lisa41rn

I work per diem in two hospitals. One hospital has a great reputation and you have 20-22 patients to cover. It's a lot but the MDs are onboard getting patients out. It runs really smooth. With the other hospital the most you have is 12 and the MDs allow patients to stay for no reason at all. It's frustrating. I'm not sure how they stay open to be honest. CMs don't do their jobs, complain all the time and are never held accountable. Was hopeful when a new manager came on board but she's worse than the previous one. Always on vacation or "working from home." There's a couple good CMs that bring the negative issues to her attention, with the hope things will be corrected, but they aren't. She views them as complainers. Can be this way anywherei guess. I think to have about 20 patients is about the norm. UR should be done separately however if you have that many patients you are managing. I do like CM but you need a great hospital with a supportive boss.

I just started a job as an RN Case Mgr at an Acute Rehab. Previously all my experience was in acute care at hospitals. I pretty much like it, but I find the rehab patients so much more difficult to deal with. I tell them things and they agree and then I find myself changing everything because family members become involved, etc. One patient I had wanted very much to go home. Was to go on Lovenox. I checked the price and it was to be $1500. He told me THREE TIMES that it would not be a problem as he was in an accident and his lawyer was advancing him money. I kept telling him he would need to get this right away and not miss a day. He agreed. Well guess what? The lawyer didn't advance him money yet as the patient assured me. I documented everything well and was told not to worry about it, but I do! Coworkers said if he says he doesn't need help, just move on. I called to check on this pt and he said he has an application which he will fax out on Monday and is sure he will qualify. I reminded him I told him the price and how he assured me the lawyer would come through. Ugh! Then, another family was totally rude when I was bending over backwards for them. I don't need to tell an experienced CM about that - we've all dealt with it. My question is how do I stop worrying about my job? I want a life when I go home. How do you deal with the stress and just shut work off? How would others deal with the Lovenox situation? How do you deal with d/c'ed patients who call you after they leave?

Thanks for that info. I'm hoping to get a year or two as an MDS Coordinator and then move up into some mgmt position. I did work in a LTC/Rehab facility for a year part-time in the past, but never worked on the floor in LTC. Frankly I wouldn't feel comfortable with that. I just went on an interview and was told I'd either have to be on call for nursing or mgmt. I would not feel safe being a nurse on the floor as I've never done it in LTC and got out of floor nursing into Case Mgmt because I wanted to get away from the hands on nursing. That's not to say I'm willing to help out as I am, but do not want to take on a full shift as a floor nurse even if it is on-call. Does anyone know if MDS Coordinators are always required to be on-call?

I have my Masters, my BSN and am a certified Case Mgr. I currently work in a hospital and deal with SNFs everyday. I have worked on Medicaid reimbursements in the past, but not Medicare. I have tried desperately to get an MDS position but everyone wants experience. Does anyone have an idea what MDS Coordinators make in MA and NH? I live where I can work in either state, but always cheat myself when it comes to asking for a certain amount of pay. I've been told MDS Coordinators make good money nowadays, but with my Masters, what should I expect? Thanks!

I don't know what it is, but for the last few weeks I have busted my butt for a very financial needy patient or two and have had that very patient be completely unappreciative for what I've done. I guess I should be happy it tends to be only a patient or two a week and the majority don't seem to care about what what I've done or if I'm lucky I do get some appreciation from a family or two. I had a patient needing IV antibiotics and didn't have much money to cover the deductible amount. I begged the hospital to help him with the bill and they ended up paying $300.00 or 1/2 of his bill. The thanks I got? He told me "no one does xxx anything around here!" I couldn't believe how he dropped the f-bomb when I worked so hard for him. I felt like telling him I don't get paid enough to be spoken like that. Instead I brushed it off that his anxiety was getting the best of him, but know one has the right to be rude to us! Today I had a lady dc'ed who needed a SNF. I called her sister-in-law yesterday to let her know the pt was offered a bed and that she would be leaving the today. Well her brother stopped by the hospital at d/c and is clearly angry that she is leaving in a johnny (fully covered in blankets) by the ambulance company and he was to bring clothes to the SNF and meet her over there. He had no bags in his hands when he stopped by the hospital with clothes had he wanted her to change before leaving. I guess what I wouldn't give this a second thought but this brother is deaf. The pt was at her baseline and lives alone. Although the brother was the DPOA it was never activated. I guess I feel bad as had he come in earlier I would have gotten an interpreter even though the pt was capable of communicating with him and it wasn't medically necessary to do so. By the time I realized the brother was upset she was already in a w/c van being transported to the SNF. We didn't even expect the brother to be at the hospital at the time of transfer. Ugh! I find healthcare so exhausting. It really is a thankless job. I hate worrying about things (ie this deaf brother - should I have gotten an interpreter although I know he came in as the pt was being transferred and his wife was told the previous day about it?!) My husband says I don't get paid enough to worry as he knows I'm very detailed and thorough, but healthcare is tough and we're all overbusy at times. How do some of you shut off your jobs when you walk out the door at work?! Does everyone worry about this sue-happy society we live in?

