August 2015
UC Irvine Medical Center
United States




Nurses stand with their patients and families every day to face and overcome the adversity of illness, injury and societal barriers. At times, those barriers are the very things intended to help a patient. I would like to share the story of Joyce Fournier and E. Joyce is our case manager in ARU and operates with a flight of angels to help guide anxious patients and families through the changing roles and responsibilities for patients with new onset of disability. The bedside nurse functions as the daily guide, engaging in care and compassion to assist those with a sudden change in health and role. The Case Manager acts in a different manner. The Case Manager meets the patient upon admission and immediately helps to plan for "what comes next." Sometimes, if they are fortunate, what comes next is merely rest and recuperation while the treatments and procedures supplied by the doctors and nurses take effect. Other times however, what comes next is a complete upheaval in the lives of the patient and everyone in their circle. Loss of role, soul-searching questions of income, love, ability, and even simply coping with a new body image are the hurdles the case manager guides his or her charges through daily. When the hurdle is the very agency charged with providing care, the case manager faces an incredible challenge, as was the case for E.
E works for a local business and was riding his bike to work one day when he was struck by a car. He suffered severe brain, spinal cord, and orthopedic injuries. After brilliant care in the acute setting, he was referred to the rehab unit to begin the long journey back to function. While doctors, therapists and nurses alike all agreed that E would benefit greatly from rehabilitation, his insurance company disagreed and demanded placement in a nursing home. Enter Joyce Fournier, Case Manager. E was not her patient. He was not in our unit. Her only contact was to briefly introduce herself when he was referred. However, when the insurer issued it's edict, Joyce mobilized all the resources at her disposal to fight for E, to obtain the services he so desperately needed. She engaged the physiatrist in the rehab unit to directly contact the medical director to plead their case. She provided document after document to demonstrate that E was already beginning to move his paralyzed limbs and recover his cognitive abilities. She adamantly stayed the course and eventually won out, garnering a five day stay in the rehab unit. Five days merely begins to scratch the surface of the rehabilitation needed for a patient suffering from both a brain and spinal cord injury.
Upon arrival E could wiggle toes on one foot and move his forearms, though only just a bit. He could not go the bathroom by himself, relying upon staff to provide invasive interventions to prevent medical complications. He relied upon others to fully perform every aspect of care. Joyce stated to the team "We have been given five days, let's get started and I will fight for the time we need." The time we needed stretched out to a full month. At every turn, we reported on E's progress to his insurer only to be met with instructions to discharge. Each time, Joyce patiently explained to the uninitiated reviewer why such a decision would be dangerous to E, how leaving too soon would make him more dependent, not less. She kept the insurance company and medical director on speed dial and continued to ensure their doctor clearly heard what the rehab doctors advised. Denials came and were challenged and then overcome by Joyce and the team. E received the care he deserved and needed.
As he prepares for his discharge, E can now walk the halls with his family. He rises from bed on his own. He feeds himself. He bathes himself. He can go to bathroom without someone or something invading his person or privacy. In short, E is able to go home. He is able to go home due to the intensive and highly specialized skill sets of the therapists, rehabilitative nurses and physician who worked on his case daily. Services that could only be provided because his valiant case manager fought for him, even before she knew she needed to. In today's healthcare, professionals encounter daunting challenges in the disease processes and severity of injuries that impact our patients and families. Joyce Fournier is worthy of DAISY recognition because she stands with and for each of her clients to stare down disease, disability, and parsimoniousness. She understood that a young man of 24 is far too young to spend months in nursing home and deserved the chance to return to his normal life. Joyce's focus on what was right made all the difference for E as she cheerfully engaged the patient and ensured he received the care he needed.