dennis8

I'm still early in my nursing career but I've tried long term care, medsurge/tele, and I've been in hospital case management now for 2 years. I wasn't burnt out in medsurge but I was still at the stage where I wanted to find something I would enjoy doing and would play to my strengths and personality. Case management is very up my alley. No physical patient interaction. Lots of phone calls, faxing, and talking to patients face to face for DC planning. If you are physically burnt out, I think case management would be a good fit. I'm not sure what your job prospects are where you live but in my area it's quite difficult to land a CM job. I got lucky because I applied for the job at the same hospital I was already working at. Good luck!

As the previous poster stated, everyone's views on adequate training and a good facility will differ between opinions. Personally, 6 weeks for a new grad in an LTAC seems kind of short, but it's better than what most places would offer (I only got 1 week at a skilled nursing facility as a new grad, I jumped at the first offer that came my way.) You weren't specific with the facility details, but LTACHs do have different units. Will you also be floated to the ICU? Considering many of these patients are very sick, I would clarify what kind of patients you would be handling and your responsibilities. And as the previous poster also mentioned, it's better to have a job than no job at all. If you end up not liking the job, I would use this as a stepping stone for the next one. Good luck!

Hello OP, I've been doing hospital case management for 2 years now. Before I went into case management I was balancing 2 potential offers, one from a Medical clinic with multiple branches and the other from the hospital I currently work. At the medical clinic I would be following a population and following their cases. Inpatient case management will definitely open more doors for you in the future and I believe it will expose you to more aspect of case management as you deal with representatives from Long term facilities, other hospitals, long term acute care, home health agencies, pharmacies, hospices, etc2x. I found that it would be much easier to transition to a population case manager role from hospital case management in the future than the other way around, and Im certain the pay would be much better in the hospital too. Good luck!

At my first job I was an RN supervisor at a LTC doing nights. RN's were 12 hr shifts and LVN's/aides were 8 hrs. I always had a difficult time filling the night shift (someone always called off for the 11pm-7am, especially weekends). We had 3 wings and at a minimum we needed 3 LVN's to run the 3 medication carts. When I asked the staff what the previous supervisor would do to remedy this situation they said the RN supervisor would either take the run or the 2 other LVN's would divide the 3rd run (not me!). How am I or the other LVNs supposed to do our own work if we had to take on more work than we can handle? Luckily there was always this one LVN from PM shift who was willing to stay over till about 1AM to help pass meds. Administration had the gall to tell me that they didn't like how they were racking up so much overtime pay for this employee. I'm glad it wasn't too long before I found a hospital job and never looked back. Sorry for going off on a tangent, but DudeWIthTheBigDog is on point. Either they need to staff people adequately or the cycle will just continue.

Hi Katstorm340. I’ve been doing hospital case management for about 2 years now and it is purely non-bedside. Depending on where you work, your duties can involve having to utilize your nursing skills. Some positions that say “case manager” may actually involve physically assessing patients, performing wound care, IV insertion, etc. I know most case manager titles in home health actually involve driving to patients homes and doing assessments and nursing interventions. Did you apply at a clinic or IPA? Because it sounds like it. I know your post was posted over a month ago, but maybe you can try asking if you have the option of not having to perform nursing interventions. Sounds like they also need your help to fill in staffing gaps.

Unfortunately it’s been so long that I forgot where I got my information. I think I ended up asking the teacher to point me in the right direction.

Hello OP! As a poster above has stated, I think dissociating yourself from your patients' issues can help a bit in toning down the mental stress you get from these type of patients. I worked in a med-surge/tele unit for 2 years and some months and I agree that treating these patients was more difficult than the others. I have since moved on to hospital case management and I get to see the other side of the situation with these frequent fliers. It is a bit disheartening to hear the insurance case manager on the other line telling me "I knew Mr. Doe was going to be back there again." But I guess it's just a reality check that no matter how much good we try to do for our patients, there will always be the minority that chooses to keep down their path. You can lead a horse to water but you can't make it drink! I do as much as I can for my case load when I'm on the clock and I go home every time with a clear conscience knowing I did my best.

What you feel is normal for any nurse who is new to the hospital bedside. It will feel that way at first, but it gets better over time. Always ask your preceptor questions. Don't attempt skills or tasks that you aren't comfortable doing unless your preceptor is around. In terms of non-bedside nursing, getting those kinds of positions will require some years of bedside experience for the most part.

Hi, I actually did not. I hit the 2 years and 3 months mark in med surge and felt like I needed to do something entirely different. I am now working as a case manager in the same hospital. It is a part-time position so I still am thinking of applying to a medsurge position per-diem close to home just to maintain my clinical skills.

