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Oncology case managers help patients, families

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There is no such thing as a typical day for Christine Shaw Regan, BSN, RN, CCM, care manager at the Cancer Treatment Centers of America, Midwestern Regional Medical Center in Zion, Ill. At any given time, she might be working with hospitalists to assess a cancer patient who has traveled from another state to undergo treatment at CTCA or helping a patient’s family locate resources to ease their financial burden.

Oncology nurse case managers, or care managers, as they are called at CTCA, provide invaluable services to cancer patients and their families. By working with patients from admission to discharge and beyond, oncology care managers take a collaborative approach to positively impact patient outcomes.

“My role is to coordinate the many aspects of care for our oncology patients from their initial hospital visit through their treatment and recovery process,” Regan said. “We also serve as each patient’s advocate to ensure they receive all of the services they need, by communicating with their doctors, caregivers and health insurance company on their behalf.”

Regan said the services she provides often go beyond traditional medical services.

“Each cancer patient has a unique journey,” Regan said. “We are not only helping to guide patients to evidence-based cancer treatments and providers, we are also working with them to manage the symptoms and side effects of cancer therapies, and to ensure they receive the emotional, social and spiritual care they need.”

Regan said many cancer patients also have co-morbidities such as heart disease and diabetes, requiring oncology nurse case managers to help develop a comprehensive management plan and to coordinate care among different health providers.

“We know the best discharges involve effective communication,” Regan said. “Especially when we may be sending a patient home to another state, and their medications may have been altered during their hospitalization. Our goal is to maintain their health between the hospital and their home.”

Donna Ukanowicz, MS, RN, ACM, director of the case management program at the University of Texas MD Anderson Cancer Center in Houston, has 41 nurse case managers reporting to her and plans to hire an additional 13 by the end of the year.

“I look for candidates who have good interpersonal skills, are organized, and skilled at collaborative negotiation and mediation,” Ukanowicz said. “Candidates are required to have a bachelor’s degree, and experience in oncology is preferred. “

In addition to being adaptable and compassionate, Ukanowicz said, it’s critical for oncology nurse case managers to be adept at self-care.

“Everyone that comes to us has a cancer diagnosis, so it can be a very emotional job,” Ukanowicz said. “Often we are helping families with end-of-life decisions, and this can cause work stress and burnout for nurses over time. Yet for those that can practice self-care strategies, oncology is a wonderful specialty area where you can truly make a difference in the lives of patients and their families.”

With the field of oncology being one of the fastest changing fields in medicine, Ukanowicz said it is also important for oncology nurse case managers to stay abreast of current research, treatments and medications, and to also earn certification.

“Every year we see new agents to treat cancer systemically with chemotherapy and bio therapy drugs, and part of our job as case managers is to see how we can get our patients access to these clinical trials, and to pay for the medications they need,” Ukanowicz said. “We are also seeing accredited case manager certification becoming a preferred or required element in many case manager job postings.”

Many oncology nurse case managers work on an outpatient basis, employed both at medical clinics and insurance companies. Theses nurses also might choose to work with an adult population or in pediatric oncology.

Linda Omi, BSN, RN, has worked as an outpatient oncology case manager at Kaiser Permanente’s Oakland (Calif.) Medical Center for 13 years. During that time, she has seen the oncology landscape change dramatically with the development of targeted therapies that now allow many cancer patients to receive chemotherapy on an outpatient basis.

Before becoming an oncology nurse case manager, Omi worked as a hospice nurse. She said her current job allows her to use her broad range of skills including problem solving, therapeutic communication and linking patients and their families to important resources within the Kaiser Permanente health system and in their communities.

“My job encompasses everything from educating patients and their families about various treatments, assessing the patient’s response to treatment and medication and educating both the patient and their family about their care needs at home,” Omi said. “Often some of the most pressing concerns facing our cancer patients are issues such as transportation to take them to their chemo appointments, or helping to alleviate their worries about finances if they aren’t able to work while undergoing treatment.”

The American Case Management Association established the ACM certification, especially for hospital managers in 2005. Case managers with at least two years of relevant hospital or health system experience are eligible to take the exam.

The Commission for Case Manager Certification also certifies case managers, and Regan received her Certified Case Manager accreditation through CCMC.

Certification provides oncology nurse case managers with recognition and validation of their professional expertise. In addition, the CCMC notes the percentage of employers who require case managers to be board certified is growing, and that more employers are offering additional compensation for board-certified case managers.

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Linda Childers is a freelance writer. Send comments to editor@nurse.com or post comments below.

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