Why I love case management? Success as a Night Nanny!

It was a tough year. My husband began a new career, my son was in college, we had a wedding to pay for, and we were trying to keep some property in the family. Money was tight, so when a friend of mine asked if I would help her with her side gig as a night nanny, I was all ears. Responsibilities included sitting with newborns while their parents slept. Sign me up! 

One night, as I fed the newborn baby, I was reflecting on a case management article I had read earlier, and I started to think about how I use case manager skills in a variety of situations in my personal life all the time, including this new role as a night nanny. Case managers develop many wonderful skills to effectively do their jobs. We must be proficient at goal setting, advocacy, communication, education and enabling autonomy. 

My job as a night nanny is more than just taking care of a newborn so mom and dad can get some sleep. I provide experience, confidence and much-needed encouragement to young parents who are experiencing something completely new. As in case management, I am not there to judge but to support the decisions they have made to care for their baby. Not only am I serving the parents, but I serve the baby as well. I study the infant, her routines, her cries, her wake/sleep cycle trying to understand what she needs. I ask questions, communicate my observations, offer suggestions, and draw upon my experience to comfort, educate, and empower. Sound familiar?

The first thing I do when I meet a new family is ask them about their goals. Is the goal to sleep train their infant so they learn to self-soothe themselves back to sleep or is the goal to keep baby quiet so the parents can get a full night’s rest? Their goals dictate the kind of service and interventions I implement with the child. Case managers also discuss the goals of the client and work to support them and help them meet their goals, whether that be discharging from the hospital to home, managing their chronic conditions to enjoy a better quality of life, or completing rehabilitation so they can return to work. Without a goal, we have no path and no destination. 

Another case management practice I utilize as a night nanny is advocacy. Being an advocate means I work to bring about change. The other night, one of the babies had a very red angry diaper rash. The parents instructed me to use the diaper cream with every diaper change. The mother was frustrated that the rash wasn’t getting any better after using the cream for several days. When I changed the diaper that night, I recognized that the rash was not a normal diaper rash but appeared to be a fungal infection. In the morning, I shared my concerns with the parents and urged them to contact the pediatrician. I was pleased to see a tube of anti-fungal cream at the changing station when I arrived a couple days later. Already the rash was improving. I recognized the rash because I am a mother to four kids, and I’ve seen it before. Being an advocate for those who have no voice comes second nature as a case manager. Advocacy is a competency I use every day that spills over to many areas of my life. 

Case managers are expert communicators and educators. We are often the hub of the multi-disciplinary wheel. We are the connectors between the physicians, the families, the hospital, the payors, other medical staff and, most importantly, the patient. We educate clients about the institutions and processes in which they participate. We teach them about their health and disease. We inform them of their options and available resources. In a similar way, I do that as a night nanny. When I meet the couple before the birth, I educate them on what they may expect, what a newborn does during the first 8 weeks, what mom’s body may experience during that time, and how dads can participate in the care of their baby and partner. If asked, I share recommendations on supplies and equipment that would be helpful for mom and baby. Like good case managers, I listen to parents’ concerns and encourage them as they prepare for a huge and wonderful life change. After the baby is born, I ask them for their insights about their child and I share some of mine as well. Together, we learn what the baby likes and doesn’t like, we learn what soothes her and what makes her mad! Communication and education is not me talking to them; it is a two way open dialogue where parents’ ideas and thoughts are important and supported. Communication in case management is also bidirectional where listening and speaking are crucial.

The best part of being a night nanny is watching the baby fall into a nighttime routine, soothe herself back to sleep and lengthen the time between feedings. The parents become more comfortable in their new roles and begin to relax. They realize they are doing just fine and don’t need a night nanny anymore! In other words, they gain autonomy, and they govern themselves without my help.

Case manager’s main job is to work themselves out of the job. We want our clients to gain the ability to manage by themselves. We want them to return to their familiar environment to continue to heal. We want them to manage their diabetes and prevent devastating complications. We want them to adapt so they can return to meaningful work and provide for their families. Autonomy allows our patients or clients to reach the end of what we provide. It is a sense of confidence and accomplishment that enables them to move forward in their journey.

The expertise that we learn, develop and perfect in case management enables us to be successful in many areas of our lives. As parents, as volunteers, as members of any group, as night nannies, we draw on our skills to help and enable others. The skills we learn as case managers transfer in unlimited situations. That’s what I love about case management.

Trina Mays, RN, BSN, CCM, CRCGuest post from Trina Mays, RN, BSN, CCM, CRC, submitted as part of our “Why I Love Case Management” and selected as our Third Place Winner!

Trina lives in Austin TX with her husband, Jeffrey, and 2 dogs, Miller and Beans. She has worked in a number of healthcare settings for over 20 years. She currently serves as a subject matter expert for quality and risk adjustment coding for Innovista Health Solutions. As a Certified Case Manager, Trina partners with physicians and Innovista care management programs to develop and implement processes that improve quality outcomes.