that always occur when taking a team, and do it all in 4 hrs, just to start it all over again with another group of patients. And BTW, I say "float pool", but I am the lone RN in this "pool". Not a big hospital, just under 200 beds...guess that's one reason I can't stay on one unit. Thank you again for your input. It helps with understanding this new role I have and will be better able to accept that it is what it is.

I've been working float pool at a local hospital for about 6 months now. While I love the general idea of it, the variety, the higher pay, etc, I get very frustrated with splitting my 8 hr shift between two units. Is this the norm with float pools? I understand floating to different units but was not aware I'd be floated within my shift. I may start out on one floor taking 6-7 patients, then float to another floor after 4 hrs to take another 4-5 patients, and somewhere in that time between reporting off and receiving report I have to fit in a meal. Your thoughts?

Seems to be the consensus that this is becoming the norm. We have surveys too, which don't amount to alot of changes. We even have a union that can't seem to resolve the issues either. It is sad that this is the way nursing has evolved. The ridiculously complicated computer documentation on top of the heavy patient load makes it virtually impossible to be an effective nurse, and no matter how much manaement says they want to reduce turnover, it is exactly this type of management that causes it. New nurses come and go and even leave the field due to burnout. Why can't hospitals figure out they are directly causing such financial hardships on themselves by not hiring the extra staff to reduce burnout of their nurses, thus, retaining them in the end. The only hospital I didn't see this practice was at a Magnet hospital that I worked at in which the norm was a 1:4 ratio on an inpatient palliative care unit. It was sweet! But then again, I guess that's why they're a Magnet!

I just returned to Med/Surg after 2 years in Home Health (nurse for about 10 yrs total). I'm appalled that administration thinks nothing of calling off nurses and loading the ones working with 7 patients! Is anyone else encountering this? I feel like my entire shift is putting out fires and flying through documentation so that I won't get caught in overtime. Then when nurses leave, the reaction is "why"???

Has anyone used Procare pharmacy and what did you think? I have had times where I'll wait close to an hour for someone to call back; always get a machine and have to leave my number. If I'm at a patients house, that's a long wait. Also, not that impressed with their recommendations. Anyone have feedback?

I recently started work at a new HH agency with a reputable name after about 1-1/2 years at another agency. I do a lot of SOC's and am feeling pressured by the QA manager to "re-evaluate" my answers to those high reimbursement OASIS questions. Although no one actually changes my answers as was mentioned in a previous post, I do feel like I have to "skew" them to reflect a worse scenario than what I actually see or how the patients say they feel. I would be interested to know how many nurses feel this way. I never felt this at the other agency I was at and I understand that we have to show improvement and indicate what the patient can "safely" do, but I just don't feel comfortable changing some of the questions they ask me to re-evaluate. It makes me question my assessment skills even though I feel I do a thorough job. Is this the unfortunate future of home health?

All very good replies. Rule of thumb, if he is alert and oriented enough and barring any swallowing difficulties or aspiration precautions, there is no reason he can't have a hot fudge sundae for breakfast if he wants. Hospice=Comfort Care. Whatever is needed to provide comfort is what should be done. A lot depends on where he is in the dying process. A little known fact among familes and patients is that when a person is actively dying, unlike you and I, a little dehydration is actually beneficial because it releases "feel good" endorphines that help with pain control and a sense of well being...kind of like "runners high". And, as another post said, the body does not know what to do with this extra food given to the patient if the organs are shutting down. This is all part of the family education that hospice nurses should be providing. Instruction to not feed a patient without explanation is just not acceptable. When I explain this rationale to my families, it gives then much comfort that they are not "starving" their loved ones to death. In answer to the sedation issue, it is sometimes very difficult to maintain that balance between pain/breathing control and alertness. Very often, families will opt for the sedation over seeing their loved ones struggling. Bottom line, if you are not getting this type of education from the hospice nurses, it is time to find a new agency.

P.S. Thank you for the compliment :)

LOL....Ok, we definitely got our wires crossed. I got the drift of it now...lol

Understand, and agreeable. I can understand firmly holding a child down to put in an IV or give an injection. Heck, I would have even been okay, not comfortable, but okay if this wound was on her foot. But as I said to my (sympathetic) supervisor; If this was an 80 year old woman being forcibly held down by two grown men while I poked and prodded at her private area, would that be considered acceptable? I think not. In fact, that just might be considered elder abuse. So why do we feel it is okay to do this to a helpless child? So, yes I can hold my head up high when I look in the mirror. The restful nights have yet to come, though.

