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What you need to remember is that your job has changed. You are not caring for your patient in the hospital, you’re planning the care your patient will receive when they discharge from the hospital. You’re looking at the patients needs right now and what setting they are most appropriate to discharge to. If there are therapy evaluations, they help a lot. Can the patient go home in the condition they are in right now? Can they feed themselves, dress, bathe, toilet themselves? Can they manage their wounds? Their movement around the home? Climb stairs? After you get a good clinical picture, go in and talk to the patient? Will they have help at home? Do they feel they can safely manage themselves at home? What is the best setting? Home with home care? Skilled nursing care? You are looking across the continuum to see where is the best fit for your patient. If the hospital has a social worker, schedule a meeting with him/her. They will be an asset to you and you will gain a lot of knowledge. In the best world, case management and social workers work together.

Hi there. If you've done case management you should try working for an insurance company. Many are opting for working from home. Your experience makes you a perfect fit.

I felt the same way you did. Some people call it burn out, others just call it tired. I was tired. I found a good job working for insurance companies, but there are so many choices out there. Don't feel badly about wanting a change. It's your choice. Do what feels right for you.

Thank you. I will try there.

None know anything about certification in Utilization Management? I've worked in CM and UR for 20 years. I was a CCM at one time but I let my certification lapse. I am now looking to fulfill a goal of certification in UM but I've hit a brick wall. Any leads?

I am very sorry for your loss. She should never have died. Hopefully the changes that are made will assure that this never happens a again to another person. She was a beautiful young woman. What a senseless tragedy.

Allnurses has helped me get through the most difficult times of my life, from the breakup of my marriage to the carreer choices I have made. I know a place where everybody is a friend. gr8rnpjt PA

If you are a caffiene junkie, (coffee, OR tea, OR caffeinated soft drinks) I would suggest you stop the caffiene right away. Nothing interferes more with a good nights(days) sleep than too much caffiene. Even if it never bothered you before, it could become a problem at any time. Your description of your sleep patterns are exactly what I went through when I worked nights. I quit drinking coffee, and developed a rebound headache. Instead of working through the rebound, I turned to medication which in my case was Fiorocet, which contains caffiene. Once I quit ALL caffiene products and worked through the rebound headaches, I finally was able to sleep again.

You're being too hard on yourself. We all had doubts in the beginning, that's understandable. You need to work through those fears and remember what you did all the hard work of nursing school for. You are your own worst enemy. Don't let the negative thoughts consume you. with

I left bedside nursing after 8 years of solid Medsurg/Tele experience. I have always worked for insurance companies, but have done every imaginable type of UR/CM nursing. I worked onsite at hospitals, worked in office settings in a large metropolitan market. I did CM jobs and UR jobs and eventually found my niche in UR. It is a great job. I love the hours the pay and I am currently working from home. I telecommute, all my coworkers work from home and we have daily call in meetings. The company I work for has gone through many changes all good. I would recommend any job CM, DM (disease management)or UR job. When you get your foot in the door, you can go practically anywhere within the managed care arena. Managed care is not going away, even with universal health care. I have a couple of suggestions. 1. take any UR or CM job you can take. You wil get your foot in the door, and you will be able to transition more easily to another job if you find UR boring. 2.Subscribe to CM magazines to help you figure out the whole process. You will get a feel for what is expected of you. 3. once you decide, work on obtaining CM or CPUR certification. It helps get the better jobs out there. (I was a diploma nurse with a solid skillset for bedside nursing.) That is what they want. But once you start working in this arena, certification gives you a leg up on the competition. 4. The job will keep you informed on new policies and practices in the hospital nursing world. If something comes up during a review that you don't understand (a new piece of equipment, or a new lab test, ask your counterpart at the hospital for more information. They will be happy to help you understand. 5. The CM world is forever changing and evolving. Be prepared to grow and change as your responsibilities grow and change. Remember change is good. 6. Remember that your job is very important. It is different from bedside nursing but it is an important function just like any other job in the nursing field. I can't think of anything else right now, but I would be happy to answer any questions you have. I have worked in every company in the the big city I work near. I have done every CM/UR job there is. I have been in managed care for 22 years. I am not sorry I did it and every job I have left was for a better job. I would not trade the one I have for anything. If I want to sleep till 7:45, and start work at 8 in my jammies, I can. If my kids have a snow day, I don't have to worry about day care. I have all weekends and holidays off, I don't wear a uniform, and neither do I have to dress up anymore. Jammies or sweats are my dress du jour, and I love it. I make more money than I ever expected in this job, and the peace of mind and lifestyle is the best I have ever had. There is stress, but it is nothing like the stress of bedside nursing (which I remember fondly). Good luck if you decide to take this new job.

When I graduated from nursing school (in 1980) I married a month later and took a 2 week honeymoon to Nassau, Bahamas, and St. Thomas. I stayed at the Frenchman's reef in St. Thomas and we took in the culture and flavors of the various resturaunts in Charlotte Amalie. We took a cruise in a Chinese junk and gazed at Cassiopea and I told my husband I wanted to return every year..or even live there. Then one morning I woke up with a rash and swelling, and, knowing that I may have eaten something I was allergic to, went to the local hospital possibly for benadryl or a shot of depo. Anyhoo, we showed up at the hospital and were directed to the waiting room...which happened to be the parking lot. Oh, yes. But of course, that was 30 years ago and obviously things have changed, probably a lot. But I had to respond when I saw the title of your post because I remember that I always wanted to work on a beautiful island like St. Thomas.