Hey Christy: So how are things going? Did you take some online courses? I totally get your frustration in a previous response. You ask one question and for some reason this site has a tendency to have responders answering about things you didn't even ask about!! (ie - they wouldn't hire you if you had no LTC experience! OMG!) Personally I prefer to be more supportive. Anyway, I've typically worked in hospitals, but went to a SNF for awhile and it was quite an experience. Doesn't take a rocket scientist to work at a hospital or at a SNF - just dedication with whatever you end up doing. Anyway, hope you found the courses helped. I am a case mgr at a hospital, but was really thinking about taking some of those 3.0 courses and make a switch. I want more flexibility than I have now and one nearby SNF has an opening. Will see what happens. Good luck to you!

I'm not sure where you live, but in the Northeast the RACs are here and auditing records. Yeah, it's not pretty! My hospital uses the McKesson Interqual software which I believe helps to meet critieria for inpatient and observation, but I've seen some CMs really force patients to meet and I don't think that's going to work when the RACs review the records. Another local hospital just build an $85 million urgent care/surgi center, etc building and they push to get every dime they can. I worked for them a short time and felt they pushed things so much it wasn't right. I'm sure they'll be paying back millions after the RAC reviews their records. I've really loved CM, but there have been so many changes that I feel like some patients are really needing to leave because if they don't, the hospital will lose and Medicare won't pay. With all the changes going on, I do believe there will be some hospitals closing.

Can anyone tell me if a patient is admitted Observation in a hospital, is it paid 100% or does the patient pay a portion? I believe much of it, if not all, is paid under Medicare part B if they are observation and part A if they are inpatient. I ask because my boss just said we should be telling the patients they are required to pay 20% of the stay if they are observation. I never heard this. I realize there is a big issue with their needing to bring in their meds from home and the 3 night stay for SNF rule. Thx

I was a case mgr about a year ago in a hospital and it was similar to a factory for the lack of a better term - patients would be admitted and discharged quicker than any other hospital I've ever worked at. They also had the highest readmssion rate in the state - no surprise. I just took a new case mgr position at a different hospital which is more easy going about discharging patients. In fact they are so easy going I'm having a hard time finding that perfect discharge time, but I'm sure I will. My question is in making my first connection with my patients at this hospital is much harder than the other hospital I was in. My current hospital has more "sophisticated" clients where as I was working in the city previously and frankly found those clients easier to deal with. In the past week, I've met one patient who gave me such a dirty look when I discussed any discharge needs that I wanted to tell her to stop being so rude! It was as if she clearly didn't need any help and didn't want to be bothered with me offering it! Many seem to feel we are asking questions which are none of our business even though I make it known the questions will help us to help them have a safe discharge. My job includes a high patient count (as most of us have!), so I need to get in and get my answers quickly yet in a way my patients don't feel I'm rushing them. Frankly I am not sure why I have to see every OBS patient or young patient when they are in for a simple procedure if their H&P says they work FT and have kids and are married, etc. Certainly it doesn't hurt to see everyone, but touching base with the nurses can be done in cases where it appaers a patient has no discharge needs. Anyway, I'm wondering how some of you introduce yourselves, explain your position and so on. While I did this a year ago, it was only for a year per diem and I never had the reactions I've gotten lately. Maybe it's just the clientel I'm dealing with now; thankfully I've only had this happen a couple times, but boy, can people be rude!! Thanks for your ideas!

