It’s difficult to overstate the critical importance of nurse case managers. They oversee virtually every aspect of a patient’s care from admission to discharge. They are the principal contact for patients and their families when addressing immediate and intermediate needs.
A patient’s short- and long-term treatment options are almost always orchestrated by a dedicated nurse case manager.
And throughout the COVID-19 pandemic, case managers have assumed even greater, more visible roles as hospitals and healthcare facilities have struggled to navigate unfamiliar terrain. They’ve been integral in ensuring that extant procedures function as intended, and new protocols are adhered to and address the needs of large, diverse patient groups.
By now, the hurdles that healthcare workers in virtually every setting faced at the onset of the pandemic are well-documented. Nurse case managers were certainly no exception.
For many case managers, “It was baptism by fire,” said Catherine M. Mullahy, BS, RN, CRRN, CCM, FCM, President of Mullahy & Associates, which provides case management continuing education, certification preparation, training, and support. “Everybody was pressured to do more with less and work in extremely tense environments with so many negatives swirling around every decision,” she added. Mullahy, along with Jeanne Boling, RN, MSN, CRRN, CDMS, CCM, FCM, Vice President of Mullahy & Associates, is also the creator and instructor for Nurse.com’s Best in Class Online Case Management Course.
Though it’s true that many case managers are also nurses, not every component of nurses’ extensive skillsets necessarily translate to the demands that case managers must meet.
This was certainly the case during the height of the pandemic.
Nursing vs. Case Management
According to Mullahy, many case managers new to the role aren’t necessarily aware of the pronounced differences between the responsibilities and challenges entailed and how these differ from day-to-day nursing.
“Some of the skills you need as a case manager transition from nursing, but many of them do not. Many nurses don’t have to do the kind of complex care planning associated with case management. Nurses are at the bedside, and they see that patient while they’re in their unit — and once the patient goes home, that’s it. But case management done correctly should consist of ongoing Involvement with that patient as they transition within the hospital and beyond.”
COVID-19 expanded the need for this kind of continuous attachment to the patient. And more case managers were called for to fill that gap.
Demand for skilled case managers skyrocketed during the height of the pandemic. There were greater numbers of sick patients with disparate needs being discharged into an array of settings.
It was up to case managers to organize and orchestrate these movements — all while keeping patients and their families (not to mention insurance companies) apprised at every turn.
“Many case managers had never done this before — they were used to primarily moving patients to their homes,” Mullahy acknowledged. “But now, there were many ventilator-dependent patients, for example, who had to be placed in facilities that the case managers were unfamiliar with and in many cases didn’t even know where these facilities were located.”
This illustrates the kinds of obstacles unique to case managers, even under the best of circumstances. The burnout and frequent uncertainty regarding patients’ status significantly contributes to attrition within case management, a problem clearly exacerbated by the pandemic.
Mullahy admits that turnover among case managers has been an issue for some time, a problem certainly not helped by the myriad stressors brought by the pandemic.
“Many case managers had unmanageable caseloads before the pandemic hit, and they carry a lot of guilt,” she explained. “They’re working 12-hour days and then going home worrying about whether or not the home health agency showed up when they were supposed to or if the infusion antibiotics arrived. Making sure their patients are adhering to their treatment plans, communicating with patients and their families, and keeping other members of the patient’s medical team informed requires a great deal of focus, organizational skills and detailed reporting which can be extremely challenging at times.”
To be sure, all nurses are relentlessly dedicated to their patients’ wellness. But nurses work on teams in which each person is committed to working in tandem to achieve the best outcomes for those in their care.
The circumstances Mullahy lays out illustrate the kind of persistent obligation that case managers feel, without the support of team members to help them with each patient in their charge.
“Nurses working in the unit know that when they leave, there will be someone coming in right behind them to see to their patient,” Mullahy explains. “Case managers on the other hand — when they’re discharging a patient, they’re solely responsible for them, and they’re left wondering what’s happening. ‘How is the family coping? Is someone making sure they’re taking their medication?’ It’s a very different, emotionally challenging role.”
Proper training is vital to helping nurses interested in transitioning to nurse case management and preparing them to bear the unique stressors and nuances associated with the role.
Nurse Case Management Training
The Bureau of Labor cites case management as one of the fastest-growing occupations in the U.S., even before the pandemic. With this upward trend, the need for training has grown along with the role itself.
In addition to a solid clinical background and experience, effective training is key to learning the particulars of things not commonly associated with standard nursing responsibilities, like community resources, payer systems, and how to best help patients across the entire spectrum of care.
Mullahy notes that though case management had to adjust to meet the pandemic’s demands, the core components of the role have remained largely unchained, and the training that Mullahy champions is specially designed to teach those skills.
“The essential components of case management have not really changed in all the years we’ve been doing this,” she acknowledges. “There are certainly little tweaks here and there, and new healthcare system related developments such as utilizing new technologies, contributing to population health management data capture, as well as changing demographics and rising incidences in certain medical conditions. But things like how you assess planning and coordinating, how you evaluate a plan then demonstrate and measure the outcomes — those things have never changed. And proper training will give you the knowledge and skills you need to do these things well and feel comfortable in an interview and get yourself a job within case management.”
Take these courses to learn more about case management:
Case Management Basics
(5.0 contact hours)
Case management is an area of practice that offers nurses an opportunity to build on their clinical knowledge, as well as their communication and nursing process skills to function in an expanded and more autonomous role than direct patient care. Nurses add value as case managers because of their knowledge of both acute and chronic clinical conditions, evidence-based treatments and therapies, organizational skills, and team leadership. This course explains the case management process, philosophy and guiding principles, competencies, practice standards, knowledge, and skills that are necessary as an effective and efficient case manager in a variety of settings across the continuum of care. This course also presents information about legislative impacts and insurance coverage influences that affect the practice of case management.
Team-Based Healthcare Improves Patient Outcomes
(0.5 contact hours)
Team-based healthcare is provided by two or more people who represent different professions with the common goal of improving the well-being of a patient. Outcomes such as relief of pain, improved access to healthcare services, early recognition of treatment failure, or other scenarios may be improved with interprofessional collaboration. The delivery of effective team-based, patient-centered care should be tailored to the population served and needs of those individuals. This module serves to outline the components of team-based care and examples of this care in different settings.