On November 17th, 2015 I had an observation clinical shadowing a Registered Nurse in Case Management. Case management is a side of nursing that is not brought up very often. We started off the shift in the nurse’s office. Morgan, the nurse, had a meeting to attend at 9:00am, so we stayed in her office to get organized for the day.
Role of the Nurse
Morgan began to explain the roles and responsibilities of a Case Manager. There are three Case managers that work together on a unit to take care of things such as insurance issues as well as discharge planning. However, the main focus is discharge planning. Discharge planning is the action of figuring out what needs to happen for the patient to leave the hospital safely. This includes DME, or durable medical equipment, like walkers, bedside commodes, hospital beds, and suction equipment.
Insurance will only pay for a patient to stay in the hospital if they meet certain criteria. The hospital uses a program called InterQual to help make sure that happens.
…show more content…
Morgan read over each patient assessment in their chart, as well as rounding on each patient daily to gather her own assessment. With all of the data, she came up with diagnosis that was required from her. Morgan stated the nursing diagnosis she most frequently uses is risk for falls. Goals are then set depending on individual needs. By collaborating with the interdisciplinary team in a therapeutic way, interventions are implemented to meet each patient’s needs. Evaluations are performed daily by case managers through interdisciplinary rounding and the goals that were made are assessed and any changed to the plan of care are made. Case managers will follow up with outside facilities that patients transfer to after a hospital admission to evaluate their progress. If a patient is readmitted to the hospital within 30 days of discharge, a reevaluation is
Discharge planning nurses achieve this move through the collection and organisation of patient data from various health professionals who treated the patient prior to and during the hospital stay. This data is used to establish the patient’s ‘baseline’ or personal average health level, and which services are needed after discharge to return the patient to this level (Holand, 2016). This could be a transition into a nursing home or rehabilitation facility, the establishment of home nursing or carer services or physiotherapy, social work, dietetics and occupational therapy professionals through
o Type of healthcare worker: Nurse practitioner o When this type of work entered the market: The medical profession of nurse practitioner was developed in the mid 1960s. The job of nurse practitioners grew from implementing work from primary care physicians into that of traditional nurses. o Reasons for creation and growth: In the late 1950s and early 1960s, increased specialization amongst physicians was taking place, which led to many doctors exploring other avenues of medicine, resulting in a large shortage of physicians practicing primary care. This left many rural and inner city areas with very limited access to medical care.
The purpose of the planning is to ensure continuity of care, so the plan is reviewed and altered to take into account changes in individual housing and social situations, and it should be tailored to the patient’s characteristics (Wibe, et al., 2014). The process of discharge planning is the responsibility of all the healthcare providers involved with the patient. It is, however, coordinated by a named person who has responsibility for ensuring that all aspects of planning have been addressed by the time of discharge from the care setting.
Licensed practical nurses (LPN 's) fill an important role in modern health care practices. Their primary job duty is to provide routine care, observe patients’ health, assist doctors and registered nurses, and communicate instructions to patients regarding medication, home-based care, and preventative lifestyle changes (Hill). A Licensed Practical Nurse has various of roles that they have to manage on a day to day basis, such as being an advocate for their patients, an educator, being a counselor, a consultant, researcher, collaborator, and even a manager depending on what kind of work exactly that you do and where. It is the nursing process and critical thinking that separate the LPN from the unlicensed assistive personnel. Judgments are based
When I am older I would love to be a Nurse Practitioner, I enjoy helping people when they are sick and taking care of them. Another reason I want to be a Nurse Practitioner is because my sister is also a Nurse Practitioner.
Each day we are faced with making decisions regarding the plan of care and discharge of a patient based on the number of days an insurance company allows to treat the patient. Most times the days allowed are less than what is required to assist the patient back to their prior level of function and ability to safely return home. This causes an internal struggle for the provider and can lead to easily accepting what the insurance company allows even though it is not always best for the patient. Typically, we follow the rule of always doing what is right, which could mean that we keep the patient on the unit longer than the insurance will provide payment.
When it comes to switching shifts, nurses usually give a quick report on the patient, so the oncoming nurse knows what is going on with the patients. Sometimes nurses are rushing through the report, skipping through vital information, which can cause harm in our patients. We must have a standard hand off report each nurse must follow to provide patient safety and satisfaction.
