Case Management Focus: Nurse Case Managers are Troubleshooters

Sarasota, FL (WorkersCompensation.com) -- The healthcare system is complex, fragmented, and built for the healthcare system, not the people who use it. Being sick or injured in such a system puts the injured worker at a disadvantage in advocating for themselves.

When sick or injured, most people cannot stand up against a system that is so busy, complex, and fragmented. As a result, they get lost in the system or give up. As I said in a previous article, some retain an attorney as they feel they cannot fight for their rights.

Nurse Case Managers are called to work with workers who sustain injuries or illness because of a workplace injury. Because the system is uncoordinated and fragmented, many feel their best interests are not prioritized and fear what might happen to them.

When a nurse case manager is assigned to work with an injured worker, their first order of business is to gain the injured workers' trust and let them know they are in place to

• Break down barriers.
• Troubleshoot by being proactive to address issues to prevent setbacks.
• Assist with transitions of care.
• Find resources needed to meet the needs of the injured worker.
• Help the injured worker return to gainful employment.

Nurse case managers are in place to advocate for the injured worker, set realistic expectations, and address the challenges of being thrust into a complex system.

Case managers are troubleshooters and advocates for patients to have a voice so their needs and wishes are recognized. They view the injured worker as a human being who needs assistance at a vulnerable time. According to the Case Management Society of America's Standards of Practice, the nurse case manager advocates for high-quality care for the client that uses evidence-based practices in the appropriate delivery systems, including:

• Promote the client’s self-determination, informed, and shared decision-making, autonomy, growth, and self-advocacy.

• Educate other health care and service providers in recognizing and respecting the client’s needs, strengths, and goals.

• Facilitate client access to necessary and appropriate services while educating the client, caregiver, and support system about the resource availability within practice settings.

• Recognize, prevent, and eliminate disparities in accessing high-quality care.

• Promote optimal client health care outcomes as they relate to race, ethnicity, national origin, and migration background; sex and marital status; age, religion, and political belief; physical, mental, or cognitive disability, gender orientation, or other cultural factors.

• Advocate for appropriate levels of care, timely and well-coordinated transitions, and allocations of resources to optimize outcomes.

• Ensure a safety culture by engagement in quality improvement initiatives in the workplace.

Nurse case managers are troubleshooters who work with injured workers to see they receive the right care at the right time in the right setting to meet their needs.

Share an example of how you troubleshoot for your client, and I will use it in a future article! You can reach me by email at allewellyn48@gmail.com.

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