A nurse case manager who puts others first
Helping cardiac patients plan how to live, or choose how to die
As a patient advocate, Tully manages the entire course of a person’s treatment.
(Richard Schultz)HONOREE: Janice Tully
When Janice Tully began nursing school more than 30 years ago, it was almost by default. Her sister was a nurse, she excelled at science, and she didn't know what other professions to consider. Besides, it seemed like a good fit.
Today, it would be difficult to imagine Tully as anything but a nurse. She's made the rounds as staff nurse at a number of institutions, from Beth Israel to the Visiting Nurse Association, eventually settling into her current position at Massachusetts General Hospital (MGH), where she is a cardiac case manager, a highly qualified specialist.
Tully admits that patients often don't understand what a case manager's responsibilities are, but she's there to provide ongoing care and follow-up after hospital discharge, helping ease a patient's transition to home, rehabilitation, or hospice. She's a fixture on the Cardiac Care Unit, meeting with patients and families, and making the rounds with nurses. Whether a patient requires pre-cardiac surgery, interventions like angioplasty or cardiac stints, or newer therapies like infusions, Tully talks to them about insurance issues, family support, visiting nurses, home care aides, equipment rental, and other details.
Studies show that case managers like Tully can improve the outcome of chronic disease care, enhancing patients' quality of life and empowerment after they leave the hospital. Case management, a practice adopted by many hospitals in the early 1970s, requires a high level of involvement with patients and family, and understanding of possible clinical outcomes. "Case managers are the glue that helps pull together the whole team, including the cardiac physicians, social worker, and occupational therapists," says Joanne Kaufman, a manager in MGH's case management department, and a co-worker of Tully's. "Patient issues can be complicated when they are very sick, and sometimes there don't appear to be many solutions beyond going to a rehab facility. But nurses like Janice peel the layers apart and look at every option, so patients can get the best care possible when they leave here."
Follow-up can require hours of phone calls or emails with insurance companies or other organizations, trying to coordinate services, says Kaufman. But Tully never lets the families and patients see all the work she's done behind the scenes. "She doesn't burden them with the intense advocating that she's done," says Kaufman. "She just says, 'Ok, I got this approved.' "
Tully, a MGH nurse since 1981, became a case manager 11 years ago, putting into practice all her previous experience working in cardiac "step-down" units. Her day begins with checking the roster of new patients, doing initial assessments, talking with other staff and those on her case-load list. The qualities that she says comprise good nursing-"caring, compassionate, smart, good listeners"-are those that she uses to help patients, whether it's someone with pulmonary hypertension or someone who's receiving a generator charge for a pacemaker. Regardless of a patient's time in the hospital, 36 hours or 2 months, Tully says she is almost always able to help because of her years of experience as a bedside nurse. "I answer the patient's questions and consult with families. Patients and families are very knowledgeable these days about healthcare, and that's a real asset."
Tully also exemplifies the continual education that nurses are receiving these days. She started as a staff nurse, then received credentials in advanced cardiac life support and a certification in case management. "There's always something new to learn," she says, and she passes on her knowledge by acting as a mentor to nurses who are making the transition to the case management sector. "I give them time to learn the job without being pressured. This was what my supervisors gave to me," she says.
And Tully, the nurse who meandered into her profession but who is now a life-long professional, has lots of comrades in her circle. "I got into nursing because my sister was a nurse. My mother-in-law also was a nurse, my sister-in-law is a nurse, and I have lots of friends in nursing," she observes. "It's a great occupation to be in."