What Kgs2017 said. The only thing I used to study was Uworld. They have about 2,000 questions in their bank. I reviewed for NCLEX in 1 month. I would wake up, do about 75 questions, remediate, and jot down unfamiliar content. That was my daily morning routine. When I finished all the questions, I would go over the notes I made over unfamiliar content. The questions are very similar to what I took on the NCLEX. Don't over study either and give yourself some days in between studying to clear your mind. The day before the exam you should just wind down and relax. If there's any advice I can give when you take the test, it's to not second guess yourself. Your first choice is usually the correct one. Good luck!

My suggestion is to apply to every nursing job you can find. Go to every interview you can get, and weight out your offers. Any experience is better than no experience while waiting out for that hard-to-land hospital job. It will look much better on your resume. I would not bet on grades alone. Also, do you feel that your interview went well? Try practicing in front of a friend or family member and see what they have to say. Sometimes we need an outside opinion to see where we can improve. You don't want to be without a job for too long. The longer you wait, the more and more "fresher" new grads who look more appealing to hire will be pumped out from the local nursing schools. Good luck, you got this

The only advice I can give is to have a sleep routine. Go to sleep and wake up at the same time every day, even on your days off. Your body will eventually get used to it. I don't even need to set an alarm, my body just wakes up around the same time.

It may seem strange, but I find it very believable. I don't know where OP is from, but in many Asian countries, students start college early due to different academic systems. I was born in the US but studied abroad for high school and college and I got my first bachelors degree by age 18. Here in the states, I know of 2 people personally who got their bachelors degree in nursing by age 19 from American colleges. Some people accelerate early, skipping a grade or two if they meet criteria. Everyone's personal situation is different. To OP, I am 28 years old but look younger than my age. I work as a case manager right now and some people give me bad stares. One of my previous coworkers in med surge whom I have now lost respect for told me "case management is a specialty that you go into once you're old or become disabled." Your situation might be a jealousy or insecurity issue on the part of those nurses.

The only thing I can think of that you can get into as a new RN that would offer M-F is a clinic job or public health. Working weekends and holidays are synonymous with hospital nursing for the most part.

Sorry for your loss. I feel your pain from losing a father, but it will get better. You will feel better with the flow of time and keeping the good memories of your mother. Nursing is the same, the longer you do it the more you will feel comfortable with it. About handing off report, I use to have a difficult time as well. I use the paper SBAR to guide me. It will also help as time goes along knowing the report style of your coworkers when you hand off the report. Some like a detailed report while others just want to get the most important details because "they are going to look it up anyway." And there are some that no matter how good your report is, they will always find a question that you will not know and it's okay to say "I don't know." I usually keep the old SBAR that the previous shift gave me and have a whiteout pen handy to change things like lab values or obsolete information so I don't waste time making a new one. My flow is usually patient name, age, date admitted, code status, where they came from (home, SNF, direct admit), diagnosis, important medical history (I only say pertinent history such as history of PE, diabetes, cancer, or what pertains to the admission reason etc2. the rest they can read up), oxygen and how many liters if any, diet status and if they take pills okay/feeding tube, IV site and fluids if any, wounds and wound care, voiding status and foleys if any, pertinent labs, pertinent imaging, and most importantly plan of care. I say this is the most important because most things can be looked up or seen but sometimes the doctor rounds and he doesn't put in his note right away, or sometimes a nurse forgets to write what the doctor says on the nursing notes. When I receive report I always ask what the plan of care is if the nurse didn't already say. Sometimes, I get "Oh yeah doctor so and so says he wants to do this procedure tomorrow so please make sure the patient is NPO after midnight." As I said before, the longer you stay in nursing, the easier it will become. Good luck, you got this!

Hello Oceanhugger! I graduated in 2016 from Kaplan College/BrightwoodCollege in San Diego (They are closed now though lol) and I feel your struggle. I actually live in Riverside County and made the drive to SD for school. My first job was at a SNF in San Bernardino. 3 months in I started walking-in to hospitals in Riverside County handing out my resume and I scored an on the spot interview with the managers and got a job a month later on a Med Surge floor. SD is a tough place for new grads. If your personal situation allows for it may be getting a job in Riverside County would yield more results. Literally, every SNF job I applied to in Riverside County with a measly resume I always got a callback for an interview. But new grad hospital programs are also in abundance here. I have a fellow coworker originally from SD relocate to Temecula for a year just to get into a new grad program in Riverside and then move back down to SD when he got that 1 year of acute experience. He's working now at Sharp. Don't give up hope! On the topic of working as a CNA. You can actually apply for a CNA certificate in the State of California using your schooling as a nurse for credentials. I actually did it while I was still in nursing school! The requirement was that you need to have finished Fundamentals. I still have the packet of documents you need to submit to CDPH if you want to do that. You can private message me if you want them ? Edit: I just re-read your original post. If you are willing to relocate anywhere I think there are some job postings I can recommend to you.

