Rosalinda Alfaro-LeFevre, RN, MSN
Terri Patterson, RN, MSN, CRRN, is president of Nursing Consultation Services and LifeTrak, Norristown, PA, the first independent nursing practice to receive Commission on Accreditation of Rehabilitation Facilities (CARF) accreditation. Nursing Spectrum recently asked her all about it.
Nursing Spectrum: As founder and president of the first independent nursing practice to receive Commission on Accreditation of Rehabilitation Facilities (CARF) accreditation, you’re obviously a leader with vision. What does your company do and why is it important to receive CARF accreditation?
Terri Patterson: Our practices provide care coordination, case management, and life-care planning for people with disabilities. CARF is the premier accreditation commission in the country for rehabilitation, so it was a natural for us to seek their accreditation. As an entrepreneur, you always want to strive to excel. You want to be a pacesetter. CARF accreditation was and appropriate avenue to pursue.
However, CARF had never accredited a private nursing practice before, so it was an area of exploration, adaptation, and adjustment for both them and us. It was scary at first, knowing you were going to be the first nursing practice to go through this process. But, when you’re an entrepreneur, when something hasn’t been done yet, being the first isn’t an obstacle, it just needs a new perspective to accomplish. You know you have to go beyond standard and traditional expectations if you’re to survive in the business world that healthcare has become.
Having CARF accreditation gives us collegial status with all other premier rehabilitation hospitals, home care agencies, and outpatient programs in the country. Because we’re the first nursing practice to achieve this level, we’re leading the way for others.
NS: I’ve heard you say that running a consultation practice today is like riding the waves without a surfboard. Can you elaborate on this?
TP: As a private practice owner, you’re constantly shifting gears. One moment you’re dealing with a clinical ethical issue, the next you’re trying to reschedule three appointments due to a court appearance. Then you have a personnel issue, or the fax machine isn’t working, or you have a cash flow dilemma. I must consider every decision I make from the smallest to the greatest considering the impact it will have on the entire practice. Decisions need to be made from both a nursing and a business perspective. I have a split personality for a reason! If the decision isn’t good for both, then the next step is to determine if it can be made at all.
Like a surfer, who must focus on the path ahead as well as perform a balancing act on the wave she’s on, today’s leaders need to focus on day-to-day challenges as well as long-range goals. And now long-range planning is changing. Many business consultants will tell you that you can’t even have a one-year strategic plan anymore, as it’s always changing. However, if you don’t keep focused on the big picture, you’ll achieve very little. Granted the big picture needs to be constantly refocused, but it must be there and be very clear.
NS: You were named Association of Rehabilitation Nurses (ARN) Nurse Executive of the Year, so obviously your peers see you as a leader. What are some things leaders need to do to facilitate their "followers" journey?
TP: Leaders need to be the role model, to set the standards and then exceed them for their particular practice area. You must be able to balance compassion and determination to achieve goals, and have an undying enthusiasm for the business, even on the days you wish you were somewhere else. You need an attitude of "this too shall pass," which, by the way, applies to both good and bad times. You have to be resilient, because you never know what issues will confront you each day. You also have to be consistent in your approach to your practice, standards, controversies, revenue management, etc.
NS: You do a lot of testifying as an expert witness. What does this involve?
TP: Testifying as an expert witness involves presenting the necessary rehabilitation care to attorneys, juries, judges, and arbitration panels, as well as participating in settlement conferences with actuaries. You must be well prepared and able to think on your feet "under fire." This requires drawing on all your nursing knowledge and being comprehensive in your evaluation of clients, their disabilities, and the impact on their lives. You must also identify future care issues, which are usually presented in the form of a life-care plan.
Being an expert witness is challenging because you also need to be aware of the legal process as it relates to your client, and have the clinical expertise to provide the foundation for your care plan, or in the case of petitions for minors in orphan’s court, your requests. You have to be flexible because you’re continually rearranging your schedule, as you are on-call frequently for court. At the same time, you must be available to meet your clients’ needs. A beeper and car phone helps.
NS: You have now helped with writing CARF standards. What has this involved?
TP: CARF established a committee last year to write standards for medical case management. Several nurses were involved. The committee also was composed of payors, administrators, vocational counselors, physicians, therapists, etc. We met for two and half days in Tucson to draft the standards with the direction of CARF facilitators. These standards were then sent to rehabilitation professionals across the country for review and comments. After that, they were finalized by the CARF Board of Directors and will be implemented this summer.
NS: You certainly have succeeded at surfing barefoot. What advice do you have for nurses who are concerned about the future of their careers?
TP: I would say to control your own destiny as much as possible. Be autonomous and don’t allow your practice to be at the whim of others. Be creative. Identify where you can practice your particular area of expertise and how marketable you are. Realize that nursing is a business and therefore needs to be approached that way. If you don’t, someone else will, and most likely, you’ll be without a career.
Nursing is a career, not just a job to help pay the mortgage, so you need to continually expand your knowledge base, become a clinical expert in your field, and maintain/exceed the expertise of others. Develop your role to where no other profession has that expertise. Most important, be sure that your value is measurable. For example, demonstrate how your services reduce costs, promote satisfaction, or improve quality of life.
NS: What advice do you have for other nurses going into independent practice?
TP: If you feel you don’t want to be looking back in 10 years saying, "I wish I would have....or I think I could have...." then independent practice is probably a good option. But you need an extraordinary amount of determination, staying power, individual fortitude, and a belief that you will be successful....no matter how many people are telling you to "get a real job." You have to remember that success means different things to different people, so only you can be the judge as to whether you achieved it. Finally, you will need to understand that a private practice is a way of life. You’re available seven days a week, 52 weeks a year. If you can "live with your career," then it may be for you. Not that you can’t have time off, but the old adage is true, "the buck starts and stops with you." It’s your integrity, reputation, and livelihood on the line. There is no resting on your laurels in healthcare or any other successful business.#
Rosalinda Alfaro-LeFevre, RN is the author of Critical Thinking in Nursing: A Practical Approach published by WB Saunders.
Nursing Consultation Services, Ltd.
www.nursingconsultation.com
1000 Germantown Pike, Suite D-1, Plymouth Meeting, PA 19462
Phone: 610-279-1122 / Fax: 610-279-1136 / E-mail: ncsltd@aol.com