Which path to take? Should I stay doing case management or return to the hospital/HH

[aaac]

I have done worker's compensation case management for almost 4 years. I was a med-surg nurse for 3 years. I have an okay job it pays about $25/hr. I am autonomous in that I can arrange my schedule around my family and I work out of my house. The down side is billing. You have to show credit for your time spent. It is hard at times to work 8 hours and show credit for 8 hours so doing 12 hours of it is next to impossible. I am at a point that I am so tired of working M-F and having no time off. I have two kids and it seems that the weekend is here and gone before I know it. I can not imagine spending 20 more years working M-F. Truthfully, case management is a M-F job. I figure that I could possibly go back to the hospital working every other weekend 12 hour shifts and work a few extra shifts a month during the week and make the same money for less hours at the hospital. I thought maybe eventually I would do agency if holidays and money became a problem. I am not sure how I will react to going back to doing hands-on nursing either or 12 hour shifts or nights. I am considering going back and doing ICU and maybe considering going on th CRNA school. Who knows maybe I am dreaming. I have a friend who is a CRNA and loves it. Does anyone know the good and bad about being a CRNA? I am not sure what is the right path to take or how to find it. Am I crazy to leave M-F 9-5 shift to go back to nights and 12 hour shifts? I thought about picking up some prn work to see if I would like the hospital again. However, I am hoping to get hired. Agency would not hire me because I have not done hands-on nursing in the past 2 years. I just thought if I tried prn work while keeping my job I might have a better idea. I just do not want to give up what I have and go back to the hospital and say "why did I do this!" I have what most people would love to have but I am burnt. How do you get past it. If I go back to the hospital, I would have more time off. But, will I get burnt on 12 hour shifts too! Too many choices! Any advice would be helpful. I am 30 and feel I need to either poop or get off of the pot. I have also considered home health. Can you do 12 hour shifts doing home health? Is it autonomous? What are the good and bad about home health and ICU?

[changeseeker]

It's been a while since you wrote. Sorry you don't have any replies yet. I am in a similar situation in that I don't know what to do with my career. I just left a home health case management job when my husband switched jobs and moved the family. I am feeling the need for change, but there are just too many options and I'm very picky.

To answer your question about home health, yes it is very autonomous. You have to have good assessment skills, communication skills and organization skills to survive. There is a lot of paperwork. I typically saw 5 patients/day from about 9am-3pm. After that I did my charting at home and made phone calls to order equipment and contact the doctors. I only went into the office once or twice every two weeks. We had interdisciplinary meetings every 2 weeks with the PTs, OTs and MSWs. I really liked it, but I feel like I need a change. Want more time with my kids and want more predictability. Sometimes I didn't know who my patients were until 9-10am and it's hard to plan your day that way. Sometimes I'd get called at 4pm and asked to go see a pt to replace a blocked foley. That sort of stuff bothered me, plus all the supplies I had to cart around in my trunk. Doing on-call home health is much more unpredicatable than being a case manager with an assigned territory and group of patients. You are at the mercy of the case managers and the schedulers. You sometimes end up getting the patients that live farther from town or are more difficult since the regular nurses want a break from them. We also rotated every 4th weekend.

Can you tell me how you got into workers comp? I'm thinking about that or case management for an insurance co, but I'm only seeing full time work. I want part time. I'd love flexible hours that I could do in the evening after the kids went to bed. Also thinking about PRN at a hospital. I'd make more money that way since daycare is $$$$ if I work during the day. It would eat up most of my pay!

Good luck to you.

[outside_child]

Sometimes I feel we are in such a good profession as far as diversity is concerned until we are really picky. I want to get off the hospital floor already. I worked mostly geriatrics, psych, homehealth, and avoided the hospital like the plague; untill 4 months ago. Hospital nursing for me is too fast; I can't absorb all the data on 6 patients; and when the doctors come in early in the morning to get report from the nurses, they get frustrated with us. We work 12 hour shifts, and when you are off 3-4 days in a row, it is difficult to get all the report you need; so you have to research it yourself during the "busy day shift". Even if I put all my computer generated reports about my patients in my pocket, doctors want you to know everything like the back of your hand, and don't care what occurs at shift change. We are getting report and trying to plan our day. Our computer generated report shows active/inactive interventions that we have to sort thru. The pace is too fast for me. I AM TRYING TO GET INTO CASE MGMT. EITHER WITH HOMEHEALTH NURSING OR THE HOSPITAL. But I find the hospital to be too fast, competitive and cliquish. With homehealth and case mgmt. I would love the autotomy, and finding my own pace that way instead of being/feeling too slow. I think I'd rather work more with the stable patients

(and stable doctors).:chuckle

[KyleNYRN]

Was just cruising the site and found your post.

I'm in the opposite situation where I am currently employed as a staff nurse on a surgical floor working 12 hour night shifts.

I am interviewing for a position with a major Health Insurance company in my area for a Health Care Improvement Specialist. I don't even know what that means.

I'm a career changer and graduated nursing school 3 years ago at age 40.

I find working nights is just messing up my life. Physically, emotionally and mentally. My family life is suffering which is the biggest issue I have with the shift. If I'm not at work, I'm sleeping FOR work or sleeping after work trying to recover. For me it's the lack of routine in my daily life.

The job I'm interview for is a M-F, 8-4 position. At this point I don't particularly care what the job entails. I just want some normalcy and predictability in my life. If hired, I would like to keep working per diem just to keep my skills current...the extra $$ wouldn't hurt either.

Maybe you need to do the traditional list of pros and cons to help you make your decision.

The rate of pay at my hospital is pretty decent. I'm making $24.50 per hour with a $1.50 differential for nights. There is NO nursing shortage here in my area. I'm lucky to be employed. The rate of pay at the insurance company is $45,000 per year. I'm not yet sure if that's salary or hourly.

The benefits to working at the hospital that I find most attractive are the hourly rate (very good for only 2 years experience) and the ability to fudge with my schedule to enable a week off without taking PTO time.

Lots to think about....