Nurses are pivotal in hospital efforts to improve quality because they are in the best position to affect the care patients receive during their hospitalization. Data collection and analysis is the core of quality improvement assisting in understanding how the system work, identifying potential areas in need for improvement, monitoring the effectiveness of change and outcome. Nurses are also the eyes and ears of the hospital to positively influence patient outcome. For example, nurses are the ones catching medication errors, falls, and identifying barriers to delivering care. In this nurse’s facility, in order to minimize patient falls the hospital implemented a falls risk assessment tool called, “The Humpty Dumpty Scale” upon admission
Nursing case management does not take the place of the nursing care delivery model in place to provide direct patient care, but supplements nursing care in a health care facility (Jacob & Cherry, 2007). For example, if a hospital’s medical-surgical unit uses a team nursing approach to patient care, a system of case management might also be in place to assist with coordinating the patient’s total care through discharge (Jacob & Cherry, 2007). Moreover, case management is not always necessary for every patient in a health care facility. Typically, case management is generally reserved for the seriously ill or injured, chronically ill, and high cost cases (Jacob & Cherry, 2007). In brief, case managers are a unique segment of the healthcare workforce.
The way that the case manager ensures safety and quality of care is by having an open conversation with their patient. These conversations include asking if they require any assistive aid to ambulate, where they currently live, if they have a ride home, if they receive any home health assistance and if they have any questions or concerns about their care. Another major aspect of the case manager’s role is discussing Medicare/Medicaid payment and options. In order for the patient to have their stay covered by Medicare they are required to have a 3-day inpatient stay. This does not include observational stays, so it is important that all patients are aware of their current status.
I want to be a nurse, specifically a nurse practitioner. I have always been fascinated with the medical field and see a bright future in it for me. I have the opportunity of meeting new people every day with a variety of personalities. There is always something new to discover in this field. A nurse practitioner's job is to be able to diagnose and treat illnesses. They also prescribe medicine and run physical exams. I am highly interested in pursuing the career of a nurse practitioner because the healthcare field is always in need for medical professionals, it pays well, and I am helping people at the same time.
The physician’s primary goal is the patient’s physical and mental wellbeing The Discharge Planner: The discharge planner, usually a nurse coordinates a patient’s discharge from the hospital and post-hospitalization care strategy. The discharge planner wears several hats. He/
Saying that you are a registered nurse is a broad statement. Registered nursing is a job that has many aspects. Registered nurses work in many different settings and they carry out many different routines. As a registered nurse you could be exposed to many different opportunities. My goal is to be a registered nurse but, I need to learn a lot. Becoming a being a registered nurse requires a lot of hard work and effort but, if I focus on my goal I will be able to achieve it.
Finally the evaluation involved reviewing the care plan by checking if the patient’s condition has improved, goals achieved and interventions applied successfully (Alfaro-LeFevre, 2010). The issues highlighted in the previous stages made it difficult to assess the effectiveness of Jane’s nursing interventions and the achievement of goals as the criteria was unclear. Despite this, all three care needs had either shown signs of improvement and/or not deteriorated further. The patient also expressed that the care plan had working effectively for her because she felt involved in the process as the orthopaedic consultant and nurses talked to her on a daily basis and that it was addressing her needs. To support this Kitwood, (2007) states that it is ultimately the patient who will say if the care plan has met their needs effectively
Nursing interventions would have been suggested in the planning stage in relation to the ability of being able to achieve each goal. Therefore, it is during this consecutive phase that they will be put into action; as well as having a justified rationale as to why certain procedures and interventions are being implemented (Gardner, 2003). This stage encompasses the processes of monitoring the patient for signs of improvement or deterioration; directly caring for the patient by performing necessary medical tasks; educating a patient about how to improve their overall health and additionally, it involves contacting the patient for follow-up. Therefore, the length of this stage differs from one patient to the next, taking place over the course of hours, days, weeks, or even months (Nursing Process, 2015). What must be taken into consideration, is that it is justified for action to be taken in an emergency or life-threatening situation, regardless of the scheduled written procedures because, as previously mentioned, these cannot always be foreseen, and it is the responsibility of the nursing and multi-disciplinary team to act accordingly largely depending upon their intellectual, technical and decision-making skills (Sirra, 2005).