Are you a nurse that is wondering what a nurse case manager really does? Before I explore the answer to that thought, I must add some humoring nursing rhetoric here. When I was fresh out of nursing school, I remember anxiously learning the ins and outs of all things ICU nurses must learn. I got the gist of what a respiratory therapist did, as well as understood why physical therapists assessed our patients, and I kind of sensed the purpose of a speech therapist (I preferred my patients to be intubated and sedated, not trying to feed themselves!).
Yet, there was this one group of nurses that would come in everyday, plop in my seat and take all my desk space right as I was about to sit down and chart for the first time since I clocked in. I called them the “white coats”, because they wore white smocks, or lab jackets that were crisp and freshly ironed. These nurses weren’t even wearing scrubs, instead they looked so polished with their dress casual attire. Being the ignorant (and somewhat envious) new nurse that I was, my blinders prevented me from seeing the big picture. The big picture was that the patients I treated had a story, a story that existed outside the boundaries of the four walls that housed acute care. I remember listening to the case manager during interdisciplinary rounds. I was fascinated that they knew these patients on such a broader, more intimate scale. That peaked an interest within me. It gave me hope that perhaps, if I kept trucking along, that one day maybe I would become a white coat. After several years, and blasting through the learning curve, I moved from critical care to hospice to emergency medicine, until finally one day, I found myself right where I never imagined: in case management. Now, I completely understand what the white coats were doing. To put it simply, being a case manager is one of the most rewarding roles I have served in, but also, one of the most difficult.
Over the years, I have asked hundreds, if not thousands, of nurses their thoughts on their specialty. While a majority of the consensus was they had a “special calling”, many would also agree that nursing has a tendency to burn us all out. Now, I have to agree that my calling was not case management, but it was my initial experience in critical care that called me to hospice. I witnessed people live a poor quality of life in the ICU, and I thought, there must be a better way to die.
That is what called me into hospice care. We all know that it takes a special person to constantly interact with dying patients daily. Being in the home setting as a provider opened my eyes to the stark psychosocial realities of these patients and families lives. It clicked! I suddenly understood why all these people, who I labeled as “non-compliant” each time the ER would bring them up for readmission upon readmission.
It wasn’t that they didn’t want to listen to the advice of their doctors. No, it was more complicated than that. I witnessed my patients opting to go without medicine so they could pay their light bill, or feed their kids. I left hospice after several years, and ventured back into acute care. This time, I wanted to be able to use that knowledge and make a big difference, so I went into emergency medicine.
Now, if that wasn’t jumping out of the pot into the frying pan, I don’t know what is. In all seriousness, I think that my community experience made me a more compassionate and caring ER nurse (and there’s a huge need for that these days). Not only could I perform CPR and run a trauma like it was going out of style, I could also assess what the patient’s barriers may be or what resources they could benefit from just from having my simple bedside small talk with them as I started their IVs and drew their labs.
Case management can prove to be a double-edged sword. I must admit, there are some pretty amazing pros when functioning in this role. The role of a case manager carries based on the area of specialty throughout the healthcare system, which offers a great deal of variety and job security. Case managers collaborate, assess, plan, facilitate, coordinate care, evaluate, and advocate for various options and services to meet an individual and family’s comprehensive health needs through communication and available resources to promote quality cost-effective outcomes (Case Management Society of America (CMSA). Case Managers often tackle complex patient conundrums, and this makes them a valued part of the interdisciplinary team. One of the unique roles of the Case Manager is being able to create individualized, patient-centered care plans. I like to think that case managers are the backbone of the care team.
Because Case Managers are an integral part of the healthcare team, there are opportunities all over for career growth. Case managers can work in hospitals, private practices, health departments, community health, long-term care, for insurance companies, law firms, remotely from home and for state and federally ran programs (like Sickle cell or HIV). They can also work with patients from all across the age continuum. If you know the Case Management Model, then it’s not too challenging to case manage in any setting. Case Managers are great navigators, it’s merely a matter of knowing how to utilize resources. Case managers also are more likely to have more flexible work hours, as well as have weekends and holidays off, unless they work in the inpatient setting, and well, that’s the nature of the beast.
