HMW Interview Template

Name: Ada Edwards

Organization/ Company: Care More (medicare managed care company)

Job Title: Primary care nurse practicioner

Brief job description:

Has small panel of 75 pts in board & care homes, assisted living or skilled nursing facilities,
responsible for their primary care
All pts are higher risk, sicker, older. See them every week to keep healthy or catch new problems
quickly to decrease hospitalization (role is designed to save the company money by preventing
hospitalizations).
Focus on end of life care, which is a very high cost in healthcare. Have discussions with pts to
keep care in line with values and prevent unnecessary hospitalization.
Worked in ICU for 7 years and responded from that perspective as well.

What is the most time consuming or frustrating part of your job/ daily activities?

Time-consuming: documentation. Its important but it takes time away from providing care.
Skills arent used, and there isnt an efficient system. Same in ICUcommon theme everywhere
for nurses.
Frustrating: family/pt expectations of nurses abilities are not realistic

What processes could be removed from your job to make it flow more efficiently?

SF Gen didnt always have supplies needed in ICU. E.g. 1 commode for 15 pts. You spend time trying to
track down equipment and never know where to find it. On top of that, things always change, so you
have to make do with what you have when supplies run out. This is a common theme but it really
depends on the facility. In trauma centers and emergent situation, even if there are supplies, they often
arent well-organized or the organization isnt consistent.

What do you think leads to the increasing cost of healthcare?

Administrative costs.
Example with cardiac cath procedure through vein/artery. Pt had heart catheterization and
result was that open-heart surgery would be required to fix problem. Pt already knew he didnt
want open-heart surgery, and the whole purpose of the cath is to determine whether open-
heart surgery was required. The patient already knew he was not a candidate for other
interventions, so this was a pointless and invasive procedure that could have been avoided.
Doctors making decisions on which equipment/devices to use based on which sales rep they
like. Borderline bribery.
Decisions are not always made in the pts best interest, but rather on the ability to bill for
certain things
 End of life care. Inappopriate procedures, services, etc. are given to people that are close to
death. Discussions are not had early enough. Pts end up in ICU and dont benefit from the care
they receive there and they are often suffering. Providers often arent comfortable with talking
about death, or they dont do it effectively. The culture around discomfort with death is present
in both pts and providers, but they often have different values. Providers dont want pts to die
and their job is to treat disease, whereas pts may prefer comfort and solace over invasive
procedures.

What recommendations would you suggest to make healthcare better?

Improve ability of different documentation systems to talk to each other, so that doctors arent
duplicating efforts if a patient moves or is on vacation and has already had a test, or if theyve
tried a treatment that doesnt work.
End of life discussions needs to be more effective. The challenge as an ICU nurse was that
nobody could make a decision to end a life so there ends up being a lot of unnecessary care
given in the ICU. These are hugely expensive stays, mostly due to the inappropriateness of care.
Fear of litigation should not drive as many decisions as it does. Families and pts without
knowledge are expected to make decisions but doctors are often afraid to override, so wrong
decisions are often made.