JVLims

I've been a certified hospital case management RN for many years and at one point decided to get my Masters'-I was not interested in management (been there, done that) or academia at the time so I earned my MBA. I do think it gives me a unique perspective on some of the stresses and strains on the health care and insurance industries and knowledge that allowed me to become a better advocate for my patients.

You could apply but without a solid clinical base in the area of case management desired (I.e. acute care, population health, primary care) it would be pretty difficult. School nursing might prepare you to do peds case management, particularly in a primary care setting where your current skills might best apply.

Congratulations on your unexpected but beloved bonus baby! It seems like a bad idea to leave mid contract, but if the pace and demands are affecting your health (and by extension, the baby's-though those little passengers take everything they need from you, leaving you with the empty tank}, perhaps there is a way to exit via a medical leave. Of course, this does not solve the issue of you being the sole breadwinner. You may be able to take a less well paid but also less demanding job, or your spouse may have to step up to the plate and either go to school at night and take a day job, or simply put school on hold for a semester or two. My spouse went to school full time (with clinical rotations some hour away) and worked nights when our second child was born. It's difficult but sometimes our spouses have to put their plans on hold just as we did to support their goals. Do not stay in an overwhelming, exhausting job if you can help it-you may risk errors or injury to your patients or yourself. Hope all works out well for you! I'm from MA too-it's hard because our cost of living is so high there really is little opportunity for most families to make it work without two incomes.

IMHO you are in a good place for someone new to practice. ICUs in teaching hospitals are wonderful places to work (and I know, having worked at a Level 1 trauma center ICU) but can be an overwhelming place to work while you are getting your feet wet. I can't count the posts on this forum by new nurses who sailed into a first job in critical care only to regret it later. You need time and space to not only gain clinical knowledge and experience, but organizational and interpersonal skills as well. The nature of ICU nursing, with its limited but intense patient caseload will be easier to navigate after you have obtained valuable experience. Your current place of employment sounds like a welcoming and comfortable place for you to hone your skills. Many new nurses would give anything to have a first experience like yours. I say stay put. If the other hospital wants you now, they will want the more experienced you later.

@rainmom....Preeclampsia and eclampsia can surface prior to delivery, during the peripartum period, or during the 6 week postpartum period!!!! What the heck is wrong with your obstetric unit???? If they can't manage postpartum onset hypertensive disorders, there is something seriously wrong. But i digress....we would contact the social worker. In our hospital, DCF is often consulted to take emergent custody.

This would necessitate a social service consult to assist with either scouring the landscape for family, friends, faith community to come take supervision of the child (or even stay with the child at the bedside while arrangements are made) versus a protective filing to alert DCF to arrange emergent foster placement. The focus would be to be as creative as possible to support the family.

It is a tragedy and so terrible to think people are still being targeted for who they love. All thoughts and prayers still going out to all affected by this senseless act of cruel hatred. BTW...Straight but not narrow! Hatred cannot stop our seeking equality for our LGBT friends, colleagues, and family.

@Marilyn411...OP seems to be one of many newly entered into our great profession who are extremely dissatisfied right out of tbe gate. I am a case management nurse now but prior to going to CM i had varied acute nursing experience x years, been a nurse 30+ years total. People entering the workplace nowadays seem to feel that their increasingly expensive and lengthy educations will somehow confer a pink cloud of happiness and professional satisfaction rather instantly. Thier posts suggest landing with a pretty terrible thud once (and if) they get their first gig. I truly understand the anxiety around just getting work...when I graduated, there were no jobs-took about 3 months to find a part time 3-11 job and I was grateful for it. Having said this, I hear a consistent ribbon of bitter dissatisfaction with the job, the patients, the rules and dictates of their employers, and their coworkers that makes me feel sad for our profession. The median age of a nurse in the US is over 50; who will continue to represent our craft?

Fyi, agree case management is less physically demanding but our liability is no less. The burden of ensuring a safe and effective discharge plan for patients is a heavy one. Our clinical assessment of the patient, knowledge of entitlement regulations, familiarity with community resources, interpersonal skills, and ability to negotiate with all stakeholders are key to developing and implementing a safe plan for patients who are heading to the next level of care sicker and after a shorter period of hospital care than ever. Add to that shrinking resources and reduced coverage for care and I hope you will reframe your thoughts about our liability. I love case management but it is not easy-especially when you have to fight the insurance company, the attending, the resident, the family members and often the patients themselves in order to ensure a safe discharge plan. For this and many other reasons I included in my original response to the OP, I respectfully think she is not cut out for case management.

Elkpark, your program sounds a lot like my ADN program. We were responsible to go to the clinical site a day before to research our patient and had to be prepared to address whatever disease process was affecting them. Pre and post conference were held in a meeting room, not in an area that proved inconvenient to staff or HIPAA-imploding...we ended the program as team leaders with an assignment. All med passes and new clinical skills were under the direct supervision of the CI. We never expected this of the staff nurses, agree with your observation that many I see have a rather loose, boundary free relationship with their students that I find troubling. Recently I observed one CI disappearing for a goodly portion of time when students were still on the unit. I can't understand that.