I hear what you're saying. Nursing is a tough field. I wouldn't leave without a notice though. You've work hard and should be able to use this job as a reference. I worked for one of the worst hospital managers in the my area. Well I found that other hospitals in the area also knew about her reputation and believed if I could last a year with her I was probably okay. I've never cutdown an ex-employer, but often a truly tough area such as yours may have a reputation for being tough on their employees. Leaving without a notice wouldn't help you though. Try to give a notice and move on! You'll find your niche! Good luck!

You're right that I have been in LTC for only six months but I came from many years of acute experience. However, it doesn't take an experienced nurse to know good from bad nursing care; a new grad can see that. Even the janitor can see it! I stated many facts, one being that the state surveys have been terrible. The majority of my coworkers do not even know that I have my MS as I tell them very little about my education; it would serve them no purpose. Simply put, they are not willing to hear what other nurses have to say when it comes to improving the care we give our residents. The goal I had in my post was gaining insight into how to handle such a poorly run facility. My biggest concern is the care our residents receive. I thank everyone who shared their experiences within their own organizations!

Thanks for the great responses. I did find one that said "It's commendable to have a Master's degree but it is NO substitute for experience. " I think you might be one of those I'm currently working with! I've worked hard for my degrees and have multiple years of nursing experience. Regardless, many with lesser degrees have made rotten comments to those with higher degrees where I work. I do not for a second believe a degree makes you a better nurse. Gosh, some of the CNAs could be better nurses than those with a nursing degree. This comment shows the shallowness of what I've experienced in LTC by a few nurses. Those are the nurses who for whatever reason would rather belittle those for advancing themselves instead of getting their butts in school themselves. Certainly no one should go back to school if they don't want to - it doesn't make anyone a better person, but don't belittle anyone else who does. I welcomed LTC nurses with open arms to the acute environment when they wanted to try something new. Regardless thanks for all the great responses and sharing your experiences. I do believe all nurses to be supportive of one another and encourage advancement of any kind.

I worked in acute care and truly wanted to change to LTC, but for the last six months it has been crazy! I shed many tears shortly after taking my LTC job as I was not trained as promised and my corporate boss did not get along with the person training me at my LTC facility. The place was and still is chaotic with staff not caring about a darn thing! I was basically stuck in the middle of two people not wanting to train me - it was the "other one's job" so I ended up training myself. I've come to truly care about many of the residents so that has made me want to stay. My place is part.of a big LTC company. I had hoped to be able to move up the chain as I have my RN BSN MS, but to no avail. I think with all the garbage going on, and no one in Corporate truly knowing all the facts, I may appear to not be doing very well in my position when in fact it has more to do with the facility than my ability. The last state survey was terrible; one of the worst in the state. No one seems to care and want change. There is a new DON. She is nearing retirement, just wanting to hang out until she does retire and has no interest in making change. Any problem she is confronted with is brushed off. The new administrator (probably about the 4th one in the past year) sits in his office all day talking to his girlfriend on the phone; never leaves the office to check things out, talk to staff or residents. There's tons of issues going on but if anyone speaks up they are viewed as a trouble maker. I really feel like I want to speak with the VP about these issues, but know I will probably lose my job. I'm fed up with keeping my mouth shut. I want change and believe these residents deserve it. Does anyone have suggestions? I've only been in LTC for a short time; maybe this is more the norm than I expect, but I hope not! Thx.

While I think there are LPNs who can be better nurses than RNs, the fact that anyone would make rude comments about a degree someone has earned is ridiculous. While working in a hospital, there was an LPN who constantly made rude comments about the RNs and what she "couldn't" do because she didn't have her RN. I finally told her if it bothered her that much, she needed to go back to school. I guess the focus here has become not that there are LPNs who are better than RNs but that so many nurses are sooooo unsupportive of one another.

I went back for education with the hope of being able to take better care of my patients. I really never thought I would have other nurses making comments like I've experienced. Anyone can go back to school; some are too lazy I guess, but those are the ones making the comments. In one ear and out the other I guess! Thx all!

