Núria Cañadas: “We are a very complete group, which generates confidence in both the medical side and the patient.”

The nurse patient manager is a crosscutting nursing position in the hospital, which was created in 1996 with the Prisma Project, when the hospital was reorganized into institutions, areas and centres.  Since then, each institute has had a patient manager, a registered nurse and an advanced practice nurse (APN).

We are in charge of the intra-and extra-hospital patient processes. We are the main point of reference both for the patient and their family within the hospital environment, as well as for the professionals involved in the care process.  We prepare surgery plans, coordinate scheduled patient admissions, and manage internal transfers from A&E, for example.  Furthermore, we are in charge of coordinating transfers from other centres and managing the surgery waiting list.

In general, I think she has to be a decisive and organized person with leadership skills.  She has to be very clear about the circuits and also about the process the patient has to follow, from the moment they are given the go-ahead to join the waiting list until they are discharged. She also has to be able to deal effectively with unexpected situations and make quick decisions at critical moments.

The Hospital Clínic has ten institutes. Each institute has its own particular features, a patient profile and specific treatments.  For example, the institute where I work—ICEMEQ—is very surgical, but there are others that may be more medical.  So, in this sense we also play an important role, as we have to manage multiple tasks, coordinate admissions, transfers, procedures, etc.  We also have to have communication skills, show empathy and understanding towards patients and their families, and be able to understand their needs and concerns.

Yes, we speak to the patient to plan their admission, a test or surgery and then we monitor them throughout the entire hospitalization process until they are discharged, working in close collaboration with all members of the team in charge of the patient’s care. We also receive patients from other areas such as the DIVAS (which belongs to the Diagnostic Imaging Centre), where they carry out techniques that sometimes require the patient to recover in one of our hospital wards.

At the ICEMEQ, the management of surgical programmes is a function delegated to a team of trained administrators specialized in one or several sections within the institute, so that in weekly meetings with the doctors, where the patient manager is also present, the surgeries for the following week are drawn up in accordance with medical, social and labour criteria, etc. depending on the waiting time guarantee.

We are the ones in charge of talking to the patient, both the administrative staff, and myself to tell them what day they will be operated on and everything they have to take into account before surgery, such as whether they have to stop taking any medication or whether there has been any change.

There is the administrative part, which is the surgical planning, and then there is the nursing part, which involves managing these admissions.  Daily admissions are planned and then I, as the manager, have to check every day which patients are admitted and where they can be admitted.  At the ICEMEQ, for example, we have five wards, and each ward has its own characteristics and its own patient profile, which we try to respect, as the staff in that ward have specific training, for example in surgery of the head and neck, or in the knee or hip, or in orthogeriatric patients.  

Decision-making is essential in the work of a nurse patient manager to ensure quality care, efficient coordination of resources and an adequate response to patient needs at all times.  We make decisions about patients at different times, from the moment they first make contact with the hospital. For example, when we have to receive a patient from another hospital or decide where to place each patient, decision-making is essential.  This may involve deciding on the allocation of beds, which often creates an ethical dilemma when making decisions. The most important thing is to place the patient in the most appropriate place for them at that time, and this also implies having to prioritize. Therefore, there needs to be constant communication between all the institutes, centres and areas in order to determine the best decision, keeping the patient in mind at all times.

When we patient managers meet, we do comment on the lack of visibility we often have, both inside and outside the hospital.  In general, we are not very well known in comparison with other professionals, such as doctors and registered nurses. This is probably because we often do our work in the background, and it is not so visible to the general public.  So, although we are not so well known, our work is vital to ensure the smooth running of the hospital’s health services.

I think this is because we have a holistic vision and knowledge in many areas, both healthcare and social. A nurse can bring a unique combination of clinical knowledge, communication skills, drive and practical experience that makes them ideally suited to managing patient processes and situations effectively and providing comprehensive patient care.  The fact that we are nurses is very important for us, as it gives value to the position of patient manager and, in reality, in few centres is this position occupied by a nurse.

Moreover, we are a very complete group, which generates confidence in both the medical side and the patient. We play a key role in the patient’s experience and in reducing waiting times.

In essence, the spirit underlying the creation of the patient manager remains the same after these 30 years. Our objective remains the same: the patient and their well-being.

Patients receive the right care at the right time. Through the efficient management of admissions, transfers and discharges, we have a positive impact on patient care.  We help reduce patient waiting times, thus improving their experience and comfort. From admission to discharge, we nurse patient managers work to ensure a safe transition between different levels of care.

Yes, completely. It’s not easy, because the moments when you have to make decisions are also complicated, but having the opportunity to help people and the hospital with efficient management is also very satisfying.