I became a registered nurse because I wanted to help patients in their healing process. I loved the idea of making a difference in their care and outcomes. After an injury forced me into a career change, I never thought I would find another job as fulfilling or satisfying. I was recently asked by a coworker what I love about being a case manager. My immediate reply was “Everything.” Although my response was a bit prosaic, it failed to shed light on the essence of case management or what makes it so rewarding.
Each day as a case manager is unique and challenging. I love the unpredictability each day offers. Patients exhibit a plethora of moods and emotions from anger, fear, hunger, and despair; just to name a few. I approach each patient mindful of their vulnerable state, and the important role I play in their recovery. Sometimes this is accomplished by discussing goals of care or offering positive words of support. I try to encourage them to be hopeful because hope can facilitate healing and motivate individuals to push forward. Martin Luther, once said, “Everything that is done in the world is done by hope.” I’ve personally witnessed the positive impact a little encouragement can have on a patient. I love when I am able to make a patient smile, despite their circumstances.
One of the first and most frequently asked questions I’m asked is, “When can I go home?” As a case manager, it is important to discuss goals of care with each patient and begin the discharge process early. Anticipating discharge needs is key to a smooth discharge. It often involves collaborating with team members to ensure appropriate care, educating the patients, planning safe discharge, and being a patient advocate. Facilitating discharge may be as straightforward as sending a patient home with oxygen, or as complex as arranging a critical care transport team to accompany a patient on an overseas flight. Sometimes the complexity requires thinking outside the box and using critical thinking skills. I often go home with a sense of accomplishment and satisfaction that I made the impossible; possible.
One of the most important and fulfilling roles is that of patient advocate. I am often my patient’s last chance for recovery. Sometimes it requires standing up to a doctor if the discharge is deemed unsafe or unsuitable. Other times it demands fighting for adequate and appropriate care.
I recently had the privilege of helping a young man who had been hospitalized for an extended period. Prior to his hospitalization, he was strong and active. His affliction and prolonged stay weakened him, making him unable to walk. While in the hospital, he worked hard with his physical therapist daily. After collaborating with the team, we believed the patient’s best chance for a full recovery would be for him to be discharged to an acute rehab facility. There he would receive up to 3 hours of one-on-one physical therapy per day to regain his strength. The patient was eager to begin his rehabilitation.
After sending the request for authorization to the insurance company, I received notification that they denied my request for acute rehab. The insurance company instead endorsed discharge to a nursing facility, which offered very little therapy. After breaking the news to my patient, I recognized that hopeless look of despair. I assured him I would try my best to persuade the insurance company to approve the acute rehab. I knew this patient’s future rested in my ability to sway their decision. I called the insurance and challenged their assessment. I argued that a nursing facility, for this patient, was inappropriate and provided justification for rehab. I pleaded with them to reconsider. When I left work that day, I knew I gave it my all and I had to accept the outcome of their decision. The following day I received a notification that they had a “change of heart” and the request for acute rehab was authorized. My patient cried when I gave him the good news. Days like that make me proud to be a case manager.
In closing, I love case management because it allows me to use my critical thinking skills to assess the patient’s condition and plan accordingly. It offers a unique opportunity to positively impact someone’s future by advocating on their behalf. Lastly, it allows me the autonomy to approach each patient individually based on their circumstances and needs. I’m fulfilled knowing I’ve made a difference in someone’s life in my role as a case manager.
Guest post from Kelly Lawton, CM, BSN submitted as part of our “Why I Love Case Management” and selected as one of our Honorary Mention Winners!
My name is Kelly Lawton and I reside in the city of Upland, California. I have been in healthcare since 2014 after graduating from nursing school and getting my first job as a registered nurse. I love reading and doing puzzles.