Ever since I started my Nursing career here in the United States almost ten years ago, I have always been fascinated and drawn to the world of Case Management. When I first heard of the word “Case Management,” I was already a Registered Nurse who had worked in various clinical and bedside areas in two different countries including my home country of the Philippines. In those two countries I have worked, the nurses’ function is mainly more on the bedside area and unless you pursue academic or managerial positions, there are hardly any career options for RNs but to stay in the bedside.
As I was laying the foundation and experience of my nursing career here in California, one friend who is an RN mentioned to me to try my hand at Case Management. At first, I was a little reluctant to step out of direct patient care as ever since I became an RN that is all I have ever known, to treat the patient directly inside the clinic or hospital. She said Case Managers provide members with care that can go beyond the four walls of a hospital. She mentioned that even after patients are discharged, I can still provide great service after their hospitalization or clinical visit. And those words piqued my interest. Looking back, I sure can say and agree that she is absolutely correct.
Some aspects of my love for Case Management start with the patient interaction itself. Case Management provides health advocacy, patient education, designation of needed and appropriate resources, and most importantly health education. Should a client need coordination or services, help in planning for future appointments, making informed decisions regarding their health care, assistance in accessing supplies needed for their health, guidance in communicating with their providers and doctors in making informed decisions, then Case Management is a much-needed service. How many times does the helping hand of a Case Manager will be needed when a member was discharged from the hospital, or and when the Case Manager reaches out to the client and the client was not able to obtain a referral to the specialist? Or probably when a client is newly diagnosed with a life-changing condition and is uncertain what resources are available in his community? Or what about a time that a client is having a dual diagnosis of a behavioral health condition, at the same time has other medical comorbidities, and needs the coordination of care and services? This patient interaction is indeed beneficial and essential.
In between provider visits, Case Management can provide ongoing support for the member. The majority of the clients that Case Management services are needed have needs that are often complex and intertwined. My love for Case Management is rooted in the desire to help these members with complex care needs. These members require help determining which among a variety of services they need, when, and in what order. They require assistance finding and accessing those services, and support to successfully complete those services. In Case Management, it is not only the client that the Case Manager is dealing with but the entire family, provider, employer, school, or even the community. Without case management, interventions are often uncoordinated and scarce resources squandered.
One thing also why I love Case Management is wherein I get to interact not only with the client or member but also with the family and caregivers of the member. Case Management assesses the needs of the client, and often the family is involved to assist the client to establish goals in several life areas. Case Management provides direction as these clients navigate the hospital, school, workplace, or community, and other agencies that will be part of their lives for a while or permanently. It is an interdisciplinary approach. Case Management is an integral part of health care. It is an interdisciplinary approach and utilizes resources that can benefit the individual, family, and community. Providing clients and families with information can improve lives. Effective case management is similar to the nursing process. Assessment of strengths and needs by the case manager and family members, working in partnership, will help to identify existing strengths on which the family can build and needs that should be addressed. Stratifying risk, planning, implementing, following up, transitioning, post-transitioning communication, and evaluating outcomes are the core process of case management to help the client reach his or her maximum potential and level of functioning. For nurses, case management is characterized by advocacy, communication, and resource management and promotes quality and cost-effective interventions and outcomes.
There are times that some members need advocacy and needing a voice to assist them in informed and shared decision-making with regards to their health. As a patient advocate, this is one area of Case Management that I truly value. Vulnerable clients may need medicine or other types of assistance. Pediatric clients with vision problems might use special applications, tablets, or computers to read as well as pediatric clients with hearing or speech problems would have special needs, too. Case managers are the ones who can help the patients in achieving an optimal level of wellness and function by facilitating timely and appropriate health care services and promoting clinical care that is consistent to standards of care and with the patient and family in mind.
The commitment to serve clients is also an aspect of both nursing and Case Management that is truly instilled from altruism. Effective case management strives to support and enhance the strength of the patient and the entire family with respect, professional support, and compassion. Bridging the gap between hospital-based care and homecare as well as helping patients who are transitioning from home to the community is essential in ensuring that the client is utilizing all the resources available. Case Management offers a significant role in becoming messengers, liaisons, and advocates of the patient and family and are the informants of providers, hospitals, home care, clinics, and the community. Case Managers are highly skilled clinicians with extensive backgrounds and treat the patient in his or her totality. Utilizing critical thinking and problem-solving, and a vast array of clinical knowledge and skills to effectively manage the care of an individual especially a client is how case managers work.
Most importantly, I love Case Management because I get to make a positive effect on a person’s life in a different way. Though it may not be directly taking care of the client, I still feel that the mere fact that the client knows that I am here, ready to guide them, to help them to resources no matter how big or small, to bridge gaps in care, and even something as simple as coordinating care, then I know I have made a difference.
Guest post from Rose Marie Alessandra C Conos, MSHS, BSN, RN, CCM, CMCN, submitted as part of our “Why I Love Case Management” and selected as one of our Honorary Mention Winners!
Rose Marie Alessandra Conos from California. Been an RN for 15 years, practiced nursing in 2 different countries prior to working in the US. Board-Certified Case Manager and Managed Care Nursing, with a Masters’s in Health Sciences major in Public Health.