VOLUME 1 ISSUE 5
CONTENTS CASE MANAGEMENT & SOCAL WORK MAGAZINE
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Senate Committee Passes Bill to Help with the Nursing Shortage As COVID-19 fatigue takes its toll on health care workers, the Illinois Senate passed a bipartisan bill out of the Licensed Activities Committee today that could help remedy Illinois’ nursing shortage.
Senate Bill 2068, sponsored by state Sen. Sarah Feigenholtz, D-Chicago, would add Illinois to the multistate Nurse Licensure Compact, making it easier for nurses such as Iowa native Madalyn Mauro to put her critical skills to work in Illinois. “Getting the Illinois license took months because they aren’t in the compact. I had to drive five hours from Des Moines to Chicago just to get fingerprinted because they wouldn’t accept Iowa prints,” she said. Crippled by a nursing shortage even before the pandemic struck, more than half of current Illinois registered nurses aged 55 or older are approaching retirement. Licensed practical nurses in Illinois face a similar shortage. Illinois’ outdated licensing policies have provided extra barriers for those who would want to work in the state. “As Illinois faces a shortage of health care workers, the Illinois Senate should be commended for the efforts to remedy the situation and provide support nurses desperately need,” said Amy Korte, vice president of policy at Illinois Policy. Illinois is one of only a few states that requires its own nursing license without offering reciprocity for licenses from other states, creating a costly and time-intensive obstacle for nurses who want to work in the state. Each nurse wishing to practice in Illinois must pay $50 for a license as well as fees for fingerprinting and background
All these extra steps prevent care providers from getting to patients where they’re needed most desperately in a timely manner. When COVID-19 hit, Mauro’s hiring process for a nurse job in Chicago was put on hold. “It put me in a tough situation,” Mauro said. “I needed a job, but I couldn’t transfer my [Illinois] license. I had to get a new license just to get a job back in Iowa, which cost hundreds of dollars.” Joining the compact means Illinois would join 34 other states including Midwest neighboring states Indiana, Iowa, Wisconsin, Kentucky and Missouri to accept multi-state licenses for registered nurses and licensed practical nurses to practice in the state. Illinois would still maintain its own nursing licenses and recognize existing licenses, and also allow nurses with compact licenses to practice in the state. The bill passed committee unanimously and was added to the agreed bill list on the Illinois Senate floor. In the House it’s sponsored by state Rep. Michael Zalewski, D-Riverside. “Adding Illinois to the Nurse Licensure Compact can help alleviate the long shifts and exhaustion nurses have faced during the past year, while also opening up career and volunteer opportunities for Illinois nurses,” Korte said. “The license has worked well for nearly three dozen other states, and Illinois has a lot to gain by joining.” Source: Ann Miller / Illinoispolicy.org
“As Nurse Burnout Rates Soar, A Growing Number Of RNs Are Contemplating A Move To The FastGrowing Field Of Private Patient Advocacy”.
Although nurses have multiple training courses to choose from, a new option—created by a leading patient advocate— deserves special attention. Unlike many, its focus isn’t familiar clinical topics, but the practical aspects of building a successful advocacy business. “Nurses already know how to advocate and navigate the system,” says Teri Dreher, RN, the driving force behind Nurse Advocate Entrepreneur. “What they don’t know is how to start and grow an advocacy company.” Dreher was among the first wave of RNs to become patient advocates. After 30 years of critical care nursing, she grew fed up with the healthcare system, watching in dismay as profits took priority over patients. In 2011, following training, she opened NShore Patient Advocates, one of the first Chicago advocacy companies, and now the largest. An active voice in her fledgling industry, she helped establish best practices that are standard today, earning her the highest honor bestowed by the Alliance of Professional Health Advocates, one of the industry’s professional associations. Those best practices—and the lessons she learned along the way—set Patient Advocate Entrepreneur apart from more theoretical curriculum. The three-month online course includes 13 hours of webinar training, book and study guide, and—depending on which of the two course levels you choose—live virtual classes and one-on-one mentoring.
