Ethnography After walking down the long hallway on the third floor of a building containing ten or more floors,

I awaited my mother to open the pass coded, black door. Once she opened it we walked down a short hallway into a large room full of cubicles that were surrounded by conference rooms and a break room. The cubicles were scattered across the back wall but my moms nurses cubicles were closest to the entrance and shaped in an L shape. My mothers cube is closest to the window, then behind her is her male nurse, behind him is female nurse one, next to her is female nurse two, and in front of her is an empty cube for a future nurse. The other cubicles are occupied by a group of people that work in underwriting and with special accounts. All of these workers communicate and interact with my moms set of nurses at any time during their work day. Each of my mothers employees were dressed nicely, but not too professional. They were either wearing a nice pair of jeans with a dress shirt or dress pants with a semi-dress shirt. Every one of her nurses spends much of the day on the phone and computer communicating with patients, lawyers, doctors, claims representatives or anyone else that can help the patients needs. Claim: This particular group of nurses that work in a unique and unusual field of nursing require a great deal of additional education and vast skill set to enable success with all the complexity of patients they handle. In the interview with Bettina Little she stated that her nurses require, In this role, the nurse utilizes a more holistic medical knowledge base as well as medical/legal knowledge. As well as, A strong foundational knowledge of medical, psychological, socioeconomic, legal that is functional and applicable. These two knowle dge basis make for a very successful team of nurse as well as for a very knowledgeable set of nurses handling this interesting and new form of nursing. Each of her nurses, manage the medical/return to work processes for approximately 65 cases. This involves much phone communication, collaboration with all members of care team, negotiate optimal care, document all activity, review medical records, transition patients between levels of care and communicate via written correspondence when needed. By having all of this communication to do with the patients and other case members this set of nurses use their specific lingo. I asked my mother to describe the type of lingo that her and her nurses use on a daily basis. Her response was, as nurses we have lots of abbreviations for various health care procedures, activities, laboratory results. Additionally, we have lingo for various communications we make from one to another. For example, doc in a box= urgent care. Some people may use other words like this but not everyone knows what the abbreviations or catch phrases for specific things mean. Not knowing the lingo is the number one way to be able to tell if someone is a member of a specific community. By watching someone who cannot pick up on what a doctor or nurse is saying when discussing medical results is a quick way to see if someone is an outsider, has some insight to the community or is an insider. Claim: Not all nurses have to be the nurse we see in the doctors office, hospital, or at any other medical center. In my interview with my mom she told me, I think we all think of

nurses fulfilling roles in hospitals and doctors offices. All of these roles are aimed at expediting the physician defined treatment plan. Our nurses create a team approach by collaboration with the injured worker, physician, claims examiner, therapist, employer, and any other involved party (i.e. attorneys) to assist in development of the optimal treatment plan and works to effect that plan for a win-win situation for all. My mom, Bettina Little, runs an office of four nurses that work in an insurance company, Employers, to insure that anyone who has had a work injury gets the best care. When I questioned her on what her and her team does on a daily basis she said; They manage the medical/return to work processes for approximately 65 cases. This involves much phone communication, collaboration with all members of care team, negotiate optimal care, document all activity, review medical records, transition patients between levels of care and communicate via written correspondence when needed. The nurse that comes to mind usually is working long hours on the hospital floor providing patients with any needs, such as medications, baths, trips to the bathroom, pre-operation procedures, and anything else that arises. These patients that those nurses are dealing with usually live in the area surrounding the hospital or in odd cases have been transported to them from out of state for a specific line of care. My moms team of nurses does some of these same things but does it from over the phone by consulting with anyone that can be able to reach that person physically. Her nurses work with patients from Oklahoma/Texas to the east coast. Claim: It takes a great deal of patience to be able to have a strong bond among employees as well as deal with the patients that can sometimes be a burden. There are many difficult aspects of a nurses work load but for my moms nurses there are specific ones. My mother states that, having to understand the Nursing Practice Act and the legal requirements to function in each state that we serve. Every state has varying laws that the nurse has to know and understand. And the behavior of people can often be challenging as the work involves pain and stressors and financial gain issues are the most difficult aspects in her daily work. These are hurdles that not all other nurses have to face in their nursing community. However, every nurse knows what it is like to deal with a difficult and ungrateful patient. Litt les team handles the patients by knowing how and who to talk to. Bettina said when asked about how her team manages difficult patients, This is a tough question because we see most of our patients at the most challenging time of their lives and that of their families. For example, if we have a severely head injured patient, a patient that slips and falls and gets a screwdriver in their eye or a severe electrocution injury, the patient and their families are dealing with permanently life changing events and emotions. The emotional impact to these folks is catastrophic. Sometimes the emotional impact can be equivalent to or greater than the medical injury. This requires great skill in communicating, developing trust through a telephonic communication and tremendous assessment skills and abilities. The team is always professional and understanding of the emotional/behavioral ramifications with patients in our work.