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Pediatrics, PICU, CM, DM
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nfahren05 has 18 years experience and specializes in Pediatrics, PICU, CM, DM.

nfahren05's Latest Activity

  1. Would like to see mandated clerical/unit secretary support on all intensive care units 24/7/365. No way to enter routine orders for labs, consults, answer phones, etc., and manage 2 critical patients at the same time. Preferably would like to see this on all acute care units, but let's at least start with the highest acuity areas.
  2. There are a lot of older (55+) nurses dropping out of clinical positions because the hospitals won't step away from the 12 hours shift requirement. We are losing a whole generation of experience because many nurses are feeling too tired at the end of the longer shifts to give safe care, especially since 12 hour shifts often end up being 16 hour shifts when there are staff shortages. National quality organizations have already backed up relative safety of 8 hour shifts over 12 hours, and have urged facilities to consider a change, but 12 hour shifts are simpler to schedule so patient and staff safety has fallen by the wayside. Many older nurses cope by moving into education, quality, risk, utilization/case management positions, but it is leaving a knowledge gap at the bedside as the nurses who are physically able to run non-stop for 12-16 hours in the ICU or ERs are less clinically experienced than their older peers. Please, if you are in a nursing leadership role, find a way to schedule those experienced and technologically capable RNs in a reasonable manner, whether it's dropping back to 8 hour shifts, prohibiting 16 hour shifts, or monitoring the number of back to back shifts that nurses work. Your patients and staff will thank you.
  3. nfahren05

    BSN is a joke

    I wouldn't say that the BSN is useless, because it does add some depth beyond the ASN, but given the choice between a BSN and an RN with a specialty certification, I'd take the certified nurse in a heartbeat. The BSN really doesn't do much in the way of research (I had significantly more actual hands-on research experience while earning my BA than my BSN) although it does allow for some basic familiarity with statistics and critically evaluating research done by others. The BSN also focuses on some topics (e.g. community health nursing and leadership) that ASN and diploma programs don't cover well, but if those aren't your cup of tea, then pursuing the BSN is probably not worth the added expense in terms of time and money, and I certainly can't advocate for it for nurses who already hold a non-nursing bachelor's degree.
  4. nfahren05

    WHERE do I begin?!

    I found that it helped to know a fair amount about the US healthcare system and payer structures before that first interview for a CM position as a non-CM candidate. If you didn't have such a course in your BSN program (and most don't have sufficient detail anyway,) consider either taking a course or doing a fair amount of just general reading about the topic. Having worked for both insurance payers and hospitals, I've seen that it's generally easier to get a position on the payer side than in the hospital. They usually have deeper pockets for training than hospitals do, although certainly not as deep as in the past. Even if you can get a position through internal channels at the hospital, you'll come in functioning at new-grad level into a very fast-paced environment, and it can be brutal. I'm not saying that it can't be done, because obviously many nurses do exactly that, but it is a much more stressful way to start in a new specialty area. Not having your CCM is not a barrier to entry since everyone knows that you can't get it at first anyway (you are expected, in most positions, to get it as soon as possible) but it does close off some avenues (e.g. work comp CM since most states require certification) so look for positions that have titles like Case Manager I where there is a tiered system with CM II/III, etc. because those are ones where the employer may be expecting to be doing some training.
  5. nfahren05

    Is managed Medicaid the worst of CM?

    Managed Medicaid is one of the most challenging areas of case management, and (due to Medicaid reimbursement,) it's one with the highest ratios of nurse case managers to members. I've done hospital case management, commercial telephonic case management, and (for 6 long months,) a Managed Medicaid program similar to yours. We encountered many of the problems that you have found, e.g. members who were difficult to find, difficult to work with, and had benefits that made it difficult for the physicians to help them. I would have liked to stay longer, but the 400:1 ratio of members to CM made it impossible to get anything done, and created a huge liability risk for us as nurses. I was involved at the start-up of the project in our state, and would hope that things have gotten better by now, but I don't know. Most of the members do need social workers more than they need nurses, but for whatever reason, the company hired more RN's than MSW's. The initial assessments that we had to do for each member did require nursing knowledge and judgment, but after that, a social worker and a clerical person could indeed have helped, assisted by a nurse, only as necessary. As an answer to your question, I would say this this is mostly the fact that you were working with Medicaid, and that most telephonic case management is quite different.
  6. nfahren05

    Looking for a new career direction

    Although it's certainly not unusual, have you considered case management? Case managers work in a variety of settings and clinical areas. If you're not entirely though with obstetrics, but just need a break from the hospital, your experience would be tremendously helpful working "in the field" with homebound antepartum patients.
  7. nfahren05

    Questions to ask at interview for womens health floor

    Not having ever heard of such a floor, that's a tricky one. There is such a huge difference between the postpartum PIH patient and an ovarian cancer patient receiving chemotherapy that it seems a bit odd for them to be grouped together (although it's not unusual for a mother/baby unit to house routine post-hysterectomy patients.) I would imagine that most nurses would come from having either oncology or maternity experience, but not both, so inquiring as to the amount of orientation that could be expected to address the weaker clinical area would be appropriate. I would certainly want to ask whether antepartum patients would be on that unit, or if they would be exclusively referred to L&D. Are the babies of the postpartum patients also going to be your patients, or will they be cared for by the nursery (or NICU) staff? Those are just a couple of things to watch for, I'm sure other posters will have additional ideas.
  8. nfahren05

    Is the ANA worth it????

