Dear Nurses, We Are Here to Help

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For the second time in just a few days, I’ve learned from an AdvoConnection advocate member that a nurse has become defensive and territorial in reaction to his choice of career.

Now, please know that I’m not dogging on all nurses. Not all all. Instead I’m looking at this as an opportunity to clarify – for everyone’s benefit, not just nurses’.

Last week I answered the question, “Does a patient advocate have to be a nurse?”  The question came in response to an experience where nurses had actually looked down their noses at another advocate, a non-nurse, suggesting she did not have the qualifications to be a patient advocate.  My answer is no.  All nurses are advocates, but not all patient advocates need to be nurses.

This time it’s very different, but no less upsetting to the person who was on the receiving end of the nurse’s defensiveness.  The advocate’s name is Ken.  He has worked for more than 30 years as both a physician’s assistant and a nurse.  In a conversation with another nurse, one who works in an oncology infusion center, he told her his plans for establishing himself as a private patient advocate.  She reacted by telling him that there was no room for him in healthcare as an advocate. SHE is the patient advocate for her patients.

Without question, I’m sure she, like most nurses, is an advocate for her patients.  But that’s not the same — at all — as a private patient advocate or navigator.  The real parallel, perhaps, is a private duty nurse.  A private duty nurse is definitely a private patient advocate, too.

But that’s not what Ken’s nurse-friend is.  Here are some of the differences, and the reasons why there is room for both nurses and advocates when it comes time to help a patient:

1.  Nurses are provider or facility-bound.  That is, the patient comes and goes, but the nurse stays, connected to the provider or facility.  As long as the patient is inside the nurse’s (provider’s or facility’s) domain, then the nurse can be the patient’s advocate.  But there is plenty of need for an advocate outside that domain, too.

2. If every patient only ever had one medical need at a time, went to one doctor at a time, got all their tests at the doctor’s office, took one drug at a time, got one bill at a time for care, THEN a location-bound nurse might be all the help that patient would need. But these days, and in particular as baby-boomers continue to age, many patients do have more than one medical problem they deal with, take more than one or two kinds of drugs, are being treated or are getting therapy for additional problems, and have too many confusing bills…  Ken’s friend isn’t the advocate who can help them.  A private patient advocate is.

3.  Hospital nurses do a yoeman’s job, managing way too many patients, often with at least one arm tied behind their backs.  We have all heard stories about when a patient pushes the help button to get up and use the bathroom only to have to wait…. and wait…. and wait…. and wait.  We also hear about the wrong drugs being administered, or infections that could have been prevented…  A private bedside advocate who is focused only on his or her one patient can be a lifesaver.  Ken’s friend can’t do that either.

As healthcare continues to get more and more confusing, as safety problems don’t improve enough to guarantee safety in the hospital, as access becomes more difficult because healthcare reform introduces 32 million new Americans to the care system – patient advocates will continue to grow in numbers, need and stature.

So, nurses (and others who haven’t yet figured out the value of private professional patient advocates and navigators)… Please understand that patient advocates are not trying to get in your way, nor subtract from your domain.  Instead, they are there to focus on their patients when you can’t, and to facilitate the communication and collaboration between their patients and their patients’ providers.

There’s clearly a need.  There’s plenty of room for all.  Let’s work together with some better understanding that both nurses AND advocates play important roles in improving their patients’ quality of life.

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FOR PATIENTSFOR ADVOCATES |

 

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Do I Have to Be a Nurse to Be a Patient Advocate?

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The answer is simple.  No.

So why do I ask this question?  Earlier this month, while attending the NAHAC Conference, the question was asked by a number of people.  As if the qualification to be an effective patient advocate relied on a nursing education.

Now please don’t get me wrong.  I am a huge supporter of nurses and nursing, in its many important forms.  I’ve written many times at About.com about nurses, nurse practitioners, and why I believe training as a nurse is far more patient-centered than other forms of medical training.  Most of my commentary comes from my appreciation for the “whole patient” approach most nurses provide.  I’m a fan – a BIG fan – of nurses and the nursing model for patient care.

Here are five reasons why a patient advocate does not need to come from a nursing background:

1.  Patient advocates actually perform a number of services, many of which have nothing to do with nursing.  Some are medical bill reviewers, some do research and writing about medical problems…. Nursing isn’t the right background or training for these kinds of services.

2.  Patient advocates are facilitators, but they are not decision-makers.  Patient advocates do not perform medical functions.  They provide options and background information to their patients, but never make decisions on their patients’ behalf.  Since they aren’t making medical decisions, they don’t even need a medical background.  (Not to say a medical background wouldn’t be helpful.  It might be.  It just isn’t necessary.)

3.  No matter what the background of the patient advocate, he or she knows when it is time to find helpful resources to help his or her client.  If the advocate is a nurse, then she knows when to call in a doctor or an insurance expert.  If the advocate is not a nurse, then she knows when to call in a nurse if one is needed.  That means a patient advocate can have almost any type of background and experience…. He will simply set up his system of resource people accordingly.

4.  Patients who need an advocate’s help are all over the map when it comes to what they can afford.  Someone who is not a nurse, or does not have medical training, will charge less (or should charge less) in many instances than an advocate who does have nursing training, making him more affordable than someone who does have a nursing or medical education.

5.  Finally – to make my points – some of the best known and most effective patient advocates, real pioneers in our emerging business of patient advocacy, have no nursing experience or education in their background.  Ken Schueler, perhaps the premier patient advocate in the United States and abroad, does not have an MD or RN after his name. (He did study at Sarah Lawrence in its patient advocacy course.)  Joanna Smith of Healthcare Liaison and President of NAHAC, has a social work background. Elisabeth Schuler Russell learned her skills while advocating for her baby daughter.