I had three years of classes behind me and think I only took about 6 classes or so for my BSN. The toughest thing was the capstone. You have to put a lot of hours into that, but you choose what you want to do and the school is really flexible in allowing you to do something you want in nursing. I worked with the nursing management at my hospital for my credit. Others had some really neat ideas though; one nurse worked for the state in forensics, another worked in a wound clinic, another worked in L&D, etc. I could be wrong, but I believe all classtime is in the evening for your BSN. I took no more than two classes at a time and did fine. I know all about getting that ADN - it took my whole life too and when I started I had a 3 year old and an 8 month old (what was I thinking!?) So even though I didn't have the pressure of very young kids when I went back for my BSN, it was still easy. Maybe if you have a bachelors already some of those courses can be used for your BSN. I'd definitely look into it. I say go for it; you'll be fine and very happy to have it over. If you've never taken online or hybrid coures before you'll see they are much easier than having to take every class at a school.

I was 44 when I completed my BSN and there were many my age in the classes. I ended up going to NEC for my Masters and took mostly hybrid courses for that degree. While hybrid and online classes can be viewed as "easy" some are, some aren't. The best professor I ever had in my life was from NEC. He was tough, but boy did I learn a lot. Anyway, I say go for it. If you haven't taken any hybrid/online courses yet, I think you'll find them to be easier as you can log on anytime you want. I have three kids and often they wouldn't even realize I was back at school since so much of it was done online. I'm not sure if I could have gotten through both degrees if it wasn't for these up-to-date options! Good Luck!

Thanks for your post. I've been doing MMQs for about six months. I work for a large company. Corporate really pushed to take credit for things that truthfully I felt they were pushing it. Needless to say the audit was horrible. I feel as though I was self-taught as my corporate boss was never around. She wouldn't even return my emails when I asked questions. The auditor was a wonderful support for me. I was pretty upset about the audit even though I did have my corporate boss there telling me how things should be coded. I now know the auditors are great resources for MMQ nurses. I'm under the impression that smaller, private LTCs do not push so hard to take points that are borderline. While I believe in taking credit for what is done, I do not believe in going over the line like the larger chain LTCs often do. Regarding nursing summaries, what date is used on them? Is it actually the date they complete the form or is it a work in progress and they sign/date on the last day of the month? For example if behaviors are assessed and they have 10 days by the 15th, but the nurse's last day to work in the month is the 27th for example and they didn't have 15 days on the nursing summary, however the ADL flowsheet shows that two days after the 27th behaviors were recorded is that acceptable? Can a nursing assessment be dated the 15th if some of the days you need for behaviors don't occur until after the 15th? Some of our nurses will write > 15 days on the 15th even if they only have 10 days at that point, but the resident is sure to have behaviors nearly everyday and they will have 15 days for the month. Someone told me they shouldn't date the nursing summary until they have a full 15 days for behaviors. Hope this makes sense Thanks for your help!

OMG! I can totally relate to your post. I feel foolish that I spent about four years in acute care, from med surg to ICU and now I literally fear running into trouble and freezing at the LTC facility I work at. I do clinical reimbursements and am an RN, BSN, MS. Do you know how many nasty comments I've had said to me because of my education? I NEVER flaunt my degrees, but I earned them. Does it make me a better nurse? Absolutely not. Some of the LPNs are amazing! I really need to put some time in on the floors, but am worried sick. I've been off the floors for about three years and have lost all confidence. I have the same worries you do. Plus, I've never worked in LTC on the floors. I have such stupid questions! At the hospital you just call a code if you need to. What do you do at the LTC? Do you always call 911? What papers do you send with a patient? What if you call 911 and they're a DNR? DNR doesn't mean don't do anything. What if a patient falls? Do you get them up or just call 911? I had a nurse say how stupid someone was that a patient fell and they put them in the bed. Well don't you just assess them and if they're okay, you put them in bed and continue to assess? I just have a ton of questions. Anyway, your post hit home! Hope all is working out for you.

