When I think about how far we've come with providing care across the entire care continuum, it reminds me of one of my favorite documentaries, Remaking American Medicine.
One of the patients this PBS series introduces is a woman with multiple chronic diseases. It's clear how important her community is, in making sure that she and her many caregivers are all on the same page.
The patient knows she can't manage her conditions on her own, so she has a care coordinator to help guide her, which makes all the difference.
Care coordinator is one of many new nursing roles that aims to help patients travel along the wide spectrum of care environments. Other positions emerging in our industry include nurse navigators, health coaches, virtual care nurses, bundled care coordinators, and nurse-managed health centers. These roles are sorely needed as care becomes more complex, and stretches far beyond the acute hospital walls.
The good news is that these jobs can help improve patient care, while keeping experienced nurses engaged and practicing longer. Here’s a look at some emerging nurse positions that could benefit your organization.
Also called Complex Care Coordinators, Care Managers, or Chronic Care Managers, these are nurses who manage patients with chronic conditions and help them stay as well as possible, for as long as possible. They are in charge of formulating discharge plans, and ensuring that patients follow through with their appointments and adhere to their medication schedules.
As the ACA requires us to work on reducing readmissions and lowering costs under the umbrella of bundled payments, the role of care coordinators has evolved. Today, there are bundled care coordinator positions, focusing on clinical paths to ensure the best outcomes at a lower cost. In order to maximize the amount providers will be paid for a patient, care coordinators take charge of managing that patient’s care, from surgery to 90 days post-acute.
RNs are well-qualified to perform these and even more advanced roles. Research shows that patients with diabetes and high blood pressure who receive care from an RN Care Manager (including initiation of medications and titration of doses) are more likely to reach their blood pressure goals than patients who are managed by physicians alone.
As health systems continue to manage population health, the role of the health coach has taken on increasing importance. These nurses help patients (especially those with chronic conditions) to create and achieve wellness-focused goals. Some state boards of registered nursing have created a mechanism by which RNs can change medication doses, using standardized procedures authorized by their physician leadership. Using these procedures, RNs who’ve been trained as health coaches could provide most of the care for patients with uncomplicated diabetes, hypertension, and hyperlipidemia.
Nurse Navigators help patients steer through an episode of illness such as cancer or surgery. They are mostly used in the Oncology and Cardiac departments today, but their use will spread as the need to contain costs grows. Very simply put, CMS is moving to reimbursing health systems for episodes of care. So, it’s important to keep costs within reimbursement levels while maintaining quality and enhancing the patient experience – and nurse navigators will help you do that.
Nurse-Managed Health Centers
These are health clinics run by nurses – many with advanced practice degrees who serve as nurse practitioners, clinical nurse specialists, nurse midwives, and public health nurses. Advanced Practice Nurses have the expertise to diagnose illness and prescribe medication, make referrals to specialists, provide pre-and post-natal care, and offer a wide variety of other primary health care services. This role requires that nurses be allowed to practice to the full extent of their licensure. To date, there are still many states that restrict nursing practice. For example, in New Jersey, NPs are unable to order home care for their patients, leaving this responsibility to only physicians.
Virtual Care Nursing
Remote monitoring for critical care has been in place for some time, providing a higher level of nursing expertise as well as a less physically demanding environment for nurses. We are seeing this trend emerge in other areas as well. Virtual clinics can provide more consistent patient oversight, while giving nurses options to keep practicing in their field longer.
We all know how important care coordination is for patients, especially as their needs evolve and they move more frequently along the continuum. Having nurses at the helm of these new care coordination roles will help you to ensure that your patients always receive the best, safest care possible, no matter where they are on the spectrum.
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