dena_rn

I finished my bachelor's degree at 35! Never too old!

I have been a case manager in a small rural hospital for almost a year. I worked bedside nursing for 4 years before accepting this position. I roughly care for a total 10-30 patients at a time. I have the whole hospital, however, my director also helps when needed. We have a part-time case manager who also picks up when needed. But for the most part, I am it. I start my day reviewing the census to see who needs an authorization for their hospital stay whether inpatient or observation. I do my authorizations first thing in the morning because some insurances only give you 1 business day to request. On Monday, Wednesday and Friday case management performs rounding with the hospitalist to see who is discharging and what needs are out there. I will also make my own rounds on the patient's to see what their needs are when we don't round. I get the patient's choices for home health/dme/nursing home, etc... Then, I set the services up. The last part of my day will include reviewing the case management file in my office to make sure all elements of paperwork are met for compliance. We also have a program where the business office will send us accounts to review that are missing authorizations, Medicare one day stay reviews, and observation day carve outs. If the census is high, I can be very busy. Oh, I forgot to mention all of the phone calls we get. Some days I do not feel like a nurse anymore, and I think anyone could do this job. But, it can be very rewarding. Especially when that family who you have worked with to get their loved one placed in the nursing home tells you how thankful they are for your help. 99% of the time I feel like I have time to sit down with the patient and not be rushed because I have meds to give. It feels good to send that patient home safely. Good luck to you! I hope I gave you some insight on what it's like to be a case manager. However, each facility and position could be different.

I have noticed the main problem with getting admissions at change of shift is deciding who does what. What is the outgoing nurse responsible for in the admission? Do they stay until it's complete, or do whatever they can until change of shift? If the admission comes 30 minutes prior to change, then we do the arrival information, and initial assessment. Then I will try to do everything I can to help out the oncoming nurse. But this seems to be a problem everywhere. Maybe the problem can be solved by having a policy that states what each person is responsible for depending on the time the patient arrives.