September 13, 2024 • 14 mins
Part 5 of 5 ~ A Realistic View Into Nursing Areas: Care Coordination & Case Management
In this episode, I focus on Care Coordination & Case Management as the last part of this five-part series. The purpose of this series is to help give you an idea of what different areas of nursing are like. Each episode will challenge you to think about whether that particular area would be a good fit for you. I share both my positive and my negative experiences with the goal of helping you find your 'fit' in the nursing field. The reality is that everything doesn't fit everybody.
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
All right. Some of my friends and I was talking about how we didn't have an accurate view
(00:09):
of nursing before we started. And my friends are just like me, paramedic turned to our
ends and we kind of moved around to different areas before we found our fit. So I decided
I would just want to kind of take a little time to talk about the different areas that
I've worked in and what that looked like so maybe you could find your fit. And for
(00:29):
me, I have experience ED, step down critical care, surgical services and DOSCP care coordination
slash case management. So I just wanted to kind of share with you what the workflow environment
with the hours and some positive and negatives, especially from being a paramedic, the positive
(00:51):
negatives of that area. So welcome to my podcast. So this is the last section I wanted to talk
about and this is where I currently work now. I wanted to talk about care coordination and
case management. And these are kind of a mystery to nurses because these areas are a little
(01:17):
harder to get into because a lot of nurses tend to get into these areas and they tend
to stay. So it has a really good work-life balance and it's not a burnout area. It's
an area that you can transition to other areas like utilization management and even with
(01:41):
care coordination and case management, you can kind of work inpatient as well as outpatient.
And like I said, you can have some really good work-life balance. I've known some care
coordinators and case managers that work from home. And so I just want to kind of tell you
that some systems, this role is split and some is combined. When I first got into it,
(02:05):
I actually got into it as what's called a care manager or care coordinator. And the
nurses did the care coordinating where the social workers did the case management. And
I explained to you what case management is, but typically to get into these roles, you
need to have a bachelor's, you need to have your BSN and also you need to have a good
(02:26):
two to four years of nursing. And it really depends on where you got that experience at
too, because that can count, especially when it comes to care coordinating. And really
be honest with you, if you've been kind of roundabout like I have, like on different
(02:48):
units, it kind of makes you a more marketable candidate because you kind of already know
from a nursing aspect of that patient care and what it looks like on the floor. So as
I talk about these care coordination and case management, wanted to tell you that the mission
(03:09):
is still the same and which is to provide a safe discharge for patients, but also move
the patient to the next level of care. So what happens is on the backend that as a paramedic,
you don't see is that after the patient is medically stable, what is next in their recovery?
Sometimes it can be inpatient rehab, short-term rehab at a nursing facility. It can be home
(03:32):
health with therapy. It can be home or it could be home with or without medical equipment
like a rolling Walker or a bedside commode, or it can be a hospital to hospital transfer
because it may be something that your hospital doesn't do. You need to get that patient
out. So case management itself, that's the care coordinating case management itself addresses
(03:56):
what's called social determinants of health. We call it SDOH. And what this is, is really
social determinants of health are things that tend to affect your readmission rate. That's
not necessarily tied to medical per se. For example, a patient's finances, transportation,
(04:17):
food, housing, and employment affects their readmission rates. And you don't believe
me? If a person doesn't have money, how can they get their medications at discharge? If
they have no job, how can they have insurance? Which means they don't have finances, which
mean they can't get their medications. So we tend to think sometimes that patients
(04:37):
are being non-compliant with their medications. Oh, we tend to say, I remember as a paramedic
saying, Hey, this person is just non-compliant with his medications. It ain't that he doesn't
want to take his medications. Maybe he's embarrassed to tell you he don't have the money to buy
those medications because some medications are expensive, especially things like Intresto
(04:57):
or insulin. Those medications can run a lot of money. And sometimes they just don't have
the money to purchase it. Or if they don't have a car to get around, if they don't have
transportation, how can they maintain appointments? For example, follow-up appointments or their
primary care appointment or even transportation to have a job. To have insurance, to have
(05:22):
a primary care. Or if they don't have food, they have poor nutrition. Poor nutrition kind
of go hands in hands with poor healing. You need protein to help heal. Well, if you don't
have adequate protein intake or adequate nutrition, you can't heal. And we all know the housing,
if you're homeless, you have a really high risk of infection. So those, what we call
(05:49):
social determinants of health, and that's typically what case management kind of comes
in and address. And case management normally, case managers are normally social workers,
but as nurses, we're kind of filtered into these roles too. And what we do is we give
them access to resources to help address those social determinants of health. So in one way,
(06:12):
we provide them a safe discharge. And in another hand, we're kind of helping assist with those
social determinants of health issues to keep them from being readmitted. So now that I
shared with you what that role is, want to kind of talk to you about the workflow. The
workflow is pretty fast paced. I have a caseload. Usually is one hospital I had was 40 patients,
(06:40):
which was insane. The hospital that I'm with now, my caseload is anywhere between, it can
be anywhere between 17 to 21, but it's still fast paced because we have dual roles. My
roles is of a care coordinator and as a case manager. So I kind of take on both aspects.
