Caroline Trinder explains why she gave up her position as a ward manager to put her clinical and nursing skills to good use in a new role as case manager with independent rehabilitation services provider, Kynixa.
I qualified in 1987 at The Royal London Hospital and then consolidated my nurse training in neurosurgical and orthopaedic wards. I soon progressed at London Bridge Hospital from staff nurse to junior ward sister and enjoyed the challenges of caring for patients undergoing all types of neurosurgery and general surgery, including amputations.
I worked in this department for seven years and reached the decision that I wanted greater responsibility. I applied for the position of deputy ward sister in an orthopaedic/general surgical ward in a private hospital in central London.
For the next ten years I was a ward manager of a 22-bed orthopaedic and general surgical ward and enjoyed the challenges and rewards of leading a team and being responsible for the organisation and management of a busy ward.
This required excellent organisation and communication skills. I was often required to be the patient’s advocate when dealing with members of the multidisciplinary team, including treating specialists and hospital consultants. The role also required caring for members of the Royal Family while ensuring that at all times, patients on the ward received the highest quality of nursing care.
I was devastated to leave the clinical setting after 16 years when I was diagnosed with an L5/S1 central disc protrusion, leading to a discectomy. Once I recovered, I had to seek employment in a non-clinical role and decided to focus my career in the rehabilitation sector.
In 2003 I was employed as a case manager for Kynixa, an independent rehabilitation company, where I was able to utilise my extended clinical skills.
Case Manager’s Role
My current role involves assessing injured clients at home, often with head injuries and complex orthopaedic injuries, including upper and lower limb amputees. These injuries are normally the result of a road traffic or work-related accident. Following the assessment I make recommendations for a complex biological, psycho-social rehabilitation programme.
My role is very rewarding. I get involved with clients in their home environment and build a rapport with injured clients’ family members – an essential part of the bio-psycho-social model.
Once funding is agreed between insurers and solicitors, individual rehabilitation programmes are implemented which ultimately produce extensive savings on the overall value of the claims process.
This has involved crossing professional boundaries and understanding the roles of the claimants’ solicitors, insurers and defendant solicitors.
I also communicate with all members of the NHS multidisciplinary team including social workers, primary care trusts, physiotherapists, speech therapists, occupational therapists, clinical psychologists, neuro-psychologists and consultants to ensure clients receive adequate treatment within the NHS.
When this is not available treatment can be supplemented via private provision.
I have also increased my vocational skills. Injured clients invariably need retraining if they cannot return to their pre-accident job so this has meant coordinating meetings with disability employment advisers and job brokers so clients can return to speedy and meaningful employment.
Many disabled clients have required renovations or adaptations to their home environment to reduce the risk of falls, promote independence and improve their quality of life. As a case manager, I meet occupational therapists and builders and help clients to obtain funding – when not available on the NHS – so this essential work is carried out. It is rewarding to set and agree goals with clients and then to achieve step-by-step goals, enabling them to gain a better quality of life.
Working with amputees, I have increased my skills regarding prosthetics provision in the UK and advise clients regarding the management of phantom pain. I have referred clients early for clinical psychological intervention for post-traumatic stress disorder with excellent results.
I am now a member of Kynixa’s specialist musculoskeletal team. This enables me to utilise my highly skilled knowledge and provide case management services to clients with complex orthopaedic/muscular-skeletal injuries. I will continue to attend professional clinical updates to fulfil my PREP requirements, including CMSUK updates.
TWO SUCCESSFUL CASES
Case 1: 40-year-old. Worked on railway as a shunter. Sustained traumatic amputation of left lower limb. Case-managed for 12 months, implementing pain management, occupational therapy referral, renovations to property, communication with physiotherapists, prosthetists and meetings with employer
Outcome: Successful return to work, 12 months following accident.
Case 2: 38-year-old nurse. Involved in a road traffic accident. Fractured left femur, 2-year history of non-union of fractured femur. Case management involved instigating pain management advice with specialist, physiotherapy, clinical psychological treatment due to severe depression, referral to private dietician and funding of a gym membership, regular communication with orthopaedic surgeon, referral to social services and GP’s support, helping to provide funding for domestic support. Ongoing case management support whilst the client was having bone graft surgery.
Outcome: return to work in a sedentary role as a nurse consultant working for an agency. She says: ‘With your help, I pieced my life back together after my accident. I knew you were only a phone call away and the support you gave me was priceless. If it weren't for you I would still be sat at home depressed; instead I am back at work and enjoying life again.’
LINKS BETWEEN A WARD MANAGER AND CASE MANAGER
• Excellent organisation and communication skills
• Highly skilled clinical knowledge
• Cutting professional boundaries
• Assessment, implementation and evaluation of care
• Patient/client advocate
• Education of more junior team members
• Case reviews with multidisciplinary team
• Involved with audit, clinical governance
Working as a case manager in the rehabilitation arena offers excellent career development potential. It is rewarding to coordinate care and be involved with the NHS multidisciplinary teams, while being able to make a difference to injured clients and help them towards regaining independence.
The advantages of leaving the clinical ward setting are that working in the community, we see clients in a more holistic way than just within the hospital environment and are able to help family members where appropriate.
It is rewarding to assess a client in hospital, recommend a rehabilitation programme and follow them through to their return to work.
There is no shift work, no late evenings on the ward and, obviously, no bed pans!