LadyK,RN

While it is true that there are many people drug seeking, I urge you to remain compassionate and LISTEN to your patients before you judge them. I have a very dear friend who has been unable to keep a job and therefore insurance because she has a rare disorder called Sphincter of Oddi disease that has just been diagnosed now that she has insurance under the ACA after finally undergoing and ERCP. I mention her because of the countless times she has gone to the ER over the past several years in excruciating pain to be dubbed a drug seeker and under medicated and discharged. She has nearly died a couple of times due to dehydration and electrolyte imbalances related to vomiting and been septic due to undiagnosed pancreatitis. As an RN I am embarrassed when she relays the barriers she has received to care. We must be careful not to stereotype people, even the frequent flyers who drive us crazy, without ensuring that there isn't an underlying, legitimate cause to their pain. As her friend, I have instructed her to carry MD documented medical history/summary with her in hopes that any future episodes that she has are met with understanding and compassion.

In effort to manage high risk patients care coordination is becoming very common in the inpatient and outpatient setting. You will have the opportunity to have a great impact on the ability of people with chronic conditions to manage their health care at home. The role is similar to case management and will likely involve a lot of patient education on how to manage symptoms, when to call the doctor vs. 911, etc. Some aspects are a bit like babysitting and can be a little frustrating if you have the perspective that these are adults who should be able to follow instructions. Remember that many patients are completely overwhelmed by their disease process and need guidance and sometimes a cheerleader to encourage them. Many patients appreciate the personal touch that the care coordinator provides and the fact that they have a go to person in helping them to navigate the health care system. This is especially true for people who may have not had health insurance for years and are now accessing care under the ACA. As far as resources, check out the American Association of Ambulatory Care Nurses website (AAACN), I think they have a webinar or courses on care coordination. You can also look at case management/care coordination websites.

I just accepted a position in a large group model HMO (we provide the care and the insurance) as a Clinical Workflow Consultant/Nursing Informaticist. I won't start for a couple of weeks but I am definitely interested in this discussion board. I have been an RN for 5 years and currently have my BSN and am working on my MSN in Nursing and Organizational Leadership. I will be required to become EPIC certified within the next 2 years.