Care Management: Interview with Sheryl Schlicht, RN, BSN, PHN, CCM
Helping vulnerable populations navigate complex and high-risk care
What is your nursing career history?
I grew up in rural Sussex County, New Jersey, and moved to California when I was 22. I’ve always loved working with the elderly population. In high school, I worked in a local nursing home. It’s always been easy for me to talk with the elderly and learn from their life experiences. (The stories of a Disney artist from the 1930s and a former secretary for Bob Hope were particularly memorable.)
I had an aunt who was a nurse and she recommended that I go to community college to earn an RN degree. I took her advice and graduated with an ADN and a public health nursing certificate in 1981.I had an aunt who was a nurse and she recommended that I go to community college to earn an RN degree. I took her advice and graduated with an ADN and a public health nursing certificate in 1981.
While in nursing school, I worked as a nurse’s aide at the local community hospital. After graduation, I was hired as an oncology RN at the same facility. I earned my BSN from Cal State Fullerton in 1983. During that period of my career, I developed listening skills that I still use to this day. Everyone deserves to feel that what they are saying is important and that they are being heard.
Several years later, I spent five years in the Air Force as a nurse officer, working on the medical/surgical and obstetrics wards of base hospitals. Following the Air Force, I wanted to return to hospital nursing, but there was a nursing glut at the time and many facilities had hiring freezes. So, I worked for 10 years as an OB nurse for mothers at risk for premature deliveries.
In 2002, I became a delivery care manager, working for a company that offered care management to health plans in order to help oversee their high-risk members. In 2014, I joined L.A. Care Health Plan, a publicly operated health plan serving more than two million members in Los Angeles County.
Please tell us about your employer and your position.
As a care management specialist, I work with Medi-Cal (i.e., Medicaid) patients with multiple comorbidities. The program is completely voluntary and my work with patients is conducted entirely by telephone. Since some patients speak other languages, L.A. Care provides interpreter services if needed. We do both high-risk and complex care management.
The most common diagnoses are congestive heart failure, uncontrolled diabetes, COPD [chronic obstructive pulmonary disease], various cancers and chronic pain. Mental health and addiction issues are also common, as are patients with multiple hospitalizations and frequent ER utilization. My job is to actively engage, guide and inspire my patients to take better care of their health and wellness — and thus decrease their hospitalizations. Patients may be on my panel for up to six months, depending on their needs.
What is the key to success in your work with these patients?
What is the key to success in your work with these patients? The key to successful care management is trust. When patients understand that I’m here to help, many open up and share with me. I do a very detailed assessment to identify potential barriers to achieving better health. The patient is always in control and can decline to answer any questions that make them feel uncomfortable. Together, the patient and I build an individualized care plan. I also provide a lot of education.
What are some of the problems you commonly see?
What are some of the problems you commonly see?This is a very vulnerable population, so patients’ main focus may be on barriers such as socioeconomic issues, transportation or homelessness. I often identify health problems they haven’t yet addressed. I encourage patients to ask questions and tell me what they need. I’m like a detective and a problem-solver. I gather evidence, look at the clues and data and then try to find a way to resolve the issues at hand.
What makes you happiest about your work?
My work is very personally and professionally fulfilling. I’ve always loved being a nurse. I enjoy talking with and helping my patients because I’m comfortable with what I know and what I do. I try to put myself in their shoes and help them work through the maze of our complicated healthcare system.
What’s most satisfying about your relationship with patients?
The most satisfying thing to me is when a patient says, “No one has ever cared about me before.” So many people out there are alone — they've severed relationships with their families and don't have many friends.
It might take a few calls for them to trust me, but then they begin to turn around. I assure my patients that I won’t abandon them. I tell them that even after we close the case they can still call me if they need me. I do my best to empower my patients to make positive changes in their lives and I facilitate whatever they need to accomplish that. I often refer them to our social work department, which connects them to resources and services in the community. I can also refer them to licensed behavioral health clinicians, who can connect them with specific services such substance use disorder programs.
We have interdisciplinary care team meetings on a regular basis, involving social work, pharmacy, behavioral health, care managers, health educators, housing specialists and the medical director. We also invite the patient and their primary care physician to attend. We present a case and ask for collaboration in moving the patient in a positive direction.
What skills or experience would you recommend for nurses interested in this type of care management?
It’s helpful to have certification in complex case management and a working knowledge of the Case Management Society of America’s Standards of Practice for Case Management [see www.cmsa.org]. Clinical experience provides a strong foundation for understanding patient experiences within the healthcare system. You must also have a passion for helping people and a great deal of patience.
Organizational and interpersonal skills are important, as are time management and detail management skills, maintaining firm boundaries and being able to quickly and accurately triage to determine who needs your help most urgently. In this work, you need to think on your feet, be a consistently positive influence and practice excellent skills in communication and motivational interviewing.
Finally, you need the ability to not take things personally when patients are experiencing great stress or anger at the system or their circumstances. In this job, you’re not telling patients what to do. Rather, you’re allowing each patient to drive his or her own healthcare. It’s about choices and empowerment.
What are your professional plans and goals?
I enjoy learning new things. Our managers are always providing us with fascinating and valuable training, including culturally responsive care, member engagement, palliative care and hospice comprehensive training as well as motivational interviewing. I just want to stay involved and always be growing as a professional. I love what I do. I’ll never stop growing as a nurse because there is always something new to learn from my patients.
Keith Carlson, RN, BSN, CPC, NC-BC, has worked as a nurse since 1996 and has maintained the popular nursing blog Digital Doorway since 2005. He offers expert professional coaching for nurses and nursing students at www.nursekeith.com.
This article is from workingnurse.com.