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Name: Kathryn Lind
Age: 55
Title: Clinical Advisor
Company: UnitedHealth
Location: Boston
Monster: How did you get to your current position?
Kathryn Lind: I interviewed and loved the sound of the Evercare model.
Evercare is an affiliate of UnitedHealth Group. We see patients in nursing homes, and we care for them there. We're able not to transfer patients out of the nursing home to a hospital and cause disruption in their lives.
After a few years carrying a full caseload, I was hired into the clinical advisor position. This position is great; it provides me with an opportunity to teach and mentor newly hired nurse practitioners (NPs) and continue to care for a reduced caseload of patients. I never want to give up delivering care at the bedside.
M: What do you do in your position?
KL: I provide primary care to elderly patients in long-term care homes, and mentor and teach newly hired NPs. I've worked with NPs assigned to homes where the staff may be having difficulty understanding the Evercare model. Working with NPs in this situation allows for some creative problem solving.
As part of the Evercare model, we emphasize that care delivery to residents in a nursing home can be positively impacted by having a consistent NP interface with the employed staff and teach good geriatric care.
I also spend a significant portion of my time building relationships with family members. Evercare mandates monthly communication with the responsible party. This becomes valuable when the resident's status changes. Often, when end-of-life issues arise, the family isn't taken by surprise and is able to make informed choices regarding their loved ones care.
M: Bring us through your typical day.
KL: I call my voice mail in the morning to determine if there has been an emergency overnight. If that's the case, I go to the facility and see that resident, communicate with the doctor and discuss options with the family.
I then see the residents on my caseload for routine visits. This is a comprehensive review of their status. Most often there are no surprises, because we encourage open communication with the nursing staff. Then I call the families and report the status to them. I collaborate with the doctors if there are any changes in status.
As a clinical advisor, I get called by other NPs during the day to review any difficult cases and may see a resident with them or provide support.
I also try to build relationships with the staff in the homes to allow for open lines of communication.
M: What have been the biggest rewards in your career?
KL: My rewards are seeing a very sick elderly resident and treating them in place -- not traumatizing them with a transfer to a different environment -- and then watching them recover. It is also rewarding to take care of a resident for a few years and have a good relationship with their family. When residents near the end of life, helping them to die peacefully when they are no longer able to respond to treatment, and carrying out their expressed wishes for care options while supporting their families can be a real blessing. It can be sad but good at the same time.
M: What are some of your biggest on-the-job obstacles?
KL: I can feel stretched when I have more than one resident who is very sick in more than one home. Carrying a computer and setting it up in very small nursing stations to print out records can also be challenging. Clarifying families' expectations regarding curing a chronic illness can also be difficult.
M: What's the best advice you could give someone who's looking to get into this field?
KL: My advice would be to give geriatrics a try. I've worked in maternal and child health, public health, camp nursing, childbirth education, VNA work, ER and ICU. I tried long-term care thinking it would be an interim job, and I loved it.
My residents have beautiful life stories, and my cognitively impaired residents tell me some of the best stories I've ever heard. Working in this field is the most challenging of all the fields I've been employed in. You'll use all of your nursing and medical skills and then some -- and you'll be doing valuable work.