    I never joined because I didn't see that the ANA supported the nurses who provided direct patient care. Recently, however, more of my objection is based on the organization's overt political bias. While it's reasonable for a professional organization to support legislation that is relevant to the organization's goals and membership, it's not acceptable for that support to become unduly partisan. Instead, I spend my membership dollars on specialty organizations that better represent my needs as a nurse.
  9. nfahren05

    5 worse things a patient can do ...

    Most of us put ourselves in the patient's place each and every day in the clinical setting, but part of what allows us to continue to do that day after day, year after year is having our own setting: somewhere that we can vent. Few of us have not been patients at one time or another; we understand the frustrations that our patients experience when they are sick and scared, but it's okay for us to feel frustrated ourselves when some of them abuse the "sick role" to get others to do things to an unreasonable degree (or, worse yet, verbally or physically abuse the nurse.) Having this forum to express that frustration is important, and does not mean that a nurse or CNA is uncaring.
  10. nfahren05

    5 worse things a patient can do ...

    Ditto. I thought #5 was strictly a pediatric thing (along with the fingerpainting part,) even ickier to hear that adults are doing this, too. #1 is even worse when he/she was the one who decked you before getting slapped in restraints...
  11. nfahren05

    How can I start my own biz?

    There are a lot of different "start up" tasks for any business, and many books on this topic. Check out a few at your local library or bookstore. GingerSue mentioned several; getting a tax id, and squared away with the IRS is another biggie. Make sure that you are familiar with the law in your state; in Georgia, the full code is on the internet (probably is in most states by now) and this contains the exact verbiage needed for many business documents. And then there's your Medicare/Medicaid angle, a whole new area to research, and CMS is very picky about how business with them must be conducted. Expect to spend at least 6m-1y just researching your start up plans.
  12. nfahren05

    I really want a job in field case management! Help!

    It's very hard to find a part time position in case management; most positions are either full time, or prn. This is mostly due to the need for "follow through" throughout the week on actively managed cases. Part time CMs are more likely to be part of a job-sharing team than on their own. Have you spoken with nurses in your facility about how they got their positions, or if any are interested in job sharing? If you have several years of experience in nursing you may be able to find a hospital CM position where you can gain some experience. This will not completely eliminate the weekend/holiday scheduling (patients do have to get discharged on Thanksgiving and Christmas,) but it will greatly minimize it. It's very ususual, though not totally unheard of, for a new case manager to be put in a field position. Field CMs operate with little support, and this would be exceptionally difficult for a new hire.
  13. nfahren05

    Have I displayed drug seeking behavior??

    This does work with most insurance companies, if the reason is clinically sound. The OP needs to consider, however, the "rebound" effect that many triptans have when deciding to purchase additional medication out of pocket or processing an appeal with the carrier. More important than "how can I get more Axert" is the question "why do I need this much?" Getting both the patient and the provider to stop and consider this question is part of why quantity limits are set on certain medications (besides, of course, the financial burden related to certain high dollar drugs.)
  14. nfahren05

    Psych nurses suspended w/o pay after one pt. rapes another

    I'm sure that we will be hearing more about this case in the days, weeks, and months to come. The staffing will be the key factor: the clinical staff does have a responsibility for maintaining a safe environment so the nurses can not be totally "excused" here for this incident, but if understaffing contributed in any way, the hospital is going to have to shoulder the blame for its failure to keep patients safe as well. Unfortunately, "security work" is part of the job in psychiatric settings; nurses have the ability and responsibility for restraining and secluding out of control and aggressive patients. Nurses are also responsible for knowing what is happening to patients in their care. And, of course, the hospital is liable for making sure that their staff is able to carry out these responsibilities. I am very concerned that the nurses' counsel did not know this (see link to article in newspaper) when discussing their defense. I agree, however, with the above posters that the hospital should have suspended the nurses with pay while this is being investigated as this is what is commonly done in this, and other, public safety occupations.
  15. nfahren05

    how to help pt's finance meds?

    For nurses working in acute care and skilled nursing facilities, the social worker and case manager are your best resource(s). Especially for patients who "fall between the cracks" of the system (i.e. income too high for most programs, but too low to be able to afford their care,) the social worker can help identify and access these resources. While it's important to know about these social resources, nurse educators sometimes forget that it's simply impossible for the bedside clinical nurse to be able to do everything: provide care, teaching the patient about his/her follow up care, reinforcing the importance of following his treatment plan, AND try to solve complex social issues after discharge. In the outpatient setting, more of the burden for finding supportive resources is placed on the office nurse, but (where the patient has health insurance,) it can be shared by the insurance case manager, along with utilizing the strategies listed above for minimizing medication treatment costs. In short, you can't fix this one yourself; it's a complex problem that requires the cooperation of multiple parties, not the least of which is the patient him/herself, adjusting financial priorities, permanently or temporarily, to meet changing health needs.
  16. nfahren05

    Press Gainey AARRGGHH

    The scary part is that they probably already do. It's a trend that started in the boutique physician practices (e.g. dermatology, plastics, etc.) and is expanding into hospitals. There are obvious ethical issues involved when it gets into the ER, but do you really think that the consultants worry overmuch about this? Or hospital administrators either, for that matter?