A nurse case manager is nearing the end of the day and a new file is put into her queue. Normally she would leave it for the next day, but her intuition said to at least contact the patient. She makes the initial call and asks about his symptoms. His responses are overly concerning for the nurse, so she opens evidenced-based medicine guidelines and starts investigating while continuing to talk to the client. She hangs up with the client and calls his treating provider. In less than 3 hours, he is being prepped for urgent surgery which his treating physician states prevented him from becoming paralyzed. Sounds like something that happened on a TV show, right!? It was real life and a nurse in worker compensation is the reason why a patient did not end up with a life-changing diagnosis of paralysis.
In the healthcare arena, nurses have helped transform healthcare delivery by improving access to affordable and appropriate health care, assisted in creating new avenues in telehealth, improving patient safety by being involved in creating health legislation that protects patients and their colleagues, and engaged in health research. Nurses have always had a holistic and patient centered approach to providing health care services. It is embedded into the educational foundation of becoming a nurse. The Institute of Medicine has issued a mandate to the nursing profession to engage more as members of interprofessional teams in care coordination. In addition to these skills, according to Gallup, Americans have rated the honesty and ethics of nurses as the highest among professions. These reasons are why nurses have become a mainstay in worker compensation care coordination.
Nurses possess hard skills and soft skills that have proven quite valuable for the complicated world of worker compensation. The top soft skills nurses have that are beneficial to worker compensation are communication, teamwork, networking, critical thinking, empathy, and conflict resolution. The hard skill nurses employ with worker compensation is their vast knowledge base. Nurse case managers often serve as a liaison and, sometimes, mediator between case parties. When considering that comorbidities are on the rise and patients’ post-recovery needs can be complex, nurses are in a prime position to provide transitional care coordination which can provide cost savings to carriers and less hospital re-admissions and re-injuries. This can be done as a triage nurse, telephonic and/or field-based nurse case manager.
As case managers, nurses assist in reviewing and deciphering medical records, perform medication reconciliation, discuss medical treatment appropriateness with treating physicians, and educate all case parties about the medical aspects of the file. For catastrophic cases, nurses can create medical cost projections and life care plans. They commonly perform these roles with insurance companies and case management companies. Nurses also employ these skills as occupational health nurses. In this role, the nurse coordinates health services and programs that assesses the health and safety needs of workers. They typically have detailed knowledge of OSHA and FMLA. Other duties they perform in this unique role are ensuring compliance with laws affecting workers and the workplace and health promotion. Some may function as case managers also. Most occupational health nurses are direct hire by employers.
In conclusion, nursing has been making segues into different industries in the past twenty years. One of those industries is worker compensation. If you know a nurse in worker compensation, please reach out to say, “THANK YOU” and “YOU ARE APPRECIATED”. If you are a nurse in the worker compensation arena, tell yourself and your peers – WORK COMP NURSES ROCK!
Blog By: Chikita Mann, MSN RN CCM