The Heart of a Nurse Care Manager

stock_xchng_heart_in_handsWhen people ask me how being a Nurse Care Manager differs from being a “regular nurse,” I always think of many answers.  I usually respond by saying, “A Nurse Care Manager is first and foremost a patient advocate,” but the picture is hardly drawn by those pale words.

How do you explain that Nurse Care Managers stand beside elderly people who find themselves in trouble with no one close enough or experienced enough to help?

Unfortunately, even when there is family involvement it is not enough for our elders who are in complex medical or psychosocial crisis. The complexities of the health care world alone are daunting and the elder care world is even more difficult to navigate. Professionals are needed. The simple presence of love, mixed with experience, skill and persistence can change someone’s world.

What we do for the elderly is rock the boat when it needs to be rocked; that’s certainly not the old school version of Florence Nightingale. While the more traditional nurse’s job is simply to implement a doctor’s orders and perform clinical jobs as a part of caring that has well defined boundaries, a Nurse Care Manager’s job is to actively change things for the better. We don’t just follow well-used templates; we create new ones as needed for quality care that fits each unique situation we find.

That often means challenging the status quo and thinking out of the box, or protecting a patient from family members who may not have their best interest at heart. Sometimes it means calling private caregivers to account and bringing in law enforcement and legal support when needed. It can even mean taking on the health care system: not a job for the timid or the risk averse.

We took Jesse out of a board and care where the owners were manipulating her bank accounts and drove her to the refuge of a safe house. We rescued Calvin from his gang of caregivers who were holding him hostage in his own home, under threat of his life. We hid Phyllis from the rages of an abusive, alcoholic son. We helped Barbara get her new leg when the health system thought her too old to bother with, and watched her giggle as she walked on it for the first time.

We insist that hospital staff treat our patients in facilities with the respect they deserve and we move them to other facilities when they won’t. We help families change doctors who don’t seem to care, who treat their elderly like the lepers of Molokai and refuse to listen to them. We won’t shrink from a fight with other health care providers and make sure our patients get the pain medication they need when suffering and dying. We will give our patients chicken matzo ball soup and chicken liver sandwiches from the deli if that’s what they need to make life worth living that day. Or, we will get them fresh flowers, Chopin or Nestlé Crunch Bars. We give full body massages and sing “Moon River” while doing it.

We have pianists come and play the baby grand when our patients can no longer play. We let them drink gin if they need to, eat steak when they’re sick to death of nursing home fare, and refuse to force feed them when they say they are not hungry. We will not patronize them, dismiss their fears or shame their weaknesses. We will not only give them medications and perform clinical duties, but we will honor them, love them and serve them to the best of our abilities as long as they are in our care.

We will not let them fall through the cracks of the health care system. We will not let them be neglected. We will never let them die alone.

The elderly many times cannot even raise their frail little arms on their own behalf, let alone a voice or a pen. Nurse Care Managers and patient advocates count it their privilege to do it for them.

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