Over the past few weeks, I have written various posts on the experiences I have had with people whom I am working with as a Nurse Advocate. Each person came with unique issues related to their health. One patient had a suspected deep vein thrombosis, one was diagnosed with a reoccurrence of lung cancer, and the third person had a GI bleed with multiple co-morbidities that took months to identify and get under control.
My role was to support them by helping them navigate the complex healthcare system by breaking through barriers each faced. These included getting appointments in a reasonable time frame, researching specialists who had the expertise to diagnose and treat them (and who were in their managed care network), working through the complexities of authorizations, payment, and reimbursement issues that accompanied each visit.
Most members of the healthcare system know, each of these issues is common and viewed by most as ‘this is just how it is.’ As a result, I would have to say the most challenging part of my job as a nurse advocate is setting people’s expectations.
I did this by explaining the situation and letting the person I was with know that I cared. I would go to the best person who could address problems and then explain the reasoning to the person. Most of the time, this pacified them but did not relieve the stress they felt
I worked to communicate professionally with various healthcare providers. This was not always easy, as most were not used to the person they were seeing having an advocate with them who asked questions that the average person did not ask. Many understood my role was to support the patient and help them as they worked with the person to design a plan of care to treat thier condition. I found communication a constant struggle that was frustrating to me and was distressing to the person I was with.
In a system that is overloaded, stressed, and very complicated, setting expectations is not an easy job. Three things that I have learned over the past few weeks have helped me include:
- Building a good relationship with both the person I was working with and the various members of their healthcare team. I tried to show each that I cared and that I would work with them as best I could to address the challenges each faced.
- Employ two-way communication. I asked the person I was with, what they wanted, and then tried to communicate this to the staff and their physicians. I listened to the staff as to their challenges and how we could work around those issues.
- Be proactive when things go wrong. I addressed problems and tried to offer solutions calmly and professionally.
I tried to remember the people I was with wanted to be treated with respect and have those who saw them address their needs so they could return to their lives. It is not easy, but writing about it has helped me reflect on what I was doing with fresh eyes. I learn something new with each encounter, and that has allowed me to understand things better and how I could handle situations in a way that meets the person’s expectations.
Thank you for reading this post. Feel free to leave a comment as to how you set your expectations as a patient and a member of the healthcare team. Doing so will allow each of us to learn new tactics.
Anne, interesting article. I keep asking myself how do we teach injured workers and your patients how to work the system independently from us? How do we teach a lay person to get around the very complex system of healthcare. Medicare expects physician offices to “teach” them about their disease and treatment plan, but they don’t teach them how to access the system. Patients expect these overworked/understaffed offices to coordinate and work for them, which may be the case but care is delayed. Furthermore, communication is sparse and wrong many times due to volume and delays. If the patient or patient advocate (usually a family member) does not assert themselves and press these offices, care is delayed and illness progresses. I believe that if we can teach people to do this, healthcare will be held much more accountable. The only way we hold these facilities and providers accountable today is via the legal system, and we know that is not be best way, it only raises cost back to the consumer. How do we teach our patients, family members, friends to assert themselves, to ask questions, to learn how to get through the system?
Ana, that is the challenge. I think it will take a generation…think about your kids…do they just accept this system? Education is key on so many levels. I don’t think until the patient is fully engaged we will see real change. I am not giving up…that is why I write this Blog…to remind everyone it is up to “each of us” to improve our own health and healthcare.
Thank you for sharing. In acute care hospitals, a discharge planning assessment is completed and patient/family are asked what they will need after discharge. I think we could do a better job in sharing what is available and having a good understanding on resources in the community. The more complex the illness the more difficult it can be.
Thank you Anne. I agree that communication with all parties and developing relationships is key. I find one of the most difficult areas to navigate through are with providers who have little understanding or negative experience with nurse case managers or advocates. Breaking the stereotypical barrier can be challenging and can undermine foundations we have established with our patients/IW/clients. They are our priority and building trust with them is key to navigate the system to get their medical needs addressed and met. It can be more challenging to work with providers than our patients/IW/clients.
Anne,
Thank you for putting this in words as I, especially as I have worked with Work Comp injured claimants for over 30 years, have had the same issues.
Thank goodness there are patient advocates and case managers who can help the average lay-person with no medical experience, do their best so the patient gets best medical care as timely as possible.
Your voiced experiences and expressions are always welcome to hear.
Thanks Anne for addressing this topic. I echo your thoughts especially regarding facilitating two-way communication among the client and medical providers.