(07:02):
So I'm setting up services like home health, home infusion, sniff placements, setting up
new start hemodialysis. I'm also setting up transfers, whether if it's transfer home,
ALS or ALS or even critical care transport. There's lots of meetings that I attend during
the day, whether if it's unit based meetings with maybe with the nursing manager or maybe
(07:28):
with the nurses themselves or complex care meetings or multidisciplinary rounds where
we all talk. I have a multidisciplinary round meeting on the units that I'm serving. There
are those come with the nurses come in, give a report, talk with the charge nurse with
(07:51):
therapy and that can be speech language, that can be physical or occupational therapy with
the provider themselves. It can be dietician and pharmacy attends these meetings. And we
also have complex care meetings. If I have a patient, for example, I've had a gentleman
who was blind on hemodialysis, a new start hemodialysis and undocumented, that's a very
(08:20):
complex case. So sometimes we get together with administration and we talk about how
to best handle those patients. So the environment is pretty autonomous, is very self paced and
self managed. So I kind of work under like, I guess it's kind of, how do you say that?
(08:44):
You know, professional courtesy. My team consists of nurses like myself, but also licensed clinical
social workers. We kind of do the same job. My hours on Monday through Friday, eight hours.
And for me, you know, I kind of like that because, you know, if I need to be off or
take some time off, I can, or if I'm coming in late, then I can just let my manager know,
(09:07):
hey, I might be coming in late today. But usually, you know, I stay a little later to
make that it's salary based. It's not hourly based. So what are some of the positives and
the negatives? Well, I think for this role, the positives can be the negatives. And I
explained to you, my job is total patient is no patient care is total admin. So I don't
(09:30):
do patient care. And that can be good and bad because no one, you can kind of lose your
skills. But two, what if you're tired of patient care, you just want to do something
admin that can be a good thing. Well, for some people that can be a really bad thing.
Also it's office based, which can be good or bad, which means it's office. So I wear
(09:52):
business casual clothes. And when I'm in front of the patient, I wear a light coat, I wear
a white coat, just like administration, physicians, the same thing. Sometimes I can get mistaken
for a physician. I have to tell them, no, I'm a nurse. But that can be a good and bad
because maybe you like to wear scrubs because to me, scrubs are more comfortable. My last
(10:14):
job as a care coordinator, I had the option to wear scrubs, but I still wore my white
coat facing the patient. This system that I'm with, I have to wear business casual.