Did you really apply for and accept a case management job not understanding what it entails? Can you envision a nurse landing next to you on the tele unit saying s/he didn't know anything about tele but thought s/he'd give it a whirl? Not trying to sound harsh, but case management is a specialty that is fast paced and involves a steep learning curve. Your experience will no doubt help you since internal triage is a necessary component of what you have been doing on tele. Case management nursing has multiple foci, the central one being advocacy for the patient while moving them through the care continuum at the right pace with the right resources to achieve best outcomes. It's marked by a lot of competing objectives, like supporting efficiency, keeping cost of care under control without sacrificing quality of care. It requires a deep knowledge of both state and federal entitlements and local/regional resources. CM requires great nursing assessment skills as you are often the person who brings all stakeholders together to advocate for what next steps will lead to a safe and effective discharge plan. You will need that thick skin you referred to and all your charm because you will be present at, and often leading, difficult discussions with families and patients, especially when their unrealistic expectations must be addressed in a firm but kind way ("why can't my mother stay another week in the hospital? What do you mean my insurance does not cover this treatment? I have Medicare, what do you mean it doesn't pay for everything?"). Add to this taking an assertive role with doctors on both collegial and unpleasant subjects alike and, if this still sounds good, get yourself some books on case management, join ACMA or your regional CM professional organization. Go to the CCMC website and start learning.

Typical week for me: clinical twice weekly at different sites, one a good 45 minutes away from the college. Would compare it to a part time gig. ADN, so by 4th semester we were team leader with an assignment of 3-4 patients on 3-11, community hospital site. 1st semester clinical was at the hospital's LTC/swing unit learning basic bedside care and organization. OB and peds more limited. Psych at a large state hospital on a locked unit. Studying never ever stopped. Worked in a mall 2 jobs off hours and studied all the time. Prep course for boards, passed 1st time, thanks to my program, the review course to build my confidence, and lots of studying. We did NOT have choices. All commuted, those commuting furthest had first pick of sites nearer their homes. Other than that, no. Have to say for new nurses I believe structure trumps choic. I read a lot of posts here from new grads who had lots of choices within their programs and they sound rudderless once they are in the workplace. Structure, even that which limits choice, helps give new nurses room to grow, IMHO. What was my nursing school experience like? A boot camp with a degree conferred at the end...and I probably would not change it.

At the risk of sounding old school...students have changed a lot as a group. There is a sense of entitlement and an undeserved superiority complex that sometimes comes across. When we were students, we recognized and respected that the nurses teaching us were at work and we were visitors in their world. Sometimes it's the little things....like taking up every computer in the nurses' station or every table in the cafeteria so we can't chart or sit down for a hurried lunch. Sometimes it's hearing you speak with derision about our professional preparation. Sometimes it's hearing you complain about what you will or won't stand for at your first job when we knew we would start out on the worst shift, with the worst schedule, at the lowest pay. Sometimes it's reading this blog and hearing you all complain about our great profession before you have even made it out of school. Sometimes for me it's hearing my ADN preparation disparaged when it seems to have propelled me into a great place in my chosen field (please note: I earned other degrees but NONE of them prepared me for real life nursing like my particular ADN program). Sorry but you asked. I would welcome you if you were at our hospital-but immature behaviors often wear out your collective welcomes quickly.

Please, please, please do yourself and your patients a favor and do NOT become a hospital nurse case manager (or perhaps, a case manager in any setting). We are out there on the front lines just as much as you are at the bedside, just in a different way. If you don't like difficult patients, demanding families, unappreciative doctors, a spectacular lack of community resources and obstreperous MCO interactions, I can guarantee you will hate case management. I personally love the challenge and for each difficult situation I experience 5 awesome and fulfilling ones....but you sound like one of those nurses who literally says at the job interview for the CM position something to the effect of "I got sick of working so hard on the floors so I thought I'd try something easier, like case management". EPIC FAIL. BTW, your 1.5 years of experience is will not qualify you to apply for most CM positions, anyway; 5 years' acute care experience is usually required.

Please don't generalize. Statutes governing care vary from state to state. Our locked unit almost never uses physical or chemical restraint. The entire unit is retrofitted to prevent the use of things like fixtures for self harm or harm to others. In our Commonwealth, we cannot give meds over objection without first obtaining a court order in court sessions held our unit unless there is imminent danger-a high bar. Generalized training may not prepare nurses in the way that your specialized training does, but it gives our nurses a good foundation from which to start. Having said that, our patients are often more similar to a forensic population and occasionally, dangerous situations occur when you are dealing with an unpredictable and acutely destabilized population.