Which Job? Home Health Case Manager or Cross-trained ER/ICU.

Nurses General Nursing

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My stats: 47y female. Graduated from nursing school (RN) May 2018. First job was ER Residency that I loved. I left after less than a year because of inability to transition to nights primarily. I secured a home health case manager position with tons of flexibility, company car, etc... Currently, I am very frustrated with this job. With recent medicare changes, my job has made it much more difficult to see and keep my patients as long as I had previously. I feel like I am always struggling to keep my patient count up without success. I am really having difficulty making enough money to keep up with my bills because of it. My other big issue is the skills I learned in the ER are not the same skills I need for this job. My agency doesn't train adequately and I turn down a lot of the more complicated patients because I don't feel comfortable on my own. I just haven't been a nurse long enough with enough varied skills. I was trained as an ER nurse which rarely dealt with colostomy bags, wound vacs, and such. I just feel inadequate so I usually take the easier patients. What I LOVE about this job is I have incredible flexibility to make my own schedule, no on-call, no holidays, no weekends.

Anyhow, I was recently offered a position in the ER at a hospital about 30 minutes away from my house. The position is 11a-11p, weekends are Fri/Sat (no Sun), no on-call, plenty of generous crisis pay if I want to pick up a shift, 8 weeks of training to start and I would be cross-trained in the ICU.

I CANNOT decide what to do. If I leave my current job, I will loose all the flexibility I absolutely love. I love being home with my family in the evenings. I love my patients. I love having a company car and working on my own everyday. I feel like a second-rate nurse though because my skills are not up to par. I have tried going in for additional training but it didn't really help because there are so many variables and when your in the field (alone) you will find you still don't know what to do. I also thought I could try really amping up my patient count, but I am not positive I'll be able to... or even if there are enough patients for me to do so.

The ER job would be an amazing learning experience and resume builder. It would be exciting and I'd feel like a real nurse again. I'd build skills with other nurses around. But the environment would be long and exhausting. It would be far from home. I would have to miss holidays sometimes.

Please give me your input on what I should do. Thank you!

Home Health
-Try for 40 visits a week to increase pay (currently only averaging about 27)
-Work about 30-35 hrs
= $1400 per week or $2800 every two weeks
= $47/hr (averaged amount pay/hours spent working)

PROS
Flexible!
Daylight
Autonomy
Lower Stress
Time with family
Car

CONS
Case Managing
Constant paperwork
Constant turnover

ER JOB
36 hours with shift differential from 7p-11p
$27.50/hr 8 hrs of/shift = $660
$29.50/hr 4 hrs/shift = $354
Total $1014 per week

Potential Crisis Shift = $630 (Could pick up 1-2 per pay period)

PROS
Education
Interesting
Other nurses to get help/support from
Super Career Move
No On-call
Easier to keep paychecks higher

CONS
Extremely high stress
Loss of family time
Stuck indoors
Loss of flexibility
Make less money per hours spent
Have to buy a car

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Specializes in Psych, Corrections, Med-Surg, Ambulatory.

I guess it comes down to: how adventuresome and energetic do you feel? How easy would it be to get a similar home health gig again if you left the one you have now?

I think if you're craving all the learning and confidence-building that goes with the ER spot, you should jump on it. This is the kind of job that doesn't get easier to adjust to as you get older. Whereas home health is where nurses gravitate to when they no longer groove on the adrenaline rush.

I guess I see ER as a more time-limited option; home health will likely be easier to get back into if and when you're so inclined. Good luck, whatever you decide.

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Two things stand out to me for consideration.

-"I love being home with my family in the evenings." This might mean that you aren't willing to completely miss seeing your family an extra day each week, or even every two weeks, to pick up a shift even though the crisis pay is appealing. I wouldn't account for crisis pay as a factor in decision making since it's not guaranteed, or you may just not want to regularly work extra 12s. This is also a +1 for home health since you currently have weekends and holidays with your family.

-I haven't worked in a hospital with an 11 am to 11 pm ICU nurse shift. You said you didn't adjust well to nights as a new grad. Would your future ICU shifts be 7a-7p or 7p-7a? Will you ever be scheduled 11a-11p in ER one day and 7a-7p in ICU the next day? I can tell you from experience that although it's possible to pull it off, that second day feels loooong. Are you guaranteed a certain number of ER vs ICU shifts?

You've found yourself in a good dilemma! Both options have positives.

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I am offered the 11a-11p position in the ER. That is guaranteed. The manager said he would cross-train me in the ICU so that I can pick up shifts there. He made it pretty clear that I can work the shift I want to work. In fact he said he didn't care if I chose 7a-7p, 11a-11p, or 3p-3a. Whatever I want is fine with him. I chose 11a-11p because that was the shift I worked when I was working the ER in 2018-April 2019. They switched me to nights and I quite a few weeks later. The 11a-11p shift was fine.

I just really am concerned about 12s and leaving my kids. But my current job in home health is driving me nuts! They have made so many changes since January because of the recent medicare changes. Now we have to call in all our OASIS documents, sit on the phone while they are being looked at for no pay during that time. We also are losing patients because they want us to cut our frequencies and discharge which leads to more problems keeping my visits up and more documentation I have to call in. ?

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I may be the outlier here but I think it’s a no brainer. Look at your cons list for the ER job and compare it to the pros of the home health job. Looks like home health has most of the things you want that the ER does not. I’d pick less stress and more flexibility any day but That’s just me. And the significant pay cut too?

However if you really don’t like your current home health case management position you could try working for another company/agency while still keeping the pay and flexible schedule.

And You’d have to go and buy a car? Free car, more money, less stress ??

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Specializes in Critical Care, ICU, Rehab.

Is your pay for your case management job based on the hours you want, or the actual hours you work; also, are you struggling financially now? If financials are the main drive then clearly whichever is paying more would be the answer.

Did you enjoy your ER job? Do you enjoy what you do now? Would you rather be back in an ER? These are really only choices you can make.

As for not taking the more complicated patients, like colostomies or wound vacs. Youtube if your friend. Seriously some of these things are just that easy. They are nothing worth turning down a patient for. If anything else, ask if you can shadow a nurse who cares for a certain type patient so you can at least see how it's done.

As for being away from your family; maybe I was a SAHM too much before becoming a nurse, I don't quite get people bemoaning missing their family because they have to work an evening 3 times a week, or they miss their family while they work night shift even tho their family is litterally just at home sleeping. It's seriously only 3 days a week. You work pretty much a day shift, and wouldn't even need a recovery day as most people would working nights. Like I said though, that's just me. By the time my youngest was 12 I was DYING to get out of the house and away from children and into the adult world three days/nights a week.



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15 hours ago, TheLastUnicorn said:

Is your pay for your case management job based on the hours you want, or the actual hours you work; also, are you struggling financially now? If financials are the main drive then clearly whichever is paying more would be the answer.

Did you enjoy your ER job? Do you enjoy what you do now? Would you rather be back in an ER? These are really only choices you can make.





I am struggling financially with my current job. The potential is there to earn more, but it is really difficult to build my case load since they are constantly cutting my visit frequency and making me discharge my patients. SOCs take forever with the paperwork so I can only do so many per week in addition to my regular visits. It is super frustrating. The only real perk to this job is the company car and flexibility to work whenever I want.

I did enjoy the ER, a lot. It was stressful, I am not going to lie. It was challenging and tiring but exciting and stimulating. It scares me to go back to 12s because I have gotten really used to being home by 4pm everyday. But the pay is consistent and the job is a lot more interesting. It is farther away and I don't have a good car of my own right now, so I'll have to buy one.

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