We don't have inpatient coordinators here, just outpatient. When they are in hospital their care is totally managed by the inpatient staff.
My day? Well, like I said, I do case management for approx 200 pts. So, a day for me consists of monitoring bloodwork (our doctors do not look at bloodwork, they can't mange bloodwork on 1000 pts) and flagging anything for the doctors that needs attention. We do clinics just about every day, and when we are working clinic we do prep work before hand - we look at bloodwork, medical history, figure out what tests they are due for, note anything that needs to be discussed with the doctors. Then when clinic actually starts, the clerks bring the pts to a clinic room and weigh them. The RN then goes in, and will review their medication list (to make sure they are taking what we think they are taking), go over their labs (we don't call pts with labs, they all run on the "no news is good news" theory), find out how they are doing - how is BP at home, how is the (whatever) we dealt with last time you were in, etc. We will do vitals, and find out if they have any questions for the doctors. We then meet the doctors outside the room and give them a run down about the pt (our doctors rotate q2weeks so they might never have seen this pt before) and tell them briefly what the concerns are. When the doctor goes in with the pt, I will speak to the pharmacist, dietitian, diabetes nurse, or social work if I identified anything they need to be aware of. After clinic we make sure the visit is charted and orders written. When not doing that, I have phone calls. My pts will call me with any questions (I have had diarrhea for a week, what do I do?) or if they want to know lab results. I call any pts for whom I have identified concerns with their labs (Hi, your creatinine has taken a jump. Are you drinking enough? Can you please hydrate well and repeat your bloodwork in the next couple of days? Your CMV level is rising, how are you feeling? You Hgb is dropping, are you passing blood in your stools? Nosebleeds?). If any of my pts need to be referred to another specialty I write the referral letters. I do reqs for diagnostics and biopsies. I field phone calls from family doctors and community pharmacies about what my pts can take or what to do with the pancreas transplant pt with pancreatitis. Or whatever. We write orders based on the labwork and/or pt's concerns after consulting with the doctors, and then ensure that orders are followed up on. I follow up on testing done as an inpatient for which results might not have been available on discharge. W4ehn pts are discharged following their transplant, I will see them at 0730 M-W-F for about three weeks and do assessments of BP, edema, bowels, mood (high dose steroids) and surgical wound. I will take out staples when they need to be removed. If my pts are admitted anywhere other than our inpt unit, I will call that unit/hospital and introduce myself, give them my phone number and invite them to call with any questions/concerns about the pt's transplant. If a pt is admitted for surgery and is taking sirolimus, I try to get the attending doctor to consul transplant to get them off sirolimus to allow better wound healing. We also do dermatology, endocrinology and gynecology clinics so we have different kinds of prep for each of those.
Pros? I love what I do. Seeing my pts get their organs and do well is awesome. I have a unique kind of relationship with my pts, some of them I have nursed for more than 15 years. I get to know them and many of them I can laugh with and joke with. My pts know me and they trust me. We have pts being treated for cancer or other illnesses who will call us rather than the oncologist or whoever because we know them better. I have a great relationship with the doctors I work with and we are given a lot of autonomy to make decisions. One of the doctors I work with will answer a question with "Why are you even asking me? You know what to do, just do it." (To which I reply that the one time I don't aks will be the time she doesn't agree with my decision.) Our multidisciplinary team is awesome and we work very well together.
Cons? The meds over the long term can do nasty things to pts. PTLD to name one. Breaks my heart to get a biopsy report showing that. Pts who decide they feel good and stop their meds, destroying the organ(s), because they figure they can "just get another one". And while I like how well I know my pts, it makes it that much harder when they die. We do cry over some of our pts. Working M-F means I must take time off for my own medical appts and such as ther are no days off during the week. The pts can become overly dependent on us. Telling a pt that I am referring them back for pre-dialysis care. Or that they need to re-start insulin because their pancreas has failed. I hate those conversations.
Hope that answers some of your questions. Let me know if you have more.... :spin: