From managing multidisciplinary teams to organising complex care packages of rehabilitation for clients, we get to know newly appointed Case Manager, Joanna Eksteen a bit better!
Why did you decide to move from nursing to case management?
I’ve been an A&E nurse, run my own company doing agency nursing and had the opportunity to work in private hospitals, community settings, hospices and on elective surgery. My previous role was actually very similar to a case manager. I managed complex care packages for Clinical Commissioning Groups. This meant assessing, recommending and putting in place a range of care services for clients who had sustained injuries as a result of accidents and required long term care.
I was responsible for managing the provision of that care – from identifying the most suitable care services for each individual, to ensuring individual carers were up to date with training and liaising with multidisciplinary teams (MDTs) that were involved in each case.
I looked after 10 clients with a range of complex needs including brain injury and spinal cord injury, supporting them to get back home and/or remain in their own homes. When I was working with case managers on some of these, they pointed out that what I did aligned very closely with the role of a rehabilitation case manager. I had a transferable skill set that would lend itself to rehabilitation in a new market. I decided it was time to broaden my horizons and take on a new challenge!
What are the three top qualities you think a case manager should have?
To be organised, reliable and really good at communicating. Oh, and trustworthy and honest – all the qualities of a nurse!
Is there a particular case throughout your career that has really made an impact on you and why?
They all do. Every time you look after someone – even when I was nurse in A&E - when you only spend a brief amount of time with a patient – you take away something from it.
It is also really important to be able to relate not only to the client but also to their loved ones and provide information, support and give reassurance. The families are very often doing their best to provide care for them under extremely difficult circumstances, because it’s small things that often make such a big difference in peoples’ lives. You have to be prepared to have difficult conversations and go all out to help your clients have a good quality of life.
No client is the same. I always learn something from each individual case and I’m then able to reflect on what worked, what made a real difference and about how I might approach similar cases or how to get the best outcomes for other existing clients. All cases are special.
You specialise in spinal cord injury; how will you apply your expertise from a nursing perspective to case management?
Because I’ve been an A&E nurse as well, I am very fortunate to have a good understanding of what the whole patient journey looks like, from them being admitted into A&E, any subsequent medical, orthopaedic or surgical needs right through to undertaking clinical assessment to developing care packages and helping them back into the community and their own home.
Ongoing clinical support is paramount, particularly with spinal cord injury patients. Something that you recommended at the start, won’t necessarily be the right thing a few months down the line - things change all the time.
I’m used to doing Immediate Needs Assessments and I feel it’s paramount that the client is involved and their needs and preferences are respected. For clients who have a had a life changing injury there are a lot of obstacles for them and their families to overcome, for example they and their families may have to get used to having a steady stream of health professionals coming into their home and providing all kinds of care.
Whether you’re a nurse or a case manager, you need to listen, talk through concerns and reassure, and also recognise when something’s not working, reassess and implement clinical decisions to continually make things better.
It’s important to keep the client informed and updated, be approachable and ready to answer questions and concerns.
You also need to look at the bigger picture – not promising things you can’t deliver and raising expectations, and making sure the families understand and not giving them false hope.
You’ve managed multidisciplinary teams across a number of different organisations. Do you find the team approach and dynamics vary across the different settings?
Not really, I just get stuck in and befriend people! I would never ask anyone to do anything I wouldn’t do myself. I don’t mind mucking in and have found that that’s really the best approach because if people know you’re willing and can rely on you, then they’re more likely to reciprocate that. A sense of humour definitely helps when it comes to team dynamics!
What three words sum you up?
Honest, friendly, approachable. Also reliable, caring, organised.
Tell us something interesting about yourself.
I have a dog called Florence Nightingale who just loves to say hello to everyone! She’s a lab pointer cross and we get up at 5am every morning to walk for an hour and a half. I’m very active so I’ll also generally try and fit in a gym or spin class before my day really gets going.
What attracted you to HCML?
I’ve worked for a number of relatively small organisations, and I decided I wanted my next move to be with a larger, successful and well known nationwide company. Bigger companies have the ability to invest in their employees. When it comes to being a rehabilitation case manager, I wanted to make sure I would be working for a company that care and actively support and provide personal and professional growth opportunities, such as CPD training.
With a bigger company you get more expertise too; it’s good to have lots of people around - more people’s brains to pick and more knowledge to share! Everyone I’ve met so far has been so welcoming and really helpful – I know I can always pick up the phone and someone will help me.
You’ll be used to dealing with extremely personal and difficult situations as a nurse and clinical nurse specialist, what do you do inside or outside of work to manage stress and remain resilient?
Walk my dog and drink prosecco (not at the same time!) Getting up at 5am every day gives me the chance to exercise, and being active really helps with managing stress and sets you up for the day in a positive way.
What keeps you motivated and inspired?
Being a nurse is a privilege, and knowing I am in a position that I can make a difference keeps me motivated. I always wanted to be a nurse, and from the age of 18, have always worked in care including at a college working with disabled children, as an NVQ assessor and a care co-ordinator at a brain injury unit. I had my family and was waiting for the right opportunity to get into nursing. I actually think it can be better going into nursing when you’re a bit older and have had had a bit more life experience because you tend to be able to relate to patients and understand what they’re going through.
But to be honest, being a nurse is what you are, it’s not just a job and that’s more than enough to motivate and inspire me.