Transcription:

Melanie Cole, MS (Host): Welcome to UAB Med Cast. I'm Melanie Cole and in this panel today, I have Alyse Hicks and Jennifer Rosales. They're both with UAB Medicine and they are both registered nurses. And they're here to talk about the role of ambulatory care transition nurses. Thank you ladies, for being with us today. Jennifer, I'd like to start with you. Tell us what is an ambulatory care transition RN and what is their role?

Jennifer Rosales, RN (Guest): Hi, Melanie. Thanks for having us back. So ambulatory care transition nurses we're responsible for triaging telephone and portal messages that we receive from our primary care and family medicine patients. To be in this role, we have to have at least two years of clinical experience as a nurse. We've all worked in a variety of areas of nursing, so we all contribute to a specialty. We also schedule transitional care management appointments, when patients are discharged from an ER or hospital, we call them and discuss any medication changes that were made, educate on disease process, safety precautions and perhaps wound care if they have a surgical wound and then also schedule a follow-up appointment soon with our provider, and then that helps prevent hospital readmissions.

Alyse Hicks, RN (Guest): I also wanted to add to that with the portal messages, we're primarily responsible for managing the patient portal. We receive about four to 5,000 messages per month on average. I know during the latest COVID surge, we got probably a little over 9,000 portal messages. So it was a lot for us to manage, but we were able to handle it.

And also with the messages that come through, depending on what's going on with the patient, they'll call our office with an urgent, with urgent symptoms, such as chest pain, elevated blood pressure, shortness of breath, a new onset of that. And so based on the urgency of the message, we have to prioritize which ones we respond to first.

Host: Well, you are all really the first line of defense and support for patients. Alyse, tell us a little bit more about the benefits and the importance of this role for that continuity of care that's so important today.

Alyse: I think one of the benefits is being the bridge between the doctor and the patient. Sometimes the doctors are so busy with managing their clinics, getting clinic notes done. A lot of our doctors are also assistant professors, so they have really busy schedules, but the nurses, we are there to handle things that we can, within our scope, talking to the patients, whether it's communicating with them in the portal, or actually calling them on the phone to help guide them on what, what their needs are.

Host: Such an important role. So Jennifer, how do you all support and partner with the providers? Alyse just mentioned a bit about how the doctors, you know, some of the other healthcare providers have their records to keep up and patients to see, and they're also professors. So tell us how you all partner with them because you are so vital in this chain.

Jennifer: Right. So we function as an extension of the provider, by working under their direction. Of course we know their preferences. So we know how to navigate their patients messages. If a patient has a new issue, that's not emergent, then we schedule them an appointment so that our provider can properly evaluate them.

Or if the patient recently had an appointment and is having issues with maybe a new medication or symptoms aren't resolved, then we know what information to get from the patient and send that to the provider, so then they can make further decisions for the plan of care. Communication is very important with our providers.

We can also send them messages during the day that, flagging them as urgent. So then that they know that that needs to be addressed, you know, before the other messages. We also convey diagnostic results to patients that providers have already reviewed. A lot of the providers, they'll cc us in results letters that they send back to the patients.

So then that way that gives the patient time to review them and then let it sink in and then we can call them and check in, see if they had any questions. Do they understand, provide further education. And then of course, if they have any other questions send that back to the provider.

Host: This is such a comprehensive job that you both have. Alyse, what are some of the challenges that you've had to overcome both before, during and after COVID? You mentioned how many thousands that come through your system every month, which really blows me away. And during COVID it must've been even more, with people so concerned about things. Tell us about some of the challenges, whether they be technical or staffing or informative.

Alyse: Well for me on a personal note, I come from the pediatric population. And so when I first started this role, I knew that it would be a great challenge for me to take on this role and to also learn more about adult nursing. Of course I had the basic knowledge, but a lot of the messages we get, a lot of the cases that doctors are working with, are very complex and they have such a diverse team of specialists that patients follow up with. I guess one, some of the challenges would be to try to prioritize which messages are important, which ones can wait, making sure that that patients are stable. And especially during COVID, it's really just also too try to keep up with CDC guidelines, COVID testing whether a patient presents with COVID symptoms or is it more a sinus related and going back and forth with that. So it has some challenges, but I will say that working with such a great group of nurses, we can come together, huddle on certain things and kind of figure things out amongst ourselves.