I don't have the option to wear scrubs. But also I'm on the unit for meetings. So like
I said, maybe you don't like the office environment. Maybe you prefer to be patient facing all
(10:41):
the time. But one thing I can tell you is that I think one of the negatives is if both
roles are combined, like the role I'm in now, the learning curve for the social determinants
of health, social worker part can be a bit long because you have to know things like
about insurance. What does Medicaid covers? What does Medicare part A and B covers? What
(11:03):
the Medicare part D covers in commercial insurance and which insurances are not so good? What
does managed Medicaid or managed Medicare? What's the difference between traditional
Medicaid and traditional Medicare? A lot of social workers know that. For me, I have no
(11:24):
freaking clue. And so I have to know that when I'm ordering certain equipment because
for example, if someone has Medicare, chances are them getting a rolling Walker and a bedside
commode together will probably not be approved. But a commercial plan with may approve both
of those. It's kind of weird, but that's just one of those things. And also your paramedic
(11:49):
knowledge don't really help you in this role. I'll be honest with you. Maybe it does if
you're used to maybe doing something like crisis management. Maybe you're familiar
with maybe certain resources in the community for certain patients. Like for example, the
homeless patients, you know, certain places they could go for shelter or to eat and food
(12:13):
banks. You know, that's the only reason, but your RN knowledge is big here because you
can anticipate discharge dates. Not only that with both, you kind of understand medically
what's going on with the patient, but it comes in good detail when you're able to communicate
with your providers. I know when I have a conversation with my doctors, they all know
(12:36):
that I have a really in-depth medical knowledge. So we can have a discussion about the course
of treatment for this patient, what's expected. I'm able to think of alternative courses,
where this patient may need to go and you're able to have a good, healthy discussion about
it. That's one of the reasons why for new grads, definitely it's not going to be up
(12:56):
your line unless maybe you come from a social work background and you find a strictly case
management job. So hopefully I just kind of share with you some good in-depth information
if this, the course that you want to go. I will tell you, if you want to get, if you
want to eventually become a care coordinator or a case management, I will tell you to go
(13:20):
to the floor for a couple of years so you can see the floor. You can see the flow. You
can see when therapy comes in, what therapy does, anticipate, participate in the interdisciplinary
rounds or a few and kind of pay attention to what's being said and how care coordinators
and high case management move and operate and also ask the shadow. So that's my advice
(13:45):
to you. Thank you for joining and that concluded this part of the series and I hope you got
something out of it and I'll see you on the talk. Bye.
As always, hey, make sure you guys follow me on Instagram at paramedic2renfo. Remember
to number two.
All right. Some of my friends and I was talking about how we didn't have an accurate view
(00:09):
of nursing before we started. And my friends are just like me, paramedic turned to our
ends and we kind of moved around to different areas before we found our fit. So I decided
I would just want to kind of take a little time to talk about the different areas that
I've worked in and what that looked like so maybe you could find your fit. And for
(00:29):
me, I have experience ED, step down critical care, surgical services and DOSCP care coordination
slash case management. So I just wanted to kind of share with you what the workflow environment
with the hours and some positive and negatives, especially from being a paramedic, the positive
(00:51):
negatives of that area. So welcome to my podcast. So this is the last section I wanted to talk
about and this is where I currently work now. I wanted to talk about care coordination and
case management. And these are kind of a mystery to nurses because these areas are a little
(01:17):
harder to get into because a lot of nurses tend to get into these areas and they tend
to stay. So it has a really good work-life balance and it's not a burnout area. It's
an area that you can transition to other areas like utilization management and even with
(01:41):
care coordination and case management, you can kind of work inpatient as well as outpatient.
And like I said, you can have some really good work-life balance. I've known some care
coordinators and case managers that work from home. And so I just want to kind of tell you
that some systems, this role is split and some is combined. When I first got into it,
(02:05):
I actually got into it as what's called a care manager or care coordinator. And the
nurses did the care coordinating where the social workers did the case management. And
I explained to you what case management is, but typically to get into these roles, you
need to have a bachelor's, you need to have your BSN and also you need to have a good
(02:26):
two to four years of nursing. And it really depends on where you got that experience at
too, because that can count, especially when it comes to care coordinating. And really
be honest with you, if you've been kind of roundabout like I have, like on different
(02:48):
units, it kind of makes you a more marketable candidate because you kind of already know
from a nursing aspect of that patient care and what it looks like on the floor. So as
I talk about these care coordination and case management, wanted to tell you that the mission
(03:09):
is still the same and which is to provide a safe discharge for patients, but also move
the patient to the next level of care. So what happens is on the backend that as a paramedic,
you don't see is that after the patient is medically stable, what is next in their recovery?
