Case managers are a difficult group to describe. We take on roles like a chameleon; ever-changing to meet the needs that are as complex as the populations we serve. Our role is often misunderstood, or even invisible to the professionals that rely on the work that we do. Our efforts are understated, yet incredibly important in assisting those that would be lost through the cracks.

I have often tried explaining what I do as a case manager but my descriptions never seem to do the profession justice. Our role is sometimes difficult to conceptualize because it falls into so many different categories and overlaps with multiple other professions. Most people I speak to are vaguely aware of the term but most are unaware of what a case manager does. Sometimes people will ask me if I am still a nurse. I’m not at the bedside dressing wounds or administering medications. I work at a computer and some days I stay in my pajamas all day, with Kitty slippers and all. Despite this, I am still a nurse. To be precise I am a nurse case manager. I am using my skills and working under a license just as I did before, only the work that I perform now is strictly mental and knowledge-based rather than procedural. I am using my experience and expertise to make sure that my clients are getting appropriate care, that they are taking the right steps to care for themselves, and that they know what to do when things fall apart. Of course, not all case managers are nurses. We are social workers and mental health specialists, among many other professions.

We work at clinics, hospitals, and offices and some do visit clients in their homes. One thing that we all have in common is that we are first and foremost advocates for the individuals we serve. We meet our clients where they are and connect them to where they need to be. This is not always an easy task and few understand the nuances and complexities of what we do. Our work can be frustrating and it sometimes leaves us feeling like we are spinning in circles. Despite this, we keep moving forward. If nothing else, case managers are patient and empathetic people. Our work draws us toward society’s most vulnerable. We hold a safe space for these individuals so that they can let us know what they need without fear or inhibition. Once they are open to accepting help a case manager can do what they do best, connect them to the care and services they need.

I believe most case managers share a set of qualities that make us well-suited to the work that we do. Case managers are problem solvers and have an innate sense of curiosity. We will research tirelessly to find resources and think of new ways to help our clients. If we don’t know the solution to a problem, then you can bet we will do all that we can to find it. We love to share our knowledge with anyone that would benefit. All case managers are educators. As a nurse, I teach my patients about their disease process, and how to manage their condition, and I teach them how to navigate healthcare and social systems to get the help that they need. Case managers also educate each other. Most are a wealth of knowledge and many of us have a running database in our mind of the local resources and how these can be linked to any given client in need.

Case managers are collaborators. Never in my life have I worked with a group of nurses so ready to step in and share their knowledge to help solve a problem. Our most seasoned case managers readily share what they have learned over the years yet remain open to the new ideas and concepts that come from a fresh perspective. Case managers are creatives. We spend an enormous amount of mental energy trying to come up with solutions to increasingly complex problems. There is no road map for case management and though each of us might inevitably take a different path, our goal remains the same, helping our clients get the support that they need. We are strong listeners and communicators. Though not all case managers are mental health specialists, all of us deal with the mental health of our clients at every interaction. We can recognize loneliness, anxiety and grief in our clients without them putting

these emotions into words. Our clients feel supported by us and often share things that are deeply personal. We communicate our client’s needs across a continuum of care, involving other specialists and professionals that can help.

While our client is always at the center of what we do we understand the limitations of the systems that we work in. Case managers are pragmatists. We are monitoring for efficiencies and striving for the most direct route to care. We are constantly evaluating costs, not just monetary, but also the cost of frustration, time, and mental energy. We understand that what is saved on one client can be used to help another and that our efficiencies in case management make room for our work to grow. Although my patients have never met me in person, they recognize the work that I do. I have connected them to care when they’ve felt lost. I’ve provided education when they thought they had nothing more to learn. I’ve found gaps in their care and needs that sometimes even they were not aware of. The rewards of case management are immeasurable. Some days are incredibly challenging, but our small victories keep us going. As case managers, we step in and make a difference. After all, case managers are the glue and duct tape holding it all together.

My name is Lilly Flatgard. RN, BSN I live in Spokane, Washington. I have been a nurse for 6 years and will be testing for my CCM certification this winter.