Jennifer: And I would like to add Melanie, what makes this area of nursing different is because we can't see our patients face-to-face. We have to do a head to toe assessment, basically blind, you know, asking questions over the phone, getting information from the patient. What did they see? How do they feel, vital signs and then gathering all that information and making our decision. Patient safety is always our top priority. And it's up to us to recognize that the patient's having a medical emergency and get them to the ER right away. And so in this field, we use our anatomy to make decisions based on the information we collect. And it is, we may not use physical skills such as starting IVs, administering medications, but we're constantly using our critical thinking skills. So that can be mentally tiring at times, and especially with the large number of messages, but we do handle it very well.

Host: I imagine you do. So, Jennifer, how has this combination of specialty knowledge that you have, leadership skills, relational expertise, you're doing face-to-face and Telehealth encounters. So you're often having long-term relationships with patients and their families and the patient centered medical home model. How has this all reinforced the critical need for RNs to provide that chronic disease management that you were just discussing, care coordination, all of these things together. How has it come together for you?

Jennifer: Right. So, patients, they see their provider, they have a short visit and then a lot of them, it can be overwhelming what all they're diagnosed with. They have a visit and they have lab work and then it confirms, you know, diabetes and high cholesterol. So doing spurts of you know education with the patient, maybe doing a little bit at a time with the patient. And then if they have questions, we encourage them to, you know, reach back out to us and then we can provide further education. I think that's important for patients to really understand, just them learning bits at a time. And then also, you know, if maybe lab work is very extensive, there's multiple issues, then we can schedule them a Telehealth video conference with the nurse practitioner or provider, and then they can do further education as well.

Host: That's so important. And I want to give you each a chance for a final thought, because what a great topic this is, and many people don't realize truly the importance of your roles in this department. So Alyse, starting with you, how do you work at the top of your scope? How are you staying on top of things? And also because it's been so stressful, staying mentally well yourself?

Alyse: That's a great questio, practicing at the top of my scope, just making sure that we manage portal messages to the very best of my ability before we send it directly to the doctor. And also too, I, think with the messages that we get, a lot of times, it's more so about investigating the case, looking at other doctor's notes from other specialties, such as cardiology or pulmonary or endocrinology and trying to put all of the pieces together.

So sometimes with doing that, I can answer the patient's question or address a concern before it has to go to the doctor or sometimes it doesn't even have to. As far as just trying to stay mentally well, I'm a believer in taking time off and requesting time off. It's there for a reason and I like to use it. I'm just trying to center myself, spend time with family when I'm not at work, trying to decompress. And even at work, if I need a moment away from my desk, I'll go to a quiet space and just count down to 10 and come back, with a more positive attitude so that we can best serve our patients.

Host: What an important model for self care you just described, Alyse, thank you for that. And Jennifer, last word to you. How has your knowledge base continued to grow in this role? I'd like you to speak about professional nursing growth, future direction and what you would like other providers to know. This is the most important, what you would like other providers to know about this role of ambulatory care transition RNs because you are the glue. You're the link that keeps the whole thing together.

Jennifer: Right. So in this role of nursing, I feel like I've learned so much. We get to see the whole picture, the whole process of a patient's healthcare journey. We get to see what initial complaints the patient has. What testing workup is done. And review specialist's notes and see the outcome and progression. So you definitely learn a lot.

We grow by interacting with our providers and asking questions. We've had to learn a lot more with COVID, staying up to date, like Alyse said, with vaccines, the virus treatments and vaccines. Another important part of this role is we've also learned how to take on more managing of the clinic. Our manager, Amy, Laura Spacey is very great. And she's also trained us on administrative duties in the event that she's out. So, I mean, nursing is just such a dynamic and complex healthcare profession. It's, you know, there's always room to grow and we enjoy learning from our providers as well.

Host: Well there are so many ways it can go in nursing now as a profession. What a burgeoning and really, really vital profession that it is and such a need right now. Thank you both, not only for everything that you do, but also for joining us today on UAB Med Cast. And a physician can refer a patient to UAB Medicine by calling the MIST line at 1-800-UAB-MIST, or you can always visit our website at UABmedicine.org/physician. That concludes this episode of UAB Med Cast. I'm Melanie Cole.