Thank you, systoly and Isabelle, too. It feels good to hear support from fellow nurses, and, although I never doubted my decision, your encouraging words make this whole ordeal more tolerable. To update you on the sad situation, the doc did not admit the little girl, but sent her home that same night. Another nurse went out the following day, opened the case, packed the wound, and wrote in her note the effect on the child was "traumatic" and the wound packing produced "bloody drainage". As for me, I was reprimanded, not for going against orders, but for my "rude behavior" toward my supervisor. I have 3 (scheduled) days off, so I'm writing my response tomorrow to attached to my written "verbal warning". I have to mention that this supervisor is not my regular one who was out that day. I talked with her yesterday and she was very sympathetic not only to me but to the child as well. There are just some people who call themselves nurses who have no business being one. (Docs too) Just my opinion. So I can only hope the child is going to be okay. I saw that the wound was MRSA positive, so I worry about the 4 month old at home. Also saw today that she was already d/c'd from our services. I fear the bottom line for all this was the lack of insurance that this family has. Such a shame that the innocent ones have to suffer from it all. (sigh)

LOL!!!!!! Thank you, Isabelle! You gave me a great laugh to an otherwise very emotional day. I did end up aborting the packing. I just could not make this little girl endure it, and I truly hope he ended up admitting her. Thanks for your input (and humor)....much appreciated!

I had an admission today on a 2 year old little girl who had an abscess on her labia (suspected spider bite). She was in for an I&D by the surgeon yesterday and sent home the same day. Today, I was sent in to open, and pack her abscess with Iodoform (I took out approx 2" from the wound). The whole procedure was so traumatic to the little girl that I didn't feel comfortable completing the admission. She had to be forceably held down by her Dad and Uncle while I tried to pack this 0.2 cm opening with 1/4" gauze. I stopped the procedure, called my supervisor, and was told, or should I say "ordered" to open up the case and pack the wound. Not feeling comfortable, I called the Pediatrician who agreed that the toddler should have been admitted to the floor after the surgery. She told me to call the surgeon and see if he would do a direct admit, which I did. Although I couldn't speak with him directly, his secretary called back and told the Dad to bring his daughter to the surgeons office this afternoon. I (emotionally drained) went back to my office, and stood by my conviction that I was not comfortable opening this case, and was told that "sometimes in home health we have to do things we aren't comfortable doing". At this point, I pretty much stormed out saying, "well fire me because I'm not going to do that kind of nursing". Now I've been a nurse for about 8 years, but only 8 months in home health, but no matter what the field, I'll advocate for my patient to the very end if I feel strongly enough. In my heart I know I did the right thing (maybe not telling my sv to fire me...lol), but I could really use some support from felllow nurses, or some constructive advice if you think I was wrong. As an added note, the little girl was refusing the oral abx, and as in many home health cases, not a very clean environment. The Pediatrician suspected a staph infection and there is also a 4 month old baby at home too. The whole picture just made me feel she was better off in the hospital with IV abx where she could get ATC care.

Can anyone recommend an affordable finger pulse ox for HH use, preferably under $100?

I work for a small hospital based agency and we have call 4-5 times a month after normal business hours through the night, except if it's a w/e, then of course, it for 24 hrs.

My experience with SQ infusions in the hospice setting is that we would change out the needle every 4 days, similar to an IV, as long as the tegaderm is intact and the site is not compromised. I've heard some can remain in for 7 days. Attach a pigtail to the hub just like an IV and it should be fine.

I work out of a hospital based agency, have been in HH only a few months, and we've had alot of changes with personnel occupying new positions, etc. Wondering how other agencies organize their scheduling and assignments for visits and case managing. Here's how we operate and if you have some helpful tips, I would love to hear them. Currently have RN's/LPN's out in field with RN also doing the case managing on a master schedule. Supervisor makes daily assignments from this master schedule. As much as possible she attempts to keep us on our "territories", but it's not always possible. We're in a very rural, spread out area, so travelling 50-100 miles a day is not out of the question. Currently, the RN's average 5 patients (SOC=2, all else =1). Very often I find myself doing a d/c on other nurse's patients who I know nothing about, same with ROC and recerts, etc. I've noticed in a lot of posts, nurses have their own patients who they follow from beginning to end, scheduling all their visits themselves, working primarily out of their home, etc. It seems our agency is in such disarray that any help would be welcome. Would love to hear how a well-run agency manages their patients, specifically in cases where the field RN is also the case manager i.e. what responsibilities are done in the office by the supervisor, what specific responsibilities to managing a caseload do the RN's do. Thanks so much for your input. I know there has to be a better way to organize everyone's day!

Not sure where you're located, but I work in PA, part of a hospital based HH, and we are "desperately" looking to fill a full-time RN because we have so much work. I travel 45 min to the hospital (office) but my "territory" is much closer to my home. AND, compared to other posts I've read, wages are above the norm. I was hired part time (my choice), but did my first 2 months full time. There always seem to be extra days I can pick up if I choose to, but truthfully...I don't know how anyone does this full time. It is true that there is alot of at home time you spend managing your caseload and organizing. That's why, for me, the balance of part time/family time is perfect!