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

I awaited my mother to open the locked, 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 cubicle 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 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, business causal. 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. 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. The nurse that comes to mind usually is working long hours on the hospital floor providing patients with any skilled nursing care needs, such as medications, baths, ambulation assistance/support, pre-operation procedures, care education and anything else that arises. The hospitalized patients and their care providers usually live near the local communities 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 also help to facilitate the patients treatment plan east coast. 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 and insurance understanding that is functional and applicable. These two knowledge bases make for a very successful team of nurses as well as for a very knowledgeable set of nurses handling this interesting and newer form of nursing. Each of the nurses, manage the medical/return to work processes for approximately 65 cases. This involves much phone communication, collaboration with all members of the care team, negotiation of optimal care, documentation of all activity, review of medical records, transitioning patients between levels of care and communicating via written correspondence when needed. These nurses communicate a lot among each other and among others that are involved in the care team; they use their own 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/acronyms 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. Others may use different words like this but not know 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 or possesses insight to the community or is considered an insider. 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 challenging, both medically and behaviorally. There are many difficult aspects of a nurses job description but for my moms nurses there are specific ones. My mother states that, Each RN has to understand the Nursing Practice Act and the legal requirements to safely practice in each state served. Every state has varying laws that the nurse has to know, understand and functionally apply. The behavior of people can often be challenging as the work involves pain, stressors and often time financial gain issues. This poses some of the more difficult aspects of 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. Littles 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 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. Through my study of the East Coast division of nurses for Employers Insurance I was able to open my eyes to how the way a registered nurse has many different job opportunities in front of them. I also saw many different ways that a care team has to communicate and handle a case to be able to receive the best care for the patient. It was very interesting to see how a view of a nurse can be changed due to their community they work in. Not every nurse has to communicate with a lot of people to get the care for the patient, while some nurses have to be with the patient face-to-face to supply the care. Knowing an insider and outsider of the nursing communities is across the board the same; in that the person either knows or does not know the lingo that the nurse is using.