The courses are highly cost-effective compared to comparable training programs. Students who pass a final exam receive 20 continuing education units—and are ready to hit the ground running. Because patient advocates’ fees range from about $125-$250 per hour, the training quickly pays for itself. “Right now, patient advocates can be counted in the hundreds, not the thousands,” says Dreher. “There is more demand from patients than the industry can meet.” In fact, Dreher saw a particular need for advocates during the pandemic. Because advocates checked in regularly with their clients, including sociallyisolated seniors, they were able to identify budding health concerns and ensure their clients received prompt medical care. Her goal is to help get qualified patient advocates up and running quickly, so they can help meet the escalating demand. Today, even leading healthcare systems like Johns Hopkins assert that every patient needs a healthcare advocate. “I know many nurses who love helping patients, but are exhausted with the system,” says Dreher—who also wrote Patient Advocacy Matters, available on Amazon. “Patient advocacy allows nurses to do the things we love without the downside. I think every nurse owes it to themselves to at least check it out.” “Not only am I passionate about patient advocacy and pulling the patient back into the center of the model of US healthcare, I am passionate about teaching and mentoring new RN patient advocates all around the country the past few years. I show my students how to save money, time and get right to the crux of how to run a private professional advocacy consulting firm from the start. Others don’t have to make all the same costly mistakes that I did. Starting my own company has been the best career decision of my life and I am so excited to be offering this course to others now. The world has never needed us more than today!” Teri Dreher, RN, CCM, is an award-winning patient advocate and pioneer in the growing field of private patient advocacy. A critical care nurse for more than 35 years, she is owner/founder of NShore Patient Advocates (www.northshorern.com), the largest advocacy company in the Chicago area. Her book, “Patient Advocacy Matters,” is now in its second printing. She is also a regular columnist in the Daily Herald newspaper’s Health section. Teri is also the founder of Seniors Alone Guardianship and Advocacy Services (www. SeniorsAlone.org), a nonprofit organization that serves senior orphans and disabled adults. Teri is also the driving force behind Nurse Advocate Entrepreneur (NurseAdvocateEntrepreneur. com), a three month online course designed to teach nurses and other healthcare professionals how to start and grow their own patient advocacy company. Teri’s best practices—and the lessons she learned along the way—sets Nurse Advocate Entrepreneur apart from more theoretical curriculum.
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COVID & CASE MANAGEMENT: EMBRACING THE VIRTUAL Telehealth certainly isn’t new, but its explosion over the past year is undeniable and has likely changed how patients perceive doctors’ office visits in the long run. There was an uptick in telehealth interest prior to the pandemic, but it faced legislative barriers and technical inertia, among other challenges. It’s quite clear that the pandemic accelerated its acceptance in mainstream care and comfort levels among patients. Because of relaxed regulations and greater accessibility and convenience, it seems that telehealth is now here to stay. Industry organizations such as the American Hospital Associationand the American Medical Association have embraced the expansion of telehealth services in primary care and beyond. Such an embrace by the healthcare community and by patients includes the invaluable work of professionals in case management. These experts help patients transition from one step to the next within the healthcare system.