Hello Mr. Confused! As many have already stated, your age shouldn't be a hindrance to obtaining a nursing degree and finding work. I live in a highly saturated area for nurses in California and had a 39-year-old classmate who got into a new grad hospital program a couple of months after graduation. The only thing I can say is nursing isn't for everyone and I am just curious about your reasons for pursuing a nursing degree. To be honest, many people who take up nursing as a second career end up regretting it due to costs and shattered expectations. Real life nursing is nothing like the TV series or movies. It involves long hours on your feet, not being able to take meals or breaks in a timely fashion, mental stress associated with clinical decision making, physical stress from lifting, turning, and sliding patients in bed, getting berated by doctors, family members, and management, and maybe even getting verbally or physically assaulted by patients depending on where you work. But at the same time, nursing can be rewarding in a sense that you see your patients get better, random thank you's from grateful patients and family, and the feeling that you learn something new every day. But just like any job, there are pros and cons to everything. I think the best aspect of nursing is the ability to transfer to different areas of nursing that makes the job feel like an entirely different line of work. Whatever you choose to do, good luck!

LTC is tough, especially when you work the floor. My first job as a new grad was an RN Supervisor at a SNF and it was terrible not knowing anything and being the supervisor. Every day was mentally taxing, but I stuck it out for 3 months and landed a hospital job. Everything about the hospital job was so much better. The patient ratio is great, the coworkers are helpful, and the bosses are pretty good. 2 years and a few months later and I am about to start a new specialty in case management later this month at the same hospital. Just use your current job as a springboard to open new doors. "This too shall pass" is what I always tell myself in difficult situations.

There are worse scenarios that could happen regarding passing on an infection to different patients. This is minuscule in comparison. Forget about it and be more cautious in the future.

I hate doing med recs. "Uh, I take two of the pink round pills in the morning and 4 red square pills at night".

It basically just means that you can't run anything else in that line together with the blood. If you want to give an IV medication and all you have is that one line, you can still give the medication through that line as long as you stop the transfusion and flush the line. Your question sounds like something out of a textbook. In real life nursing, the answer will depend on facility policy. I personally never encountered an order to give IV Lasix during a blood transfusion. Usually, patients on fluid overload who need a transfusion will be given IV Lasix pre-transfusion. If you want a textbook definition of "dedicated infusion line", read your textbook.

Thanks for the reply. I actually have been looking at cms.gov for the past few days, I just feel like the information is all over the place and that it's difficult to learn things from the website unless you know what you're looking for. But nonetheless, thank you!

Hello all. Anyone in the CM field knows of any websites or tools that I can access online that can help a nurse new to hospital case management? I'm trying to research as much as I can before I start the job. I was hoping that there's an online resource that provides information regarding the most current rules and regulations on insurance, reimbursements, hospital length of stay, etc. I don't mind paying for something. I still have to undergo training, but I'd like to study up and not be too clueless before that happens ?

I did Uworld as well when I took my NCLEX two and a half years ago. What really helped me was doing ALL the questions and remediating each one of them. I was fortunate enough to not have any other obligations at the time, so I did all the questions in three weeks. I divided how many questions I needed to do every day to finish in that time period. I would do the questions in the morning and remediate in the afternoon and took weekends off to relax. It was a daunting task, but when I took my NCLEX there were so many similarities to the questions in Uworld that I was in disbelief. When using Uworld as your sole study tool, it is possible to pass without doing all the questions, but the more you know the better prepared you will be. I'm sure there are other question banks and tools that are helpful but I feel like Uworld was the most helpful for me.

I know it's been a while since I posted on here, but I wanted to give some closure to this thread. Almost a month has passed since I interviewed with my hospital for a CM position and I left a voice mail last week asking for an update. I ended up hearing back from HR two days ago and they said they are willing to take me on board and the reason it took so long was due to the budget approval. Apparently, she didn't want to give me false hopes so she waited until everything was approved, fair enough. The downside is that the position they are offering me is a part-time, weekends position on day shift. The upside is that the rate they are offering me is $16 more than what I am currently making and they are still going to fully train me before I go part-time. I asked them to let me think about it over the weekend before I make a decision. After speaking with a close friend that works in the CM office, I decided I will call them on Monday and take the plunge. Thanks to everyone for the advice on this thread!