Yes I got my BSN from Rivier a few years ago. Some classes were online, some were hybrids. I don't think I had any of the BSN courses that were class-only. I didn't have a lot of classes to take though. I got my RN years before and finally decided to go back to finish my BSN since I only had a few classes. I couldn't believe how easy it was to get my BSN. Getting my RN was a killer (at least it was for me) and getting my BSN was a breeze. I encourage you to go for it. I ended up going to get my MS right after I got BSN. Glad that's over! I'm shocked at how some of the nurses act because of my degrees. I don't flaunt it, but I have the degrees and they're on my badge. I worked hard for my degrees, but fully understand some LPNs make better nurses than some RNs. I suppose it all depends on where you work. Good luck!

I always worked in acute care until 6 months ago when I got a job at a LTC facility which is where I always wanted to be. I have my RN BSN MS and worked VERY hard for all my degrees. Do I feel I'm better than anyone else? No way! Do others make rotten comments about my being an RN? Oh yeah! Just today, an LPN, who has a great position, cut down one of the RNs and said "he's an RN! Yeah right, he's no REAL NURSE!" and looked at me. I lead a life where I'm nice to everyone from the janitor to the top dogs! I really don't believe anyone is better than another. I'm sick of having rotten comments made though and really don't know how to handle it. It makes me wonder if my desire to learn the LTC area is a mistake. Is this the norm or am I just working at the wrong LTC facility? Thx.

I left a hospital to persue Case Mgmt at another hospital and did not have to take a test to check my nursing competency as I was not doing hands on nursing for that position. I have now finished my Masters and would love to return to my previous hospital in a quality control position, again not hands on, but am worried they'll have me take a nursing competency test upon hire as I had to do when I was originally hired by them. I'm shocked at how I forgot so many details about hands on nursing. Does anyone know if most hospitals require their RNs to take competency exams if they are working in management/quality control? If so, any idea where I can get some practice questions? I cannot remember anything I needed to know when I started nursing or what the test was like! Thanks!

I've been a nurse for a few years and just received my MS. While I also have my BSN, I just cannot find my niche. I spoke with one nurse who said it took her over 20 years to find her niche! I can't wait that long. I've been a floor nurse and while I believe I was good at it, I took my work home with me and it was exhausting. When I spoke to my bosses who were always supportive they stated they were the same way and "good nurses tend to do that!" Not really a big help. I ended up going into Case Mgmt and worked for one of the Directors who has one of the worse reputations. I didn't know that at the time. She was terrible to work for, but I survived a year per diem. I left as I was offered another job elsewhere (non bedside) with a subacute facility. I really thought I'd like it, but the place is part of a huge national LTC company and this one place is ready to be closed by the state as their recent review was so bad. I feel like I just keep getting the worse positions; those no one else really wants. I don't know how to find my niche. I have three kids and am busy, but would love to work from home and have flexible hours. I've known other CM's who have done this. How can I find a job working from home? Does anyone have any ideas of flexible nursing jobs? I hate to lose my license by not working in a nursing position, but I've been finding nursing so depressing! Gosh, the place I'm at is terrible. I feel so bad for the patients and the care they receive. I'd love to just leave now and not go back, because of the quality of this place, but then I'd be jobless. While I can live without a job, I don't know that being jobless is going to help me find a new one. I suppose I could use the fact I just finished my Masters as an accuse for not working, but don't prefer to do that. Help!!!

I'm sure you're right. You think an ADON job would work? I thought I'd give it at least in a year in my current position and then consider it at that time. I really don't see the acting DON doing anything all that impressive but she's not the permanent DON so that could be part of it. It is an important position, so experience is important. Thx!

I currently started a job in a LTC facility as an MDS Coordinator. While I'm excited to learn the postion, I met some nurses who believe I should try for the DON job they have open. I'll be receiving my MS in the next month, have about 4 years acute care experience before leaving staff nursing to take a CM position for the last couple years. While it was a tough decision to leave acute care, I believe LTC has so many more opportunities. At first I shot down the idea of my taking the DON job, but then after thinking about it, am wondering if I should consider it. While I need to learn more of the rules and regs in LTC, my concern is being away from bedside nursing for a couple years. Can I handle that part of it? I've seen some DONs who end up having terrible nursing skills, but are great with budgets and managing issues that come up. I suppose the clinical part would all come back to me. Perhaps my biggest fear is that some of the staff are horrendous! I hate the idea of having to be responsible for them. Is this idea of being a DON just a dream? Any suggestions?