6 Best Practices for Case Managers in This Growing Era of Virtual Care: 1. Embrace Patient-Centric Care With consultations, evaluations, prescription management, and many other aspects of healthcare now available via virtual avenues, providers are focusing on more patient-centric care. But that can be a challenge for telehealth when patients who have not yet used virtual care are uncomfortable with it. This is why it’s essential for providers to bring the same personalized care they’ve offered during in-person office visits to telehealth platforms. It’s also why providers may need to revisit the basics. This can include more technology (and more access to it) that helps patients make appointments, ask questions about their medical conditions, and “even learn more about the current air quality and how that’s going to affect their health that day.” But it can also mean putting more emphasis on connections. Case managers already meet patients and their loved ones where they are. Many are well-versed in virtual care planning and coordination while remaining HIPAA compliant. Others continue to evolve how they interface and to develop their digital skills and connections depending on their setting. In their efforts to “mobilize appropriate resources and personnel in new ways,” they’re asked to make
decisions each day that center patients. Making those decisions also means identifying “new and inventive ways for patient screening, stratifying risk, assessing, planning, coordinating care, and performing follow-up, care transitions, communications, and evaluations.” 2. Utilize Different Modalities Effective telehealth is so much more than a 15-minute Zoom consultation. It creates numerous opportunities to deliver care in a variety of ways, such as: • Synchronous care: Real-time audio/video interactions may include additional medical devices like digital stethoscopes, smart scales, and more. • Asynchronous care: This technology stores data from one point in time to be collected and analyzed later. For example, patient portals enable communication through secure messaging platforms. • Remote patient monitoring: This ever-growing segment of telehealth allows the direct transmission of protected health information (PHI) via monitoring devices to healthcare providers. This may expand to a wide array of new technologies such as wearables or passive sensors. As the digital world of healthcare evolves, case managers will continue to “see a whole ecosystem start to grow around virtual health, video visits, in-home monitoring, and e-care.” They’ll also be on the front line of embracing technology and helping more patients become comfortable using it. 3. Encourage Patients To Embrace Virtual Care For some, telehealth is a huge advantage – including those with mobility challenges, disabilities, and chronic health concerns. Rather than navigate their way to doctors’ offices and hospitals, patients facing such conditions can now widely receive care from anywhere. Case managers can maximize the value of these opportunities by: • communicating with patients about the availability of covered telehealth services (many of these come with important updates on reimbursements) • taking advantage of telehealth resources, including using digital assessments, to reduce the volume of individuals seeking care within facilities • reaching out to patients who may have limited access to technology and connectivity, particularly in rural areas, and offering flexibility in the platforms and services 4. Ensure The Safety Of Telehealth Services As an internet-enabled service, telehealth faces an inherent risk. Healthcare professionals and organizations must take caution to protect patient PHI as well as educate their patients on the steps they can take to improve the safety of their data within their own environments. This, of course, includes case managers who must be aware of telehealth best practices, policies, and protocols as they collaborate in coordinating care. 5. Recognize The Limitations Of Telehealth While telehealth services have been around for a while, many providers and patients are still becoming familiar with them. It’s important for case managers to recognize the fluidity of the situation and be flexible as their patients adjust and as the technology evolves. It’s crucial to pay particular attention to: • regulatory and licensure updates • the necessity of any in-person visits and coordination needed due to specific health conditions, urgency, etc • the need to address difficult topics and appreciating patient concerns for privacy • the varying level of familiarity and comfort with technology among patients • any limited access to devices 6. Recognize That In Many Ways Nothing Has Changed Some of the best practices followed by case managers have existed for years and are still the same in
this pandemic. In many ways, the only thing that has changed is how care they interact with patients and their loved ones. All of the essential features, including comprehensive patient assessment, counseling when needed, and developing and implementing individualized care regimens, apply now more than ever. Telehealth opens up different avenues to provide these services. Case managers bring value to these avenues in many ways, such as: • defining the roles and responsibilities that are required to perform remotely • discussing training opportunities for remote responsibilities as needed • having familiarity with individual roles and responsibilities, including documentation requirements • creating escalation and support procedures that address technical and patient challenges having access to key contact information such as technical support, peers, and relevant personnel • ensuring the security of PHI and the adherences to HIPAA regulations The following tips can help remote case managers just as they do other remote healthcare professionals as they tackle virtual needs: • Create a dedicated and private space for work. • Designate specific and secure work devices. • Establish a smooth workflow. • Connect with colleagues routinely. • Be mindful of the new dynamic and don’t be afraid to communicate any problems along the way. • Take time for self-care. Source: Harmony.Solutions.com
