Nurse case managers have become an important part of the healthcare system in America. According to one report, there are more than 112,000 currently working in the country, and although we do not have employment projections for them, we can expect that more and more trained nurses will join the profession in the coming decade.
The American healthcare system has long emphasized the use of preventive medicine to keep the population healthy, improve outcomes and keep costs down.
Over the years, it was determined that this approach was not producing the desired effects. As a result, we now have patient-centered care that aims to improve patient outcomes and cut costs for everyone involved, from the patient to the hospital to the federal government.
As these changes have been implemented, the role of the nurse case manager has grown. Many healthcare facilities now rely on them to liaise between different entities within the system.
What is a nurse case manager?
A nurse case manager is a highly educated registered nurse (RN) who leverages their medical skills, business and management knowledge, and interpersonal skills to meet patient healthcare needs. They do this while helping healthcare institutions better manage some processes so that they can keep costs down.
These professionals work as part of a team to coordinate and assess the long-term needs of patients, undertake and complete assessments and update care plans. They are involved right from the moment the patient is admitted into the hospital until they are discharged, and many do follow-ups to ensure that the patient is healing as they should after they leave the hospital.
The role of the nurse case manager was born out of the need to manage the patient care process. Over the years, the industry realized that by better managing the process, costs are kept under control and patients report better outcomes and higher satisfaction with their treatment.
Unlike an ordinary RN, the nurse case manager has a broad role that falls beyond treatment and care. They are advocates for the patient regarding all aspects of treatment, and their mandate is to ensure that patients are happy with the care that they receive. In the process, they help the healthcare facility save money.
Most employers are keen to hire nurse case managers who have some form of higher education training, like a Bachelor of Science in Nursing (BSN). A BSN imparts knowledge on patient care but also teaches students business and management.
This is one of the benefits of BSN-prepared nurses. Apart from having the necessary skills to provide high-level patient diagnoses, treatment and care, they also understand the business side of healthcare, which is why they can function as case managers. Students can enroll in an accelerated BSN program at Wilkes University where they cover courses like the physical assessment of patients of all ages, pharmacotherapeutics and decision making in nursing practice.
To qualify, they must have a bachelor’s degree with a 3.0 GPA or higher, letters of recommendation and a statement of professional goals. Requirements may differ from one university to the next, but all of them require that applicants have a bachelor’s degree.
Along with their classroom courses, BSN students will also undertake practical training through a clinical placement program. Working in a healthcare facility exposes them to real patients with real illnesses, and they understand the complexities of working in different departments within the facility.
Those keen to become a case manager should specialize in business courses during their program. They should also take some time to understand the role of the nurse case manager within the hospital, especially on the business front.
How do nurse case managers help patients deal with the treatment process?
Before we get into specifics, it is important to note that the roles that we will discuss here are not written in stone. They can vary depending on where the case manager works, who they work with, and the overall goals of their job
However, there are certain things that most nurse case managers are expected to do:
Explain patient care plans to patients and their families
These nurses usually work with chronically ill patients, such as those with Alzheimer’s, heart disease, diabetes and cancer. When these patients check into the hospital they are assessed by a team of medical professionals and a care program is created for them based on their own unique needs.
The nurse manager’s role is to explain the care program to the patient, and their family or caregiver. They talk about the illness and what steps the team will take to cure it or keep it under control, the medications and procedures that will be administered as well as the day-to-day care that the patient can expect.
It is the job of the nurse case manager to field all questions from the patient and the family or caregiver and to give comprehensive answers that help clarify the situation.
Help patients understand their health coverage plans
Insurance plans can be quite confusing for the average patient, and many do not understand what is covered and what is not. The nurse case manager takes the time to study each patient’s health plan so that they can explain it to them, letting them know how far it will go and what they are entitled to.
If a patient does not have a comprehensive health plan that covers most of their care, the nurse case manager can explore options that make treatment more affordable and discuss them with the patient to see if they are acceptable.
Help patients get their payments processed
For patients who are chronically ill, it can be a chore to follow up with the insurance company to get compensation or get their bills processed. The care nurse takes over this role to make sure that everything is processed quickly and accurately.
