Contributor:
Christy McDonald, BSN, RNC, Case Manager

I have witnessed an amazing workforce in our hospitals during this pandemic. While physicians and nurses are clearly lifesavers at the bedside, hospital rooms are scarce. These frontline workers need the partnership of nurse case managers to arrange safe discharges and free up beds for those waiting in the ER. But this partnership provides much more than just discharges.

Nurses have a unique perspective that is vital in every area. This idea was explained well in 1952 by Hildegard Peplau, “mother of psychiatric nursing,” who understood the strength of nurses that could create a personal connection with their patients. She created a Theory of Interpersonal Relations, where she named 6 main roles for nurses which could be applied individually according to the needs of the patient. This differentiation of roles including counselor, surrogate, teacher, stranger, resource person, and leader can help nurses today in many different areas of care beyond psychiatric nursing. I believe it has been very beneficial for RN case managers working alongside bedside nurses to fulfill these roles for patients during this pandemic.

These behind the scenes case managers efficiently arrange placement while taking the time to comfort patients and family members, filling the role of counselor, which allows the patient to express their feelings to the case manager. In a time of urgency, these nurses can be a listening ear for family members to process their worries and discuss medical conditions. Often information has been relayed, but family members don’t want to take time away from the bedside staff with clarifying questions. The loved ones value the time and sacrifice given so highly that they are willing to forgo understanding. I personally filled the role of surrogate, which allowed me to fill in for family, when I had a patient who never told his bedside nurse he was a vegetarian because he didn’t want to bother her. He was only eating the bread of his sandwiches. I was able to speak with his spouse who informed me of his diet, and quickly messaged the nurse who changed his meal that very day. The teacher role is something nurses are excellent at providing in normal circumstances, however this pandemic has created a unique need for patients to be educated on a novel virus.

As with all nurses, case managers connect with their patients and loved ones, and want the best outcome for all involved. This in it’s simplest form if fulfilling the stranger role by offering the decency that should be given to any human. However we know that we often connect deeper with the emotions of a patient. For example, a fellow case manager cried with a family member about no visitation policies, because we all mourn the necessary changes needed to slow this pandemic. While continuing these much needed conversations, case managers arrange for home health or skilled nursing admissions. If we can find placement for recovered patients, those who are sick and waiting in holding areas of the ER can receive care from our skilled floor nurses. I worked tirelessly to find an open bed in another state for a pt while discussing end of life decisions with another family, fulfilling both the resource role providing information and the leader role offering direction with the patient’s wishes. It takes so many people working together to provide care in these unprecedented circumstances we find ourselves fighting.

Nurse case managers truly maintain the flow of care so we can provide the maximum benefit to as many patients as possible. Without nurse case managers there would be nowhere for our loved ones to go. And with them we can fulfill the necessary roles as described by Peplau needed to care for our patients.

About Christy McDonald

Christy is a hospital case manager in a large metro healthcare system. She had the privilege of being a bedside NICU nurse for 17 years before moving into Case Management. She has cared for those in public schools, remote Haiti, and the hospital setting. She serves on the Board of Directors for a Haitian NICU and children’s home.