By Megan Murdock Krischke, contributor
March 10, 2014 - Care coordination is at the heart of an undergraduate nursing education, and stretches across a number of specialties. Using clinical assessment as well as psychosocial skills in a holistic manner, it has also become a stand-alone specialty where the opportunities for registered nurses are plentiful and expected to expand.
Joy Hanson, MN, RN, CNL, says care coordination involves clinical and psychosocial problem solving that is very satisfying.
“I get the opportunity to work with nurses of all different years of experience. Many nurses have worked in a variety of other arenas before they find their way into care management,” explained Joy Hanson, MN, RN, CNL, administrative director for clinical care coordination at Virginia Mason Medical Center in Seattle, Wash., “I often hear nurses comment about the specialty: ‘This is why I went into nursing; this is what I really want to do.’”
“Care coordination is an unbelievable opportunity for nurses. One of the key satisfiers for ambulatory care nurses is the long-term relationship with patients--care coordinators get to have exactly that,” expressed Sheila Haas, PhD, RN, FAAN, co-creator of the American Academy of Ambulatory Care Nursing’s (AAACN) Care Coordination and Transition Management course/core text.
Dana Nelson-Peterson, DNP, MN, RN, NEA-BC, administrative director for ambulatory care nursing services at Virginia Mason, adds that anticipating needs and rallying resources that help keep patients out of inpatient care is a high point of the job for many of the care manager nurses with whom she works.
Part of what is driving the expansion of the specialty is the move toward a pay-for-performance model--the better the outcomes, the higher the reimbursement rate--and the move toward a patient-centered medical home (PCMH). RN care coordinators are likely to play a central role in both of these models.
Dana Nelson-Peterson, DNP, MN, RN, NEA-BC, notes that many nurses find the ongoing relationships with patients a highlight of care coordination jobs.
“We have seen some phenomenal outcomes as a result of having RNs serve as patient care managers,” remarked Nelson-Peterson. “One of the key elements has been bringing the ambulatory care coordinator nurse into the acute care setting and thereby increasing the level of communication between acute and ambulatory care.”
In the second half of 2013, through the use of RN care managers engaging with other team members in the coordination of care, Virginia Mason reduced readmission rates for pancreatitis patients from 15 percent to 0 percent and the average length of stay for these patients dropped from 6.8 days to 6 days.
While there are some similarities between case management and care coordination, these are distinct specialties. Hanson explained that case managers are looking more at the financial utilization of resources and asking whether or not a patient is meeting the criteria for an inpatient stay. Care management, however, is more holistic and encompasses more of a clinical course and the navigation of what the patient and family are experiencing and connecting them with resources and information.
“Using RNs as care coordinators is a clear application of the Institute of Medicine’s recommendation that nurses should practice to the full extent of their education and training,” emphasized Haas. “Care coordinators can work in hospitals, clinics and in the public health arena. The push today isn’t for more care but the right care, in the right place, at the right time, and to standardize care for a population with complex medical issues. Providing this care requires education that insures nurses have the right knowledge, skills and attitudes.”
It is out of that need that the AAACN developed The Care Coordination and Transition Management Core Curriculum that will be available in May.
Sheila Haas, PhD, RN, FAAN, is a co-creator of the AAACN Care Coordination and Transition Management course/core text which will be available in May.
“There is such a high demand for education in this specialty that we have already started offering our 13 online training modules--people don’t want to wait until May!” said Haas. “Additionally we are offering the first module free to introduce nurses to the value of the course.”
“To be a successful care manager you must love to hear patients’ stories. You need to be able to listen to patients and their families and understand their situation, goals, hopes and the course of their treatment in both the short and long term,” explained Hanson. “You must also be able to work with practitioners ranging from nursing assistants to hospital executives and across specialties.”
“The largest barrier to care coordination is the lack of interactive information systems. Every institution has an information system, but only 20 percent are fully interactive--meaning that they can communicate across institutions. This is a huge issue,” asserted Haas.
“Additionally, it is critical that care coordinators document the services they are providing,” she continued. “There is no other way to find out what they are doing and what results they are achieving. This is the path to receiving Medicare reimbursements--Medicare wants to know what was done, was the person delivering the care competent, what processes they are putting into place and what are the outcomes.”
All three experts encouraged nurses to consider care coordination because it is an area of high need as well as high satisfaction.
“Our nurses get to see patients and families move from the frustration of experiencing fragmented care to experiencing an increased sense of safety and empowerment in their care. Patients frequently comment to our care managers, ‘If I didn’t have you as my anchor through this experience, I don’t know what I would have done.’”
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