Smart advocates will find their training where they can, when they need it, for a particular reason.  For example, an advocate who decides to focus on cancer patients might take courses in understanding oncology.  Or an advocate who needs help understanding extensive medical terminology might take a course to better understand it.

All nurses are patient advocates.  But not all patient advocates need to be nurses to begin with.

If you are considering a career as a patient advocate, then start where you are planted.  But start.

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Updates on this post:

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Read About AdvoConnection Patient Advocates in O Magazine!

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AdvoConnection’s advocates were thrilled to have been included in an article called Someone on Your Side (A new prescription for navigating the medical maze) in the August 2010 issue of O Magazine.

The article begins with a patient story.  Tracy Cloninger figured out what so many patients do — that the healthcare system just isn’t paying enough attention.  When her endocrinologist failed to schedule her radiation treatments for her thyroid cancer, Tracy hired Hari Khalsa, the Health Whisperer (patient advocate located in Massachusetts.)

Gail Gazelle, MD, from MD Can Help was quoted extensively in the article as well.  Gail pointed out the benefits of hiring an MD as your advocate.  We should point out here that not all aspects of patient advocacy assistance would require an MD.  When you interview an advocate, you can determine whether an MD is required.

If you want to learn more about your diagnosis, Ken Schueler of HKS Advocates, another AdvoConnection member advocate, provides a suggestion for a great resource – disease advocacy groups.

And Trisha Torrey, founder of AdvoConnection and author of You Bet Your Life! The 10 Mistakes Every Patient Makes (How to Fix Them to Get the Health Care You Deserve) was also quoted.  Her bottom line?  Make sure the advocate you hire has the credentials that will help you best.  MDs, nurses, nurse practitioners and others with medical training can be important for some advocacy needs.  But sometimes an insurance or claims specialist, or even just someone who can check in with you (or your loved one) to provide drug dose reminders is all that’s needed.

Read more about Hari Khalsa, the Health Whisperer at her website.

Read more about Gail Gazelle at MDCanHelp.

Read more about Ken Schueler at HKS Patient Advocates.

Many thanks to Leslie Goldman, author of the article.  She got patient advocacy right – a new career for some, and a lifesaver for others.

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Do you want to explore the possibility of hiring a patient advocate to help you with your healthcare?  Check out AdvoConnection to find one.

Are you an advocate?  Or are you thinking about a career as an advocate?  Learn more about AdvoConnection membership.

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What Does a Patient Advocate Do?

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That’s a good question — what does a patient advocate do?  And there are a handful of answers, depending on the kind of help you need.

Some advocates help you with insurance claims, or review your hospital bills.  Others might sit with you at home while you convalesce, or help you understand a difficult diagosis and an extended list of treatment options.  In fact, there’s a long list of services patients or health advocates might provide.

Most of these are simple to understand, because this kind of help has actually been around for awhile.  The type of patient advocacy that seems most confusing – but can have the biggest impact on your positive medical outcomes – are medical / navigational advocates.

These advocates will sit with you in the doctor’s office and ask questions, or will help you make a difficult medical decision, or will sit at your bedside to monitor your hospital care, to be sure you get the right drugs, or don’t acquire an infection.

Here’s a metaphor to help you better understand why this is important:  Fifty years ago, if you wanted to buy a house, you found someone willing to sell, and the two of you worked out all the details.  If you needed a mortgage, you got it.  If you needed a lawyer to draw up the deed, then you hired one.

But over the years, particularly as credit problems started to arise and the legal requirements got tougher, we began to see real estate brokers establish an expertise as the go-between – between the seller and the buyer.  These brokers have a much larger bank of knowledge than someone who only buys or sells a home two or three times in a lifetime. They understand the process, know home values, mortgage options, negotiation – they know far more about everything related to the transaction of buying or selling a home than most of us do.  Today, very few home transactions take place without a real estate broker to orchestrate them.

Unfortunately, the healthcare system (no matter what country you live in) has become so tenuous that patients really do need a go-between to help them navigate.  Doctors can’t do it alone anymore, nor can nurses.  Without that expert to step in and shepherd us, we patients may succumb not to our disease or condition, but to the problems in the system that is intended to help us.

There is excellent care available!  But it takes these experts — these professional private patient advocates — to find it and make sure we patients access it.

Whether you need help navigating the maze of healthcare — or help with your medical bills, insurance claims, home health, eldercare, a midwife or doula – or even legal help – you can find it at AdvoConnection.

Update:  January 2015

Are you considering becoming a patient advocate?  You might be interested in this recently published book:
So You Want to Be a Patient Advocate?  Choosing a Career in Health or Patient Advocacy

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AdvoConnection Blog Launch

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As Every Patient’s Advocate, the most frequent request I hear is to try to make a connection between a patient, or the loved one of a patient, and someone who can help navigate medical care on behalf of that patient.

Here is a list of the kinds of services they request:

  • Preparation for the doctor’s appointment
  • Accompaniment to doctor’s appointments, tests and procedures
  • Medical research to learn more about diagnoses and treatment options
  • Translating medical language (medspeak)
  • Navigating HIPAA laws and privacy matters
  • Insurance choices, filings, negotiations
  • Elder care / geriatric care
  • Home health services
  • Organization / administration / paperwork
  • This blog will discuss the status and options of patient and health advocacy.

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