Sometimes it can be inpatient rehab, short-term rehab at a nursing facility. It can be home
(03:32):
health with therapy. It can be home or it could be home with or without medical equipment
like a rolling Walker or a bedside commode, or it can be a hospital to hospital transfer
because it may be something that your hospital doesn't do. You need to get that patient
out. So case management itself, that's the care coordinating case management itself addresses
(03:56):
what's called social determinants of health. We call it SDOH. And what this is, is really
social determinants of health are things that tend to affect your readmission rate. That's
not necessarily tied to medical per se. For example, a patient's finances, transportation,
(04:17):
food, housing, and employment affects their readmission rates. And you don't believe
me? If a person doesn't have money, how can they get their medications at discharge? If
they have no job, how can they have insurance? Which means they don't have finances, which
mean they can't get their medications. So we tend to think sometimes that patients
(04:37):
are being non-compliant with their medications. Oh, we tend to say, I remember as a paramedic
saying, Hey, this person is just non-compliant with his medications. It ain't that he doesn't
want to take his medications. Maybe he's embarrassed to tell you he don't have the money to buy
those medications because some medications are expensive, especially things like Intresto
(04:57):
or insulin. Those medications can run a lot of money. And sometimes they just don't have
the money to purchase it. Or if they don't have a car to get around, if they don't have
transportation, how can they maintain appointments? For example, follow-up appointments or their
primary care appointment or even transportation to have a job. To have insurance, to have
(05:22):
a primary care. Or if they don't have food, they have poor nutrition. Poor nutrition kind
of go hands in hands with poor healing. You need protein to help heal. Well, if you don't
have adequate protein intake or adequate nutrition, you can't heal. And we all know the housing,
if you're homeless, you have a really high risk of infection. So those, what we call
(05:49):
social determinants of health, and that's typically what case management kind of comes
in and address. And case management normally, case managers are normally social workers,
but as nurses, we're kind of filtered into these roles too. And what we do is we give
them access to resources to help address those social determinants of health. So in one way,
(06:12):
we provide them a safe discharge. And in another hand, we're kind of helping assist with those
social determinants of health issues to keep them from being readmitted. So now that I
shared with you what that role is, want to kind of talk to you about the workflow. The
workflow is pretty fast paced. I have a caseload. Usually is one hospital I had was 40 patients,
(06:40):
which was insane. The hospital that I'm with now, my caseload is anywhere between, it can
be anywhere between 17 to 21, but it's still fast paced because we have dual roles. My
roles is of a care coordinator and as a case manager. So I kind of take on both aspects.
(07:02):
So I'm setting up services like home health, home infusion, sniff placements, setting up
new start hemodialysis. I'm also setting up transfers, whether if it's transfer home,
ALS or ALS or even critical care transport. There's lots of meetings that I attend during
the day, whether if it's unit based meetings with maybe with the nursing manager or maybe
(07:28):
with the nurses themselves or complex care meetings or multidisciplinary rounds where
we all talk. I have a multidisciplinary round meeting on the units that I'm serving. There
are those come with the nurses come in, give a report, talk with the charge nurse with
(07:51):
therapy and that can be speech language, that can be physical or occupational therapy with
the provider themselves. It can be dietician and pharmacy attends these meetings. And we
also have complex care meetings. If I have a patient, for example, I've had a gentleman
who was blind on hemodialysis, a new start hemodialysis and undocumented, that's a very
(08:20):
complex case. So sometimes we get together with administration and we talk about how
to best handle those patients. So the environment is pretty autonomous, is very self paced and
self managed. So I kind of work under like, I guess it's kind of, how do you say that?
(08:44):
You know, professional courtesy. My team consists of nurses like myself, but also licensed clinical
social workers. We kind of do the same job. My hours on Monday through Friday, eight hours.
And for me, you know, I kind of like that because, you know, if I need to be off or
take some time off, I can, or if I'm coming in late, then I can just let my manager know,
(09:07):
hey, I might be coming in late today. But usually, you know, I stay a little later to
make that it's salary based. It's not hourly based. So what are some of the positives and
the negatives? Well, I think for this role, the positives can be the negatives. And I
explained to you, my job is total patient is no patient care is total admin. So I don't
(09:30):
do patient care. And that can be good and bad because no one, you can kind of lose your
skills. But two, what if you're tired of patient care, you just want to do something
admin that can be a good thing. Well, for some people that can be a really bad thing.