Another advantage of being a case manager is the pay. According to the 2012 ADVANCE for Nurses Salary Survey, the national average salary range for a case manager was $59,410 to $71,652 annually. Salary does appear to be dependent upon geographic regions, with nurses living in the northeast bringing in the highest salary. The U.S. Bureau of Labor Statistics reports the national average for a Registered Nurse as of 2011 was $69,110.
Now, I must admit that there are some cons to being a case manager. These may be different in the various fields, but I know that one common frustration between case managers if the failure of the “system”. I don’t mean politically, but in general, it has more to do with witnessing the adversity that people face. I work with high risk Medicaid recipients, and I am sure my frustrations may be a lot different than that of a Workman’s compensation case manager. Neither has a tougher job than the other, but we face that system failure all the same. It’s the failure of being to allocate resources even when there is systems set in place to prevent such hardships. In many ways, a nurse case manager functions very much like a social worker. In the face of healthcare reform, I worry that things will get some complicated that it will no longer be rewarding. So, in a nutshell, being a case manager can feel very defeating most days, and also frustrating. Case managers must balance the ability to remain professional and grounded, while assisting in cases that they may find emotionally taxing. Case management can lead to compassion fatigue if self-care is not practiced.
Case management nurses are responsible for coordinating care and navigating patients through the healthcare system, with the goal of developing a treatment plan designed to promote the patient’s health so they remain stable enough to stay out of the hospital. A case manager is typically assigned to a target group of patients, such as those with cancer or HIV/AIDS, or to a specific age group like neonates or postpartum women. While Case Managers do not provide direct hands on care, they do function as an imperative piece of the care continuum. Not only does a case manager assist with navigating the healthcare system, they also work to make financial systems work more effectively. This stems from the piece of the Case Management model in which Case Managers ensure patients receive quality care while being mindful of the costs and resource allocations. This type of skill set highly differs than those who work at the bedside. Case management is highly community centric, as described in my reflection earlier, there are aspects of our patient’s lives that exist far beyond the four walls of the hospital.
In order to be a Case Manager, you will need an active RN license, which is required in all states. The NCLEX-RN exam must be successfully completed with an associate degree, bachelor’s degree or nursing diploma. Many employers prefer Case Managers that have earned a bachelor’s degree, but those with an associate degree can certainly work in this field once experience is comparable.
A qualified candidate would have approximately 3-5 years of clinical background in order to understand both the medical and the psychosocial issues that accompany chronic illness and injuries. Oral and written communication skills are essential to communicate effectively with other healthcare professionals, patients, and their families. Other skills that are needed are the ability to problem-solve and to be proficient in conflict resolution skills. Computer skills, organizational skills, and the ability to do research are also important to effective case management.
The Commission for Case Management Certification is an organization that provides eligible nurse case managers with adequate clinical experience an opportunity to become board-certified case managers across the spectrum of health and human services.
Once a Registered Nurse preps and passes the Certified Case Manager (CCM®) examination, board-certified case managers then demonstrate they have the expertise, knowledge and professional experience to provide case management services. As with most specialty certifications, a minimum amount of continuing education hours must be maintained annually in addition to those required by the nurse’s state board of nursing, though not all states currently have a continuing education requirements to maintain licensure.
Now is an exciting time in Case Management. Due to the Affordable Care Act, the need for experienced case managers is higher than ever. With Case Management being one of the fastest growing areas in the nursing profession, nurses have a multitude of possibilities in the next steps on their career pathway. Some other perks to travel nursing in general include:
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By Jennifer Petrea, RN
Jennifer Petrea is a Registered Nurse from Concord, with clinical experience that includes critical care, ER, trauma, hospice & palliative care and case management. Jennifer is currently pursuing a Master’s Degree in Nursing and certification as a Clinical Nurse Leader. Jennifer also works as a freelance writer for various medical, health and fitness projects. Learn more about Jennifer on Google+