psychnurse127

I used to work from home as a utilization review nurse. I worked for an insurance company that dealt with workers compensation cases. In my experience, I sometimes felt like I was literally chained to my desk. I was being monitored on every phone call and on every movement of the mouse. I was expected to open and close a certain number of cases and all of our stats were listed and sent out to every person in the department to see. Working from home has its perks but it really depends on your employer. It's not as enjoyable when you are micromanaged. If you can find one that is more focused on quality of work rather than quantity of work, then maybe you'll have a better experience than I did. However I did enjoy my commute of waking up from bed and walking down stairs to my office.

I currently work in geri-psych and I always tell my coworkers who have second jobs in LTC that I have so much respect for anyone who works in LTC. Since I work in an acute setting, my patient ratio is 6 to 1. And some days I feel so overwhelmed. I can't imagine having to be responsible for 50 patients! So many problems can arise in just one shift. I know I couldn't handle that many patients and I am so thankful for nurses like you that are able to do the work that you do.

I work on a geri-psych unit and my patients are mainly diagnosed with dementia. And sometimes I am shocked at the words that come out of my patients mouths. The only thing that I feel like I can do is not take anything personal. Because one minute my patients are throwing punches and spitting at me but the next minute they start calling me "honey".

I worked for an insurance company as a UR nurse and I felt very overwhelmed and overworked. Everything was about productivity and was all about quantity vs quality. Makes sense because the more cases we completed, the more money the insurance company would make. However, I'm sure hospital UR is also very difficult but I can only speak for insurance UR. I was hired with 3 years of floor nurse experience with no special certification or classes.

I know your post is over a year old but I figured my post could maybe help someone searching for the same question. I was in a similar situation and felt burnt out by floor nursing. I wanted a change and applied to any position available. Lo and behold I landed a job as a UR nurse for an insurance company. The company allowed nurses to work remotely from home so after a month of orientation, I was sent home to work. Every day is usually very similar. I have a case load that is sent to me by intake and I review each case by looking through all the medicals that were sent in which includes MD progress notes, PT notes, OT notes, nurse's notes, xrays, labs, etc. Basically everything and anything that the adjuster/attorney sends to us. I once had a case where the adjuster sent in 400+ pages of medicals. After reviewing the case, I determine if the claimant's request (surgery, therapy, DME, medication, etc) is medically necessary according to guidelines. If I feel that there is not enough evidence for me to approve the request, I send the request to a physician that also works for my company. That physician then either approves or denies the request. The approval or denial from the nurse or physician must have an explanation of why and what guidelines are used to determine the necessity. Once it is approved by the physician or by me, I compose a letter and send this letter out to the all parties including the claimant, requesting physician, adjuster, and attorney. I do this until all my cases are completed for the day. In between I make phone calls to doctor's offices, attorney's offices, etc if I feel that I need more information to make my determination. Hope this helps!

It really just depends on the setting that you apply to. Inpatient settings usually prefer experience/require years of UR experience. Insurance companies prefer the UR experience but do not require. I can only speak for insurance company UR. I worked for 3 years as a psych nurse and wanted to try something different and actually got a job as a UR nurse for a third party insurance company. They didn't require any special certification or classes. They were looking with someone with clinical experience and willingness to learn. After about a month of on-site training, I was sent home and was allowed to work from home.

How have you adjusted working at the VA? I too was a new grad that started my first RN job in psych (more in particular geri-psych) in the private sector for 4 years. However my unit admitted patients with IV fluids, foleys, GT feedings, etc. We are more of like a med-psych floor. And now I just recently got a new job at the VA in inpatient psych, and I feel like I am honestly losing my skills because the patients must be completely medically cleared in order to be admitted to our unit. They cannot need any IVs, GT feedings, etc.