Wow! That is a horrible story! Thank God his son spoke up. That is a sobering alternative to the hug debate.

First, Congratulations on graduating and obtaining an internship so quickly! Don't be discouraged, it happens, everywhere! Be glad that the unit that said they didn't want you did so because that would have probably been a terrible unit to work on! Good luck with your new position and don't let what was said discourage you. Keep working hard and offer help when you can, accept it gracefully when others offer it, don't let anyone get you down, if anyone gives you problems, let it roll off your back, be friendly because that is a good thing, and remember when you have more experience to be nice to the new ones. I think you will do fine.

Back when I was in bedside nursing, my specialty chose me actually. Or the staffing people chose my specialty. They kept floating me to telemetry. I was afraid of the monitors. I didn't know what was a good strip and what was bad. I asked a lot of questions and wanted to know more. The nurse manager asked me to come work steady nights on her floor. I told her I wouldn't mind it but I didn't understand telemetry enough. I agreed to work there if they would train me. The next month, they started a telemetry course for the new nurses on the floor (there were 5 of us) So my specialty was chosen for me.

I had a patient recently that had one as well (not this one) and hers went to her lungs. She was on a vent for a few days and recovered completely after a couple of weeks. Very scary, and unbelievable how devastating the outcome can be.

I'm so sorry this happened to you. It must be hard to have to walk away from your dream job. If you were to have another job,what would you want to do? Can you type well? Do you want to work from home? Many insurance companies now offer work from home positions. The company I work for highly supports the work from home option. In fact, 20% of our work force world wide works from home. So that is an option, if you live near a large city, look for insurance companies in your area. There is a need for NICU nurses to follow NICU babies telephonically. Look online. That would be my suggestion as working from home has always been my dream, and I have been working from home for the last 3 years. The pay is good as well.

afrocentricRN, You did a great job advocating for your patient. I know how it affected you. I too was at my grandmothers side when she left this earth. Her pain was very well controlled in the end, so I did feel good about her passing. I also wanted to commend you for what you do every day in the ER. It's a difficult job, and its good to know that there are empathetic nurses on the front lines.

I can understand your concern about calling the insurance company, however, chances are the bill will still be paid, but the hospital will be flagged for a quality issue. Too many quality issues and the hospital could lose their contract with the insurance company. Either way, good call on diagnosing yourself.

I would agree with everything that has been suggested already, with a little tweaking. I would warn admin of her plans to call the admin on call every time she is unable to locate the RN in charge. Then follow through. And I would suggest she look for a different job. However, I would never quit a job until I had a new one lined up. Good economy or bad, it's just not a good idea to quit one without the new one in the wings. Something could fall through, and she may be stuck without a paycheck for a couple of weeks. And nothing coming in means bills don't get paid. Just sayin..

I started nursing school with a girl who was so squeamish, she actually fainted at the sight of blood the first time she saw a blood draw...down on the floor, fainted. She continued through nursing school and continued to be squeamish, but she became a good nurse because she hid it all very well. The patients never knew, and the instructors had no idea either. I would suggest keep looking at the books, and try to read some of the text that describes what you are looking at. If you continue to be interested, remember that there is nothing you can't handle once you have completed school. Plus, there are jobs that don't include bedside care so if you decide on an office job, you can have something to strive for.

I was an original participant in the first Harvard nurses health study. The nurses who have participated in the study have contributed invaluable information to the study and it takes very little time and there is no cost, ever. I too, got my letter in the mail asking for my help in encouraging participation in the new nurses health study. I urge all nurses who qualify for the study, to become a part of history and research. The information gathered is invaluable. Become part of history (well maybe that is going a little overboard, but , whatever, please consider being a part of the study)

Agree, you can and should report it. Will it go anywhere? Probably not. But it may be something that will make him less apt to do it again to YOU. Don't be afraid of any doctor. Just becaue they have an MD after their name they are not above the decency and respect that they expect from you. You can confront him as another poster said, but again, it could make him only more angry and confrontational.

Keep your chin up. I work in managed care and I can tell you, patients are spending less time in acute and our medical directors are pushing for more patients to go to skilled care if they cannot quickly and safely be discharged home. We in managed care highly value a good LTC with a stellar reputation. The nurses in the LTC's are the front line for making a great LTC facility.

First of all, congratulations!! you're almost done! That is a great accomplishment, and you deserve kudos! Regarding your question, I believe letters of recommendation are saved for after the initial interview. I may be wrong, but the last time I interviewed and needed letters of recommendation (like 10 years ago!) I had them ready and handed them to the interviewer after our interview.

Keep trying. Not every employer is like that. I know the shortage is over but there are still good jobs to be had and employers who respect staff. Look at it this way, if they would treat a prospective employee like that, they probably treat their actual employees like crap.