Registered Nurses Provide Valuable Support to Rheumatology

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.

“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.

Patient Relationships
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.”

Additionally, she tells the families “they can call me for anything—no matter how insignificant it may seem. I discuss reasons for them to call their primary care physician and reasons to call our practice, because this is often a confusing issue.”

As a pediatric clinical nurse specialist, Ms. Liburd helps patients celebrate their accomplishments. “These celebrations include music, tiaras, Mickey mouse ears, some crazy dancing and lots of hugs,” she says. Patients celebrate such milestones as being weaned off prednisone, stopping methotrexate treatment or having a birthday. They also celebrate after a long hard fight with an insurance company results in a new medication being authorized. “We’re in this [experience] for the long haul, and our families recognize this.”

Education & Training
RNs have either a two-year college education with an associate’s degree in nursing or a four-year college education with a bachelor’s degree in nursing, according to the ACR website. Rheumatology nurses have specialized knowledge and expertise in the care of patients with rheumatic diseases.

To help new nurses become well versed in the specialty, Ms. Liburd suggests rheumatologists provide RNs with as much educational support as possible, such as journal articles and books. She also encourages rheumatologists to pay for nurses to attend national annual meetings and conferences, such as the ACR/ARHP Annual Meeting.

“The cost to the practice will be well worth it overall,” she says. “Rheumatology constantly changes, with new drugs, techniques and concepts. RNs need to keep current with updated information.”

Karen Appold is a medical writer in Pennsylvania.