RN58186 3,833 Views
Joined Jun 19, '11.
Posts: 143 (63% Liked)
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:
A pt had been discharged from hospital without a cause being found for his symptoms. When he was admitted again a week later with the same symptoms the admitting diagnosis was "Recurrence of whatever".
One meds error I made as an inexperienced nurse was avoidable but the room assignment should never have been made in the first place, according to the NM.
Bed 1 - Mary Smith
Bed 2 - Mary Smith
The first patient was AA and the second was Caucasian. When I made my error, Mrs. Smith, in bed 1, was out of the room.
The pharmacists in our clinic deal with refill requests. When pts run out and don't have a follow up booked, or haven't had bloodwork done recently, we will bridge their supply until we can get them into clinic and they go to the lab. And if they don't show for that clinic appt the "leash" gets shorter and shorter - i.e. we might give a one month bridge, then a two week one, then one week, and we keep shortening the time frame until they get the hint. We have some pts who have gotten themselves down to one day supply of meds, and we will not lengthen that time until they come into clinic and have appropriate bloodwork drawn. And after a week or two of having to trek to the pharmacy everyday, they decide the lesser of the evils is to come to clinic and get their bloodwork done. We absolutely do not get the doctors to see a pt just because they dropped in, unless we have assessed the pt and determine that it really must be dealt with immediately. Pts "pitching a fit" at the nurses or pharmacists (or clerical staff) for any reason will not be tolerated by our doctors and when the pts do eventually come to clinic they will get a firm talking to from the physicians. Since there are only two programs in this part of the country that deal with transplant pts, our doctors tell them if they don't like how we do things they are welcome to transfer their care to the other program 3 hours up the highway. The nice thing is we get total support from our doctors and managers and it is an established practice of dealing with these pts that we all follow so the pts always get the same message, regardless of who they speak to.
Two things come to mind:
Elderly lady from the Caribbean, blind on dialysis. About 22 years ago. In a four bed room and she would spend much of the night calling "God, help me! Please God, help me! God, are you there?" Needless to say, the other three pts were not impressed. One night shift we could hear her all the way to the desk calling for God. In desperation, one of the other nurses punched her bed number into the intercom and said "This is God. Go to sleep." Never heard another word from her but she told the day nurses she had "heard God's voice loud and clear last night". Never called out at night again.
Elderly gentleman with dementia. I recognized the name as the same of a benefactor I had heard of through my work with Girl Guides. I was helping change him one day and after we had fixed the blankets and made sure he was okay, I said I had a question for him. I asked him if he was the same Mr X who had been involved in this particular Girl Guide camp. He started to cry and he said to me "You know, that place turned out way better than my wife and I ever dreamed it would. We just thought it would be an okay place for the girls to put some tents, and I can't remember how many girls use it now." I reassured him that it was well used and very well loved and that we would always take care of the land. After that day he could never remember my name, but he knew he had some sort of connection with me that he didn't have with the other nurses, although he could never had told you what it was. But everytime he saw he he would hold out a hand and say "There she is! There's my girl!" He is long since gone, but I still think of him everytime I go to camp.
I've never seen pts or family members help themselves to anything more than a juice out of the fridge. However, if she is visiting someone in the hospital, my sister will lift every roll of plastic tape that she sees lying around.
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