CASE MANAGEMENT THE GIFT I WAITED FOR MY ENTIRE CAREER

My role as a Case Manager is relatively new.  Therefore my experiences may not be what others feel. I understand this and appreciate learning more.  I am still in the phase of learning from others and exposure to various situations.

What I feel Case Management is?  That is such a question that it requires not one simple response.  I feel Case Management to be a rewarding experience for those of us that thrive on the unknown every single day.  No two days are alike.  No two cases are alike.  I am like a Gumby doll having to move my mind for many situations.  Moving my responses based on their varied needs.  How I approach most people is dependent on where they are coming from.  I happen to work with many that are not as savvy or financially fit to be able to attend to the needs of their healthcare issues.   Many are negligent of their own self-care and then become ill requiring the skill of their providers, nurses, other professionals, allied healthcare staff, and Case Manager.  I may not be their direct RN but nonetheless, I am always an RN.  As their Case Manager, I must expand on my ability to relate to their social, psychological, emotional, and basic needs to survive.  I must try to find solutions for their very basic issues that most people take for granted.  There are so many obstacles in their path and I work to pave the road for them.  Whether it be them walking down that road or acceptance of the changes they now have. 

I feel with Case Management my ability to do assessments is put to the test.  I must assess the person where they are at.  I must ask the questions in a way they can understand. Then base my next question appropriately. How do I phrase my words?  Am I watching my tone of voice?  I can determine whether or not to explore various issues further.  My gut instinct once again comes into question, as it always has throughout my nursing career.  I listen to their responses with my ears and my gut.  I am lucky I can read people quite well, so I am suited for this better than those that cannot.  I am one of the rare Case Managers that truly loves doing assessments.

I feel that in Case Management I am doing the ultimate at patient teaching.  I go with what is needed at the time.  They may not directly ask the question but my ability to see things in the “big picture” method helps here too.  I must gauge when they are getting overwhelmed and do it in sections. This is also my favorite part of Case Management.  Patient teaching is so valuable to each individual patient and their family.  Whether I am teaching them about their new medication, a diagnosis, dietary guidelines, or helping them determine how they can respond to their provider,  I am always teaching.  Many current patients tell me “I always like to ask you because you explain it in a simple way I can understand.”  That makes my day!  That is what I want for them.

I feel that with Case Management we are also problem solvers.  We must piece together the puzzle of many issues.  Why their MRI did not get authorized, why their provider selection of a certain medication was not approved, or why the request for Home Health nursing was denied.  Or were they discharged home yet we can see they do need Home Health from our assessment of them? We must coordinate their care for so many issues.  What if they are getting evicted and they cannot take their precious dog with them to the shelter?  Searching for safe places to keep their pup can be very daunting but so meaningful to the patient.  How to help them when they feel their PCP or other provider does not listen to them? Do we intervene or do we suggest another provider? At what point do we suggest they obtain some behavioral health work?  That is handled individually based on many variables. Do we get involved and make their appointments for them?  Or do we commend them when they can do this on their own?  Once again, it is based on the individual and their background story.  

I feel that as a Case Manager we must contort that Gumby body to respond to our patients.  Do I present as the nurturing motherly type?  Am I the direct, black and white nurse with a no-nonsense stance?  Or am I that kind open-minded listener? The kind that nothing they tell me will affect me to react surprised? Do I suggest possible solutions or just let them vent to me? Regardless of how I respond to them, this takes a skill that many nurses and social workers possess.  Some of us truly enjoy the challenge with a difficult patient or issue to work with these people that need our help. The one skill I am still working on is how to react when a patient I have been working with for some time is nearing the end of their terminal illness.  This one is not one I expected to feel so deeply.  I feel the grief, their loneliness but also the peace and acceptance they now have.  I must remind myself they were so appreciative of my role in their life. I must also nurture myself at this time. 

I truly feel Case Management is the gift I waited for my entire nursing career.  I worked so many specialties over several decades.  I covered all my bases to be a well-versed RN.  I didn’t realize I was preparing myself for this position from the very start.  My former coworkers are not at all surprised by my present position because of all the reasons I have mentioned above.  It may have been a change of scenery for me to become a Case Manager but once I learned the technical aspects, it all fell into place. This is me, this is where I belong.  

Guest post from Sue Lopez BSN RN, submitted as part of our “Case Management Is… Contest” and selected as an Honorable Mention!

Sue Lopez BSN RN, lives in Phoenix Arizona. I have been an RN for 42 years. My career has been extremely varied. Mainly all specialties of Critical Care, including ER and PACU. I have worked as a traveler for Critical Care Positions in this state and a few others. I have been in management and an educator. I have worked with several charity groups and fundraised to help animals and humans. I have received the Humanitarian Award at one of my employers due to the huge fundraiser I did for others. I have been to our legislator to speak regarding the protection of animals. I have done volunteer work for humans, animals and children.