Should I stay in case management or go?

Trauma Columnist · Dec 10, 2005

I am a case manager in the ER. Have you considered hospital case management? Personally, I hate the computer stuff (UR) but love the patient stuff. That might be one option. Another option would be staff nursing - if you want to get out of case management all together. That would give you the 12 hour shifts that you want. A third option is to go back to school and depending on what route you want to pursue, that would open up even more options. Good luck.

aaac · Dec 10, 2005

TraumaRUs,

I have thought about doing other case management but am afraid that it will not be any better because the hours are M-F. I enjoy the CM that I do now because I can work out of my house and travel, which changes things up. I am afraid to leave what I have and regret it and not be able to find a CM job working out of my house if I decide to come back. Likewise, I have considered going to CRNA school but feel I am doing it a lot for money. I am not sure that is a good reason to do it but have heard others do it for that as well. Do you know anyone that left the hospital and did case management and then went back to the hospital? If so, what was their reaction? Did they enjoy going back to the hospital or did they regret it?

Karen_tn_37211 · Dec 10, 2005

I went back to the hospital January, 2004 after doing case management (work comp) since 1995. I like it and am not considering going back to case management until I'm too old to do this any longer (I'm 45.) I like the 3 days or nights/week. It doesnt seem like I'm working all the time like it did when I worked M-F. Also, I'm making more money per hour if you consider the salary I made and often worked more than 40 hours/week. Plus I feel like a real nurse now....not just out there getting people back to work, billing hours and saving insurance company/employer money. I say go for it.

aaac · Dec 11, 2005

I went back to the hospital January, 2004 after doing case management (work comp) since 1995. I like it and am not considering going back to case management until I'm too old to do this any longer (I'm 45.) I like the 3 days or nights/week. It doesnt seem like I'm working all the time like it did when I worked M-F. Also, I'm making more money per hour if you consider the salary I made and often worked more than 40 hours/week. Plus I feel like a real nurse now....not just out there getting people back to work, billing hours and saving insurance company/employer money. I say go for it.

Thanks!

I think I am going to go back to the hospital hopefully picking up a few shifts for a few months and get my a feet a little wet before I jump ship. I want to make sure that I am okay with doing weekend and nights since that seems where the money is. Plus, I will make 4 years in March and would like to at least make it to that point. I am not sure on how I am going to react. I am not much of a morning person or a night person but I always say you can not have your cake and eat it too. I have considered going down to 30 hours and work 2 shifts a month at the hospital and likely make the same money. I thought about trying to do 3 tens with WC but you know how that goes. I think this will be my deciding year. If going down to 30 hours does not cut it, then I will likely jump ship.

Do you feel if you wanted to that it would be hard to go back to doing WC case management? I am not crazy about WC but I love the travel and love working out of my house.

Do you do weekends? If so, how have you reacted to doing weekends and holidays? What type of nursing do you do now?

Karen_tn_37211 · Dec 17, 2005

I just finished a travel assignment in California (6 months). I'm back home now. I dont mind working nights or weekends as everywhere I've worked I've gotten differentials for doing it. If something comes up I havent had any trouble finding somebody that will swap with me (most likely due to the higher pay). I'm thinking of taking a week-end only position so that I can make even more money. (Hospital I'm at now pays $5 more a hour just for working a weekend only position. This is in addition to the regular $2.00 per hour they pay for weekend hours.) I feel like I can always go back to case management without any problem.

RNLeavingTheOC · Dec 19, 2005

I too am having the same issue of staying in case management or going back to clinical nursing. I have about 3 yrs CM behind me and before that 7 yrs of ICU/ER. I got very tired of telephonic WC CM and switched to a utilization review position at a great hospital system. My advice would be to maybe try a different type of CM before completely going clinical. As far as the 12hr shifts go, you either love them or not-but time off during the week when you have worked M-F for years is priceless.

In my situation I am moving to Northeastern Arkansas in June 2006. I may have to go back to the bedside if I cant find a local CM job. That means recert of BLS, ACLS, PALS or do I finally take my CCM...decisions, decisions!

Good luck!

aaac · Dec 19, 2005

I too am having the same issue of staying in case management or going back to clinical nursing. I have about 3 yrs CM behind me and before that 7 yrs of ICU/ER. I got very tired of telephonic WC CM and switched to a utilization review position at a great hospital system. My advice would be to maybe try a different type of CM before completely going clinical. As far as the 12hr shifts go, you either love them or not-but time off during the week when you have worked M-F for years is priceless.
In my situation I am moving to Northeastern Arkansas in June 2006. I may have to go back to the bedside if I cant find a local CM job. That means recert of BLS, ACLS, PALS or do I finally take my CCM...decisions, decisions!
Good luck!

Thanks for the advice.

