Registered nurses (RNs) play many supportive roles as part of the rheumatology care team. According to Norma Liburd, RN-BC, MN, a pediatric clinical nurse specialist at Johns Hopkins All Children’s Pediatric Rheumatology in St. Petersburg, Fla., one of those roles is that of a closer.
Explore this issueNovember 2018
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“After a patient and their family meet with the rheumatologist, an RN ties up loose ends by teaching them about the rheumatic diagnosis and the risks and benefits of treatment vs. non-treatment,” she says. They also teach patients how to administer oral and injectable medications, how to swallow pills and offer techniques for remembering to take medications. Ultimately, they reinforce the information the physician provided.
Ms. Liburd says rheumatology RNs in an outpatient setting complete parts of a physical assessment, such as joint counts, and assess comorbid conditions, such as infections and concurrent illnesses.
Administrative tasks: Ms. Liburd triages phone calls from sick patients, answers their questions about drug interactions and relays laboratory and diagnostic results to patients. RNs also help patients and their families navigate the maze of insurance choices and financial assistance options. They can facilitate prior authorizations and write appeals letters to insurance companies.
Ms. Liburd coordinates care and assists with referrals to other specialists, such as an ophthalmologist, occupational or physical therapist, pain manager or psychiatrist. She provides psychological support to patients by referring them to community and support programs and resources from outside organizations, such as the ACR, Arthritis Foundation, Lupus Foundation of America and many others.
Social media has also been a helpful resource for parents of children with rheumatic diseases. “Many parents have been able to connect with other families through [the Arthritis Foundation in Florida’s Facebook page],” Ms. Liburd says.
“We also refer families to the national meetings these organizations coordinate,” she says, noting that nurses are involved in local and national meetings of such organizations and have served on committees.
From the onset of a patient’s illness, RNs work closely with patients and their families, establishing good relationships with the practice. To achieve such a bond, Ms. Liburd aims to learn as much information about a patient and their family as she can. Before meeting with a new patient, the provider discusses the patient’s diagnosis with her, including such details as their joint involvement, symptoms, medical history and treatment plan.
“Simply knowing that I need to teach a child’s parents how to administer a methotrexate injection is not enough,” she says. “I want to know what brought them to this point and any concerns the family may have, so I’m not blindsided when I walk into the room.”