Outpatient Case Management, Sabrina Keys, Regal Medical Group

How long do your relationships with patients generally last?

Most relationships with patients last less than a year, but there are a few that continue for over two years. We actively manage members for 30 to 90 days, but they’re welcome to reach out to me at any time in the future, even if they’re off my caseload.

How do you motivate patients?

With our elderly members, we get their families involved. The member needs to understand what’s happening, but we also educate the families, because they’re the eyes and ears at home.

We motivate people to take their meds by making sure they understand the consequences of not taking them. They also need to know how important medical follow-up is and how seeing their providers is crucial.

Members with complex medical situations and multiple diagnoses must manage a lot of medications and appointments, so everyone should be on the same page. We have a compliance program for those patients who are noncompliant, to make sure they do what they need to do to move their treatment plans forward.

How does trust develop in these types of nurse-patient relationships?

When you’re talking with a patient over the phone, you get an intimate glimpse of their home life. When they realize that you don’t judge them and that you’ll continue to show up and help them over and over again, trust naturally builds.

My patients also get to know my life to a small extent. I work from home, so patients hear my kids in the background and ask about them. I share just a little in order to help patients see that I’m a normal person with a home and family, just like them.

Rather than being a relatively anonymous nurse in scrubs who might care for them for just one day in the hospital and then never see them again, I become a part of patients’ lives for a little while. This can bring them some comfort and a sense that I really care, which I do!

How effective do you think this sort of case management is?

This kind of case management really helps people stay on track. Family members can be helpful, but that isn’t always enough. Some members don’t necessarily listen to their families for a variety of reasons, so we can be an objective source of information, education, coordination and encouragement.

Most patients appreciate it very much. Patients often don’t remember what they’re told at discharge, so we review their discharge plan, make sure referrals are in process and help arrange any aspects of their follow-up that need our attention. This helps patients feel cared for and know that they’re on track, especially after surgery or a hospitalization.

Do you have a certification in case management?

Not yet, but it’s definitely on my to-do list. Certification would give me more tools and strategies to work with, and would add a lot to the foundation of my case management skills. Certification also demonstrates that you’re interested in your specialty and want to grow and develop as a nurse.

Regal encourages employees to grow and do the things we want to do in order to develop as healthcare professionals. They reimburse us for these types of expenses, which can mean a lot to a hardworking nurse who has a family to support.

What would you say to a nurse who is interested in case management?

They should first work at the bedside. This helps to really understand what patients face in the hospital and what the hospital discharge process is like from the perspective of the discharge planner, the case manager, the patients and the patient’s loved ones. Appreciating the entire picture is important.

Nurses who want to be case managers should be caring, detail-oriented, focused and dedicated. As a case manager, you want to keep patients healthy and out of the hospital as much as possible, so prevention and education are key.

This role is definitely not for nurses who love adrenaline — case management may occasionally be a little fast-paced when a crisis situation arises with a patient, but it’s nothing like the speed of the hospital environment.

Do you have future plans for your career?

I want to go back to school eventually, perhaps as an NP when my kids are older.

I lean towards the clinical aspects of care rather than leadership. I worked as a charge nurse for a while, but I want to continue to work with patients and their families directly.

What do you most love about what you do?

I love building a different type of relationship with patients than I used to at the bedside. When you’re at the bedside, patients get well enough and go home, which is great for them, but leaves the nurse with no idea of how the patient is doing over time. Developing trusting relationships that produce good outcomes is very satisfying.

KEITH CARLSON, RN, BSN, CPC, NC-BC, has worked as a nurse since 1996 and has hosted the popular nursing blog Digital Doorway since 2005. He offers expert professional coaching for nurses and nursing students at www.nursekeith.com.

In this Article: Care Management