My girlfriend was reporting that her hospital is looking at budget planning for the next year. Because there is a nursing shortage they are pulling back on registered-nurse Care Coordinators to work as staff nurses. I was dismayed by this but in a roundabout way it reminded me why I love nurses. When threatened with losing something you love, you hold on tighter.
I see nurses as the best resource for the future of our health-care system. The training that Care Coordinators receive prepares them to make a real difference in the lives of complex patients. They can save a tremendous amount of money by keeping patients out of hospitals and improving their overall health.
I would love to see all triage nurses receive the additional education and tools that Care Coordinators are receiving. Triage nurses are in the front line of health care; the information we gather can help direct the care of our patients. If our patients are calling the clinic in stress, it makes sense to me to have a good triage nurse listen to the stories and help decipher how serious their concerns are. They can help patients decide what they want to do. I like to give patients options, listen to their feedback and help them decide next steps.
They are usually scared, stressed and having decreased ability to cope. Often it’s their fear and stress that causes them to call and worry they have cancer or some other horrible disease. They read something on the internet. Or a friend of a friend was recently diagnosed with a cancer and she feels pain in the same spot. As they are talking I am listening for trends and patterns. I try to see if there is a story behind their words.
A few years ago I had a patient call in asking for a refill of her anxiety and pain medication. She was having migraines again. I asked her the questions I ask of all my patients. When did this start? How severe are the headaches? Are you having any other symptoms? As she was answering my questions, I was checking when she had last taken the medication. I noticed she had not had pain or anxiety medication for about five years.
When I ran out of routine questions and she finished her answers, I said, “Please excuse me for asking, but did something happen that you needed these medications in the past and now you need them again? How did you get rid of the migraines and anxiety five years ago?”
She said seven years earlier when her family was fishing, her husband reached over the side for the bait bucket. He was drunk; he fell overboard and drowned. He left her alone with two small children.
I said, “I’m sorry. That must have been awful.”
She said it was okay. It had been a long time ago and he wasn’t a good husband. She said five years ago she met a wonderful new man and was able to pull her life back together. At that point she didn’t need the medication anymore.
But now her headaches and anxiety were back.
She admitted that she was having some issues with the new relationship, plus her children were creating some stress. I asked if she had ever gone through any counseling after losing her husband; she said no. She said she hated to admit it but losing him was a relief because he was abusive and they were better off without him. She said she was offered counseling but believed she didn’t need it.
I said her story sounded painful to me. I said I was sorry for the difficult years of marriage with her husband.
She said, “It was difficult.”
I said it must have also been difficult to be alone.
She said, “It was.”
I said we each go into a marriage or a relationship with dreams and plans for a perfect life but it seldom works out as we planned. It usually takes a lot more work and is a lot more challenging than we expect. Timing, luck and opportunities often play a big part – but also lack of opportunity and unforeseen circumstances.
I told her that unresolved emotional and psychological trauma can come out as pain. Unless we deal with the true cause of suffering it keeps resurfacing.
She accepted my offer of a Behavior Health referral. She was ready to stop the cycle, and decided she didn’t need the medication right now.
She could have scheduled an appointment, and not mentioned her social and psychological history. She could have had a battery of tests because of her headache. But an MRI of the brain costs about $7,000. This woman needed counseling not medication.
I believe a good nurse triage could prevent the need for at least one CT Scan or MRI per month. During one year this nurse could save at least $84,000. Multiply that by 12 good triage nurses. That’s a savings of more than $1 million. Plus the patients would have been provided more appropriate care.