A Time to Look Out for YOUR Own Safety

Case Management Focus

By now, I am sure you have heard about the Dec. 4 killing of Brian Thompson, the CEO of UnitedHealth, that occurred in Mid-town Manhattan. The killer has been caught, and the police investigation is ongoing. As time passes, hopefully we will gain more insight into this heinous crime.  

What has been alarming is the reaction from the public that the killing was based on how healthcare insurance companies are using cost-cutting methods to deny care to people to increase profits for the C-Suite and shareholders. Violence or this murder will not fix the inequities that are happening in our complex healthcare system. It will take a team of all of the stake holders (including the general public – Patients and Caregivers) to revamp a system that seems to have lost it mission.  

As a nurse case manager, I see this outcry as a warning to all of us to be careful and take safeguards when we are confronted with threats from people who feel they are wronged by decisions made through guidelines, policies, and laws.  

Why is workplace violence exceptionally high now? According to a recent study by Liberty Mutual, here are a few reasons:  

• COVID-19 both exacerbated existing sources of violence and opened up new areas of confrontation between healthcare providers, patient families, and the general public. 

• The national opioid crisis has led to a rise in drug theft that can turn violent. 

• A shortage of mental health resources — combined with increasing pressure on these resources — means more patients wind up in crisis in hospital emergency rooms. 

• Hospital environments can trigger fear of illness and pain, which in turn may unleash aggression. Long wait times and overcrowding can exacerbate aggravation.  

• Patients in healthcare settings may be experiencing conditions that increase agitation and aggression, such as head injury, withdrawal, or dementia.  

• Violence in healthcare across all sectors is increasing due to changes in laws and rules that have limited or made resources harder to obtain.  

• Insurance companies' mandates appear to put profit before safe patient care.  

Most people do not understand how the healthcare system works or how healthcare insurance works, as it is not like any other system we utilize in our lives. People feel they do not have a say in the system and are at the mercy of people they don't know who do not have their interests at heart.  

Healthcare is expensive, and there is little explanation or alternative when a person or loved one is sick. Insurance guidelines are complex and do not mean a lot to the end user, the patient/caregivers. To the average person, insurance companies dictate care instead of the treatment team's advice. There is an 'us' vs. them battle.  

Nurse Case Managers are the face and voice of the healthcare system. Even though decisions are made by managed care doctors and hospitalists, the nurse case manager often delivers the news and takes the brunt of what the patient/family feels. This can put nurse case managers in danger.  

So, what can nurse case managers do to stay safe? I would ask each of you reading this post to share what you and your organization are doing to keep you safe. If you don't see any action, bring it up at your next staff meeting.  

Here are some tips that might help keep us safe.  

1. Approach the situation in a safe environment. If you are face-to-face with a person when delivering bad news, make sure you are in an open environment with help available in case the conversation escalates.  

2. If you are threatened, report it right away. Call security and get to a safe place.  

3. Do not escalate the discussion—try to humanize what you are saying and make a point of letting the person you are talking to know that you are listening to them.  

4. Bring leadership into the discussion and work your way out of the discussion.  

5. If you are on the phone with a patient or the family, follow your company processes as to what information you give out (for example, your first name only so you cannot be found in a directory. I see this more or more…where insurance company personnel do not give their last names, director's phone numbers, or specific workouts to the general public.  

6. If you must deliver bad news, bring a solution. Work with the treating physician and administration to find a way to meet the client's needs. You might be the only person who will do this, but it is an important part of our role as nurse case managers. 

7. Use your contacts to find organizations/suppliers that will work with you to meet the patient's needs, a discounted cost for self-pay patients, and medication for the patient to take if they cannot afford what was ordered. Ask if there is a payment plan for someone with a large balance due to a high deductible and who does not have the money to pay. Try to find a way to work with the individual. Many people need to learn the impact of high deductibles when they sign up for their health plans. Be patient and try to find a workaround that will meet their needs.  

8. Take time to educate your patients on how their insurance works and how to use it best. Employers need to do a better job of educating employees on their policies. People need to know what their out-of-pocket costs are and are urged to set up savings plans or to save money themselves to pay for unexpected healthcare costs. Many people have high deductibles to keep premiums lower but only have the money to pay for care costs once they reach their deductibles. Insurance companies have a responsibility to provide this education to their members.  

9. If you are a hospital or insurance case manager and you have to deliver news that will be hard for a patient or family to understand, try to find a workaround….As a fellow case manager has said, "We are not 1-800 Hell No Case Managers! We need to take those extra steps to find the resources to meet the needs of the patient or family.  

The system is complicated, costly, and, at times, fair. Our roles are not easy, and many people feel helpless due to their illness or inability to address the situation.  

We each have a role to play in humanizing healthcare and making it safe, effective, equitable, and within reach for all when needed.  

I hope this article sheds some light on the state of our healthcare system. We are in very precarious times.  

Bottom line – Stay safe. Do what you can within your scope of practice. Report anything that might be suspicious or cause you harm, and stay safe.  

If you want to comment on this post, please email me at allewellyn48@gmail.com.  

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