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nd-of-life specialists compassionately gear patients with terminal diagnoses toward their passions, legacy, and unique meaning here on this earth. We medically manage symptoms based on their goals, establishing a unique plan of care with the patient and their family. We accomplish this plan of care with a community of experts in end-of-life medical management, spirituality, and psychosocial work . We must demystify misconceptions about hospice. Patients do not always die very soon, we do not medicate them to death (that is against the law), all meds are not taken away and you can still see your doctors! We educate and hold patients’ hands when they are most vulnerable. We use the lowest possible efficacious doses of medicine to relieve symptoms like pain, anxiety, shortness of breath, or swelling. The focus is life, “the how good as opposed to the how long” in our work. Patients who come onto hospice at the right time may live longer because we often see in end-of-life care that “less can be more”. The mind, body, and spirit are focuses of hospice. As we say at Transitions, it’s about living. The relationships we develop with our patients allow us to walk the path of suffering with them, which was my mission from the beginning, as written in my medical school personal statement in 2002. Families come to us for education, someone to make it okay or to guide them when faced with complex difficult decisions, such as taking a loved one off a ventilator or stopping IV antibiotics. This element of healthcare provides a window to deliver quality care at such a delicate and crucial time. I will never forget the breast cancer patient who had an aggressive cancer ravaging her arm with tumor burden and infection. She had such a sense of humor, knowing that she could not go to her trailer home this summer because she was too weak. She reset her expectations of herself and agreed her goal was proper pain management, even if it meant some sedation from medication. I always remember her because she had the best attitude while her arm was almost falling off from a pathologic fracture. I learned that day that life is about attitude, no matter what is happening. She was so brave in the face of adversity, keeping her spirit strong and her smile shining until the end. Her hospice experience allowed her dignity and comfort until her death. Practicing hospice has been a teacher to me. I have learned some of life’s greatest wisdom by observing this type of bravery.
As a Hospice and Palliative Care phys providing end-of-life care day in and da home and cry each day from seeing d “end-of-life care is highly satisfyin
sician, many people have asked me if ay out is excruciatingly sad. Do I come death? “Quite the opposite” I respond, ng and morally rewarding work!”
Recently, the young wife of a Head and Neck cancer patient I saw at Transitions did not understand from a spiritual perspective why we were not recommending IV fluids in her husband’s head and neck cancer. I was able to sit down with her, over some ginger tea, and explain his cancer and how IV fluids could detract from comfort now since his lungs were fluid overloaded. She shared her Hindu spirituality with me and stated that if only she had done more reiki and if he had more love, this would not have happened. She relayed 7 years of anticipatory grief that day with me. Slowly, I allowed her to speak and guided her with questions and gently educated her on how we could accomplish her goal, but differently than she thought, medically. We spoke about self care, boundaries, spirituality, and how she would be the lead of the home after he was gone. She became receptive after several physicians tried to talk to her in the hospital. With no agenda, I just met her where she was and she called me the next day to transition him to hospice. She understood and trusted that their goals were my goals. I even added medications, in fact, that afforded him a comfortable death. To her this meant if he went in peace, his next journey would be of peace. A patient of mine from 2013 who was a writer Madeline L’Engle, wrote “until my journey led me to hospice, I didn’t understand how valuable they are. I misunderstood what they did and when I mistakenly thought that they were called end of life and didn’t know about the quality of life that is given to the patient and support for the family much earlier than that! I had a team consisting of a specialized team of doctors, nurses, and a chaplain who truly made my situation ‘quality’! They are people who not only care about me and my family’s needs, but share themselves. They are a community of care. The ‘quality of life’ is not only about medical solutions to situations that the disease causes, but planners about what to do when this happens and we do this when this no longer works. It is about keeping me comfortable and doing what I am able, as long as I can. They are walking with me and my family and that is a tremendous gift, to know that you are not alone! Help me spread the word about hospice, for life is precious!” Hospice is a misnomer, a gift with a bad wrapping job, because it is so often misconstrued. When we finally understand that it’s so much more than death, but in fact about ensuring that patients live the type of life they want, for the rest of the time they have on this earth, we begin to realize what hospice really is -- it’s about living. To learn more about Transitions or to schedule a meeting with a Regional Hospice Coordinator, visit www.transitionshospice.com or call 877.726.6494.
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Founder of Nurse Advocate Entrepreneur, Teri Dreher Shares Insights on the Benefits in Becoming a Professional Advocate.
Published on Aug 10, 2021
Founder of Nurse Advocate Entrepreneur, Teri Dreher Shares Insights on the Benefits in Becoming a Professional Advocate.