It was about 9 p.m. when a Bronx mother called in a panic. Her 22-year-old daughter, who suffered from debilitating multiple sclerosis, had dislodged her urinary catheter -- an extremely painful situation.
"The daughter was screaming, and the mother didn't know what to do," says Betty Velez, the nurse on the other end of the phone line at the 24-hour Customer Care Center where our VNSNY CHOICE Health Plan members call when they need a quick response. "I instructed the mother over the phone how to remove the catheter. She did, and the pain went away instantly."
The same night, she fielded a call from one of the Care Center's regulars, a 60-something man with behavioral and physical health issues who had been calling every evening since his mother, his primary caregiver, passed away. Betty, as she often did, talked him through activities of daily living, reminding him to get dinner and take a sponge bath. "Who else can he call at 8 at night, crying because he misses his mother?" she says. "By the end of the call, he was no longer crying. He was stable, he could get on with his night." Depending on his status, she might send a nurse out the next day; eventually, the VNSNY CHOICE care team worked together to get him into a group home where he felt less alone and much more comfortable.
National Nurses Week provides us with an opportunity to take a look at how healthcare, and nursing along with it, is shifting its locus from inpatient-based acute care to long-term managed care in the home. Focused on the goals of increasing quality and access to care, while reducing its cost, nurse-led telephonic care management is an increasingly vital component of successful healthcare -- one that accentuates the importance of simple, yet essential skill: communication through a clear and compassionate human voice.
"We are a stabilizing force," says Kate Hughes, After-Hours Operations Manager, who has been with a nurse with the Customer Care Center for a decade. "We talk to people who are in need. Sometimes it's clinical, other times it's not -- maybe their home health aide didn't show up, or maybe they just need company, someone to talk to because they're anxious. We're not the nurse in the field, but we perform the same service. The only difference is that our connection is the phone line. The warmth and clarity of our voices makes a big difference."
The skilled, compassionate voice on the phone is an extension of nursing care's best practices, providing healing and comfort to people in need with the right balance of art and science. They are prepared for all manner of challenge, emergency and day-to-day management of health and wellness. The nurses have hands-on access to patients' medical records, so they are well prepared for whatever crops up. "We each always have two screens in front of us, so we're writing, asking triage questions, and able to pursue the best course of action," notes Kate.
They know what questions to ask, and, most importantly, they know how to listen. Betty tells the story of a woman in Queens who calls each and every day with a medication question for her adult son. "Every day, she'll try to find a question," Betty says. "Can she crush this pill? Can she give him half now and half later? Can he take it with cold medicine? You have to look past the question. What she's really looking for is reassurance that we're always here. Our nursing skills and that note of caring in the familiar sound of our voices bring her peace of mind."
Sometimes the calls require care management and allocation of resources, such as when an elderly patient broke his arm over the weekend, was discharged home, and additional home health aide hours had yet to be authorized. "We'll authorize someone to have services over the weekend, and send a nurse out Monday morning to assess the plan of care," says Kate. "If we find a situation that's unsafe, we fix it. We're the safety net."
As the healthcare landscape shifts and technology evolves, telephone care management has become a natural progression for many nurses. "It's definitely an emerging part of the nursing profession," says Kate. "We have our education, our field work, the compassion part and the technological part. This is an exciting career path -- I really love my job."
Even among her colleagues, Kate is often, first and foremost, a friendly, helpful voice. "People here know my name and voice, but they don't necessarily know my face," she says. "When I said my name in a meeting the other day, people said, 'Oh, that's you. I only know your voice.'"
This National Nurses Week, as we recognize the many wonderful ways that nurses make a difference in our lives every day, let's not forget those excellent listeners and reassuring voices who are standing by on the other end of the phone.