I am in the boat of decisions! My main issue is that I do enjoy case management but always thought that if I did what I loved I would enjoy working. I do enjoy my job to an extent but miss the chance to vary my hours if I want to do so. I feel crunched because I enjoy what I do to an extent but know I do not feel like working 5 days a week for 30 more years. Unfortunately, case management is a 5 day a week job. Plus, I would like to make more money. I feel stupid working 40 hours a week when I could work half that and make the same money. I have considered going back and doing prn work on the weekends and doing nights so I can get a feel before I jump ship. I am considering nurse anethesist or nurse practitioner program as well. I know that I do not want to work nights and weekends the rest of my life either. So, I feel in order to make more money and have more freedom with my hours it might be best to do the CRNA or NP program. I am 30 and not getting any younger plus I will need to get ICU before I do CRNA, if I go that route. I just feel that if I do another type of CM I will be burnt again in a few years and only older. Also, the discouraging part of my job in WC arena is that it seems that the laws dictate everything and no matter what you do I do not feel that I am impacting the case except as a messenger. It seems like everything that is disputed as unnecessary ends up getting approved anyway because of legal circumstances. YOu try to be cost effective and everything gets approved anyway. Is UR that way? I figure if I go and do ICU and try it and decide shift work is not for me and I do not want to advance my education then I can always go back to CM. How is working in the ICU? I worked on a busy med-surg floor for 3 years and was not able to provide adequate care to the 8+ patients that I had. Do you feel that way working in ICU?

RNLeavingTheOC · Dec 19, 2005

I totally know where you are coming from in regards to WC. My experience in WC was out here in CA, where 99.9% of my cases were litigated. I was going to be a field case manager but three weeks before I was going to make the transition from telephonic I asked my boss how the billing and salary worked-it was revelaed that I would make $5grand less but be able to bonus and make as much as I wanted (in other words how much I wanted to fluff my accounts)...that was it-I got an offer making more working for one of the Medi-Cal health networks doing transplant CM, still telephonic though. Burnt through that real quick-basically was a messenger in that role. Now I am working for a hospital based medical IPA group-we basically process the referrals for the PCP's and specialists. We cover members of several big name HMO's in our region. Its very interesting and great way to learn ambulatory care-especially if you want to be a NP someday. I use Milliman and Interqual for review criteria. There is no interaction with members, only the health plan, and the medical team. If I want to I can mini-manage a case or two short term, maybe help with a complex out of network referral or something. Hardest part of the job is the denial language and timelines. Other than that its a piece of cake.

The ICU is a great place to work if you can juggle tasks and prioritize. You may only have two patients but you will be busy between them both most of your shift. Investigate into Critical Care training pograms your local or regional hospitals may be starting up, usually in the spring or fall. A great chance to jump into that specialty. As ICU you will typically make more, at least here in CA.

Thanks for your response

aaac · Dec 19, 2005

Thanks for the advice too! The only problem about the ICU route is I will probably have to jump ship to do it. THey are not likely to train me to work prn. I figure I could do med-surg prn a few months to see if I like the shift work and if so do ICU for a couple of years and then make a decsion regarding CRNA or NP. I keep having this feeling that I will not know unless I leave. I guess I can always go back to CM. But, I like working out of my house so much and hope if I do decide to go back that I can get a job out of my house again. I must say I do like field better than TCM. You get a better insight and I enjoy the travel.

lynnr_98, BSN, MSN, RN · Dec 20, 2005

Wow! I'm so glad I found this thread. I've been working in WC case management for about a year and have been thinking of leaving also. I am so tired of the BS like rush referrals, injured workers not showing up for appointments, etc. Plus, I always end up working on the weekend to catch up on my billing and reports. I've thought of going back to the hospital but don't really want to work weekends or holidays. I also hate getting up early so don't want to work days, but also can't see myself working nights. The local VNA has a M-F position from noon to 8:30 pm that I'm thinking of applying to but hate the thought of working every M-F. I used to be a Public Health Nurse and had an alternative schedule with every other Friday off but the pay was very low. The last thing I'm considering is leaving nursing altogether and going into new home sales. I have my real estate license but never used it and I'm told you can make a lot of money in new home sales but I'd have to work weekends. The hours are good though - usually the models are open from 10 am - 6 pm. It might be worth it if I could make a lot of money. I don't know what to do at this point but know that I can't stand to do WC much longer...it's driving me crazy!!!

RNLeavingTheOC · Dec 21, 2005

WC is a tough field to be in I agree, sometimes I would get so frustrated with the adjuster too! I also know how poorly a PHN gets paid, its a wonder they can even staff those positions. Funny how when I was a staff nurse I would dream of being a "desk" nurse-now I dream of what else I could do. Down your way by Temecula you would have numerous opportunities with the new home industry. Every Sunday in the OC Register I read the new home section-so many new developments at attractive prices--prices that nurses could afford. Luckily as nurses we have the flexibility to go part time while pursuing other interests.