Over the past few months, I have gotten back to doing onsite nursing case management and what I call nurse advocacy. It has been an eye-opening experience. I find my key role is finding resources for my patients and improving communication between members of the healthcare team such as physicians, other healthcare professionals like physical therapists, attorneys, adjusters, patients, their families to ensure things get done.
What I learned is since being ‘back in the game’ is that there are more people to communicate with. Insurance companies have provider networks, which in theory should streamline things but adds another layer to an already confusing system. I also see how busy people are and many things get missed or are put off, which just delays the process.
I find myself making calls but not getting a resolution and having to circle back hours later to follow up on what I called about in the first place. It seems like a lot of duplication and delays in what are simple requests for services.
Trying to keep everyone informed and on the same page is a challenge. I have started to have group calls, where I get the provider network care coordinator, the provider, and myself on the phone so we all hear the same thing and leave with an understanding of what each of us is to do so we can move forward.
I see my role as the one who untangles issues and advocates for my patients as they seem to get left behind in the complex system we call healthcare.
It has been fun being back, but it has also been disappointing to realize that we still have a fragmented system built to meet the needs of the healthcare system and not the people it serves.
The bottom line: stay well, so you do not have to get into the system! But if you do…..hire a nurse advocate as it will save your sanity!
Have a good week!
You hit the nail on the head, Anne: “I see my role as the one who untangles issues and advocates for my patients as they seem to get left behind in the complex system we call healthcare.”
That’s our role and it’s the biggest benefit to hiring an advocate. Because – who can manage doing all that when they are sick, debilitated, scared, and struggling with cognition while juggling all those challenges?
Good post. Thanks.
Anne: Thanks for your verbalization.
Since working internally in Insurance companies as a CCM for Work Comp, I have also done on-site field case management. I have loved my work but trying to untangle all with the he-said/she-said, and turning 80, at this time I will only do a rare “task” assignment.
For over 35 years, it has been my pleasure to help injured workers weave through the tangled webs and see them recover.
If I were younger, I certainly would pursue Patient Advocacy.
Moving to a new area I have learned how ‘spoiled’ we were in the greater Chicago health systems where most used Epic. Even if providers belonged to a different health system they could still get the most up to date information on a pt. As a pt, I could look up lab results, office notes and communicate with staff. Believe me that is missed when not available.
Indeed. Patients/clients are fortunate to have you on their side!
COVID places a huge stress on effective communication especially with so many CM’s working from home. Hospital based CMs continue to be the eyes and ears of many providers especially when it comes to discharge planning efforts. Effective advocacy is key to prompt and efficient care transitions. When my role becomes frustrating I allow my confidence to take over and am thankful I have the competencies, knowledge and skills to “untangle” the tangles. My patients are very appreciative and at the end of the day I know I have accomplished my goal of patient centered care delivery.