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Discussion

Two Weeks

Hello everyone,

I am having this dilemma and I am in desperate advice. So currently I am working in a post-acute nursing home as a Case Manager. I really love the experience but find myself overwhelemed with the amount of work. At work, I also feel like I am doing mostly supervisor work (carrying out orders, reporting change of conditions of patients to doctors), and I am barely working on like discharges. I feel like I should be rounding on patients and following them to see if they are stable for discharge, how they are doing in therapy, etc. But the nurses there are dependent on case manager with reporting their change of conditions to MD. I mean, I do round with a few doctors once a week for their patients, but I would love to be doing this on a daily basis...

I go in at 6:30 am every morning and leave sometimes at 8 o'clock at night. And when I am at home, I will still be doing work to prep for doctor rounds the next day, etc. since I will be too busy during the work hours doing labs and assessments for all these change of conditions.

Anyways, recently Ive been trying to carry out a little less orders so that I would have time to round and see patient/family members so I would pass on orders that I get after 3pm to the supervisor. But then that caused me to get into a disagreement with our DON that she mentioned she would like to see me do more and wishing I would be on the floor more because I am in my office all day. She also mentioned that I tend to pass work on to others... so I was a little taken aback by this. Because she is in our group chat with the doctor, she reads the things I report late at night sometimes and knows that I work late. We also tend to be short staffed, so I notice a lot of our office nurses (quality nurse, etc. end up on the floor for medpass or supervisor). We had a meeting once to discuss this where our DON mentioned we each take turns to be supervisor. At one point we all had our turn, so I asked the DON if she wouldn't mind being sup that day and she went off saying she's so busy, etc. It was a long conversation where basically I wasn't able to say my piece as she was talking over me. I felt that wasn't fair because our work was being pushed aside and we were already behind.

So ultimately, I put my two weeks in. I am still in contact with other nurses who left before me, and they also believe that it is not a good environment to work in as the DON is such.

I will miss however, the pay from this position and the experience to the point where at times I do wonder if I am making the best decision for my career and financially. I will be returning to my previous position as a floor nurse at a sub-acute facility with a $4 pay cut. They spoke to me a couple times when I submitted the letter to say that they will change my position to hourly instead of salary so I can accumulate overtime. So that is where my dilemma is.

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    Whoa. I definitely feel that the DON needs to take her turn at being supervisor. When she says that she is 'so busy', she is also saying that she is busier than everyone else. This is not a way to build a team. Does the DON put in as many, or more, hours than you and the other administrative nurses (i.e., quality control, etc.).

    Do you prioritize the patients that you round on, or do you do rounds on even the stable patients?

    Why aren't the nurses carrying out their own orders? I can understand needing assistance at times, but not expecting you to do all of the orders. The same with change of conditions. Not every change of condition is critical. Yes, I know about MDS and change of conditions being reported, maybe I should have used the work 'emergent' instead of critical.

    What is the history with the job you have? Has there been frequent turnover? Do you have approximately the same number of case managers as other facilities your size?

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    • Author
    32 minutes ago, ocean.baby said:

    Whoa. I definitely feel that the DON needs to take her turn at being supervisor. When she says that she is 'so busy', she is also saying that she is busier than everyone else. This is not a way to build a team. Does the DON put in as many, or more, hours than you and the other administrative nurses (i.e., quality control, etc.).

    Do you prioritize the patients that you round on, or do you do rounds on even the stable patients?

    Why aren't the nurses carrying out their own orders? I can understand needing assistance at times, but not expecting you to do all of the orders. The same with change of conditions. Not every change of condition is critical. Yes, I know about MDS and change of conditions being reported, maybe I should have used the work 'emergent' instead of critical.

    What is the history with the job you have? Has there been frequent turnover? Do you have approximately the same number of case managers as other facilities your size?

    I agree that this is not a good way to build a team. I have been at two other nursing facilities before this one and I would recall when floor nurses called in, our DON would be the one who stepped in as supervisor. I mean, maybe it's the fact that she specifically said "we can take turns as sup" and then when brought up about her turn, she strongly dodges it that I feel is unfair. I do understand she is busy as well and she does also stay late sometimes, however I feel like we are all just as busy with our positions. Im not sure about quality nurse or infection control nurse, but as case manager, I am always working from home.

    I did ask our DON before why not give more responsibility to the nurses, I mean they are the ones who see the patient so they can do their own change of conditions and as case manager I would like to just be following up with it. However according to our DON, the nurses have about 24-30 patients for medpass and she does not want to overwhelm them anymore. Therefore, they rely heavily on supervisor and CM. I would like them to at least do their own labs, but we do that also. If anything, I do understand some doctors want only one person reporting to them, so I wouldn't mind doing that, but it would be helpful if I could spend the rest of the time following up on those change of conditions or rounding on patients rather than carrying out orders all the time.

    In regards in your questions, this nursing facility does have frequent turnover, but I am still in contact with some of the previous nurses who have left and they said the main reason is because of the DON. I would say we have approximately the same number of case managers as other facilities this size. For the past few months, I have been the only case manager. They have actually hired another one thinking it would be better with 2, but I have turned in my two weeks...

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    • Experts

    Are you sure you're taking a pay cut? Are you getting overtime for every hour above forty per week? Are you getting paid for the hours you put in after you get home?

    If you divided your weekly paycheque by all the hours you put in for that week, are you even getting minimum wage? I get that you liked the work, but there was way too damn much of it. Not sustainable. Your DON had no qualms about throwing you to the wolves and then complaining that the wolves were still peckish. You were smart to vote with your feet.

    In a very short time, you'll look back on that job with a shudder of relief.

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    • Author

    I will be taking a $4 pay cut for leaving and returning to the floor at a different facility. I have not been getting overtime currently as it was a salary position, but they are willing to change it to hourly.

    I like the work as it is very busy but not as stressful as being on the floor. going back to the floor will not only be a pay cut but be very stressful. However, one advantage is that I will not take the work home. So I am trying to weigh the two options.

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    3 hours ago, TriciaJ said:

    no qualms about throwing you to the wolves and then complaining that the wolves were still peckish

    I have no idea how, but somehow i will work this phrase into a conversation. I love it.

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    Newgradrn2016,

    You seem to really like case management. It even sounds like you still like your current CM gig despite the horrid conditions. How about staying in the CM position at hourly pay while looking for a new CM position that will respect your need for a personal life? Why run to the floor if you hate it? If possible, power through at the CM gig until you get a better one.

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