Also it's office based, which can be good or bad, which means it's office. So I wear
(09:52):
business casual clothes. And when I'm in front of the patient, I wear a light coat, I wear
a white coat, just like administration, physicians, the same thing. Sometimes I can get mistaken
for a physician. I have to tell them, no, I'm a nurse. But that can be a good and bad
because maybe you like to wear scrubs because to me, scrubs are more comfortable. My last
(10:14):
job as a care coordinator, I had the option to wear scrubs, but I still wore my white
coat facing the patient. This system that I'm with, I have to wear business casual.
I don't have the option to wear scrubs. But also I'm on the unit for meetings. So like
I said, maybe you don't like the office environment. Maybe you prefer to be patient facing all
(10:41):
the time. But one thing I can tell you is that I think one of the negatives is if both
roles are combined, like the role I'm in now, the learning curve for the social determinants
of health, social worker part can be a bit long because you have to know things like
about insurance. What does Medicaid covers? What does Medicare part A and B covers? What
(11:03):
the Medicare part D covers in commercial insurance and which insurances are not so good? What
does managed Medicaid or managed Medicare? What's the difference between traditional
Medicaid and traditional Medicare? A lot of social workers know that. For me, I have no
(11:24):
freaking clue. And so I have to know that when I'm ordering certain equipment because
for example, if someone has Medicare, chances are them getting a rolling Walker and a bedside
commode together will probably not be approved. But a commercial plan with may approve both
of those. It's kind of weird, but that's just one of those things. And also your paramedic
(11:49):
knowledge don't really help you in this role. I'll be honest with you. Maybe it does if
you're used to maybe doing something like crisis management. Maybe you're familiar
with maybe certain resources in the community for certain patients. Like for example, the
homeless patients, you know, certain places they could go for shelter or to eat and food
(12:13):
banks. You know, that's the only reason, but your RN knowledge is big here because you
can anticipate discharge dates. Not only that with both, you kind of understand medically
what's going on with the patient, but it comes in good detail when you're able to communicate
with your providers. I know when I have a conversation with my doctors, they all know
(12:36):
that I have a really in-depth medical knowledge. So we can have a discussion about the course
of treatment for this patient, what's expected. I'm able to think of alternative courses,
where this patient may need to go and you're able to have a good, healthy discussion about
it. That's one of the reasons why for new grads, definitely it's not going to be up
(12:56):
your line unless maybe you come from a social work background and you find a strictly case
management job. So hopefully I just kind of share with you some good in-depth information
if this, the course that you want to go. I will tell you, if you want to get, if you
want to eventually become a care coordinator or a case management, I will tell you to go
(13:20):
to the floor for a couple of years so you can see the floor. You can see the flow. You
can see when therapy comes in, what therapy does, anticipate, participate in the interdisciplinary
rounds or a few and kind of pay attention to what's being said and how care coordinators
and high case management move and operate and also ask the shadow. So that's my advice
(13:45):
to you. Thank you for joining and that concluded this part of the series and I hope you got
something out of it and I'll see you on the talk. Bye.
As always, hey, make sure you guys follow me on Instagram at paramedic2renfo. Remember
to number two.
Popular Podcasts
Crime Junkie
Does hearing about a true crime case always leave you scouring the internet for the truth behind the story? Dive into your next mystery with Crime Junkie. Every Monday, join your host Ashley Flowers as she unravels all the details of infamous and underreported true crime cases with her best friend Brit Prawat. From cold cases to missing persons and heroes in our community who seek justice, Crime Junkie is your destination for theories and stories you won’t hear anywhere else. Whether you're a seasoned true crime enthusiast or new to the genre, you'll find yourself on the edge of your seat awaiting a new episode every Monday. If you can never get enough true crime... Congratulations, you’ve found your people. Follow to join a community of Crime Junkies! Crime Junkie is presented by audiochuck Media Company.
24/7 News: The Latest
The latest news in 4 minutes updated every hour, every day.
Stuff You Should Know
If you've ever wanted to know about champagne, satanism, the Stonewall Uprising, chaos theory, LSD, El Nino, true crime and Rosa Parks, then look no further. Josh and Chuck have you covered.