Schedule appointments and ensure that patients show up for assessment
Nurse case managers follow closely to make sure that patients see the doctor when they should. They schedule each appointment and call patients in advance to make sure that they attend. You may wonder why this falls under the case manager’s purview. This is because missed appointments place an extra burden on the system.
Often, patients who miss appointments deteriorate and cost more to treat. Because it is the job of the nurse manager to keep treatment costs down, it is their job to ensure that chronically ill patients turn up for examinations and assessments.
Interview patients to find out their histories, needs and existing support networks
Nurse case managers collect this information on behalf of the treatment team so that they can create well-informed care plans. They will talk to the patient not just about their illness but also their general family health history to determine if there is a predisposition to the illness.
They also talk to patients about the care that they have received so far, where they received it, and what sort of progress they have made. Nurse case managers will discuss caregivers, what they have done for the patient, and what plans are in place for them to continue to provide care.
All this information is necessary when creating tailored treatment plans, and the nurse liaises between the patient and the team to help create as comprehensive a plan as possible.
Educate patients and families on health-related issues for better homecare
The patient will have the best outcome if their family or caregiver knows exactly what to do, when, and why they are doing it. The nurse case manager takes time to discuss specific health matters such as diet, hygiene and exercise so that caregivers understand what they need to do for their loved one after they are discharged from the hospital.
They are available to answer all questions and sometimes will even perform physical demonstrations to show caregivers the best way to take care of the patient.
Help prepare patients to resume a normal life
When a patient approaches discharge they can be quite confused about how they ought to resume their normal lives, especially if they have been in the hospital for a long time. The nurse case manager works with them to make sure that they are prepared, both physically and mentally, to go back home.
They connect them with physical therapists to help them regain their strength, and counselors where they are needed. They can also guide them to care options if they need a caregiver after they get home.
Help patients prepare to go back to work
It can be tough to go back to work after a long convalescence, and the nurse case manager works with patients so that they can be physically and mentally prepared. If they need special exemptions, the case manager can prepare documentation that the patient will present to the employer.
They talk to the patient about what they can and cannot do, and how they can ease themselves back into work slowly to avoid injuring themselves.
If the patient is facing psychological obstacles, the nurse connects them with a therapist or counselor who discusses the difficulties they are facing and offers them coping strategies.
Keep track of patient outcomes and suggest changes where necessary
Not all treatments work as they are supposed to, and it is the job of the nurse case manager to make sure that patients are healing as they should. They conduct regular assessments and talk to patients about their progress and their overall feelings about the treatment they have received.
If the care plan that was prepared for them is not working, the nurse should suggest alternative treatments to the team that will give better results and leave the patient feeling more positive.
Monitor patients for symptoms
If a patient deteriorates in any way, the nurse case manager should be able to spot the change, perform the necessary diagnostics, and inform the rest of the team so that they can suggest the best treatments.
Changes in the patient’s condition can be observed, or the patient can talk to the case manager or carer about a new symptom that they are experiencing. The nurse case manager should be prepared to listen, and they should carry out exhaustive diagnostics to determine the problem.
Provide home support
If patients do not get adequate care after they are discharged, they will soon be back in the hospital because their condition has deteriorated. This places an additional burden on all who are concerned, so it is the job of the nurse case manager to make sure that patients get proper care once they leave the hospital.
They can put the patient in touch with a social worker or other caregiver who is available to look after them every day, and they may pay a visit from time to time to make sure that they are getting optimal care and support.
Update patient records
The nurse case manager is tasked with making sure that patient records are up to date for the care team, the caregiver, and the patient. These records are captured in the hospital system so that they are available to healthcare providers in the future.
How difficult is the work of a nurse case manager?
As you can see from the above roles of nurse case managers, these are busy professionals, but it may not be right to say that they are busier than other nurses. Their responsibilities are different, but they work just as hard as a regular nurse.
It is therefore important that these professionals take good care of themselves. They should strive to eat healthy, balanced meals, rest between shifts, and take time off from work regularly to recuperate. They should also exercise regularly if they are to have the kind of stamina that is necessary for their work.
Nurse case managers should also take care of their mental health, seek ways to decompress, and talk to mental health professionals when necessary.
The role of a nurse case manager is an ideal one for anyone who has a background in nursing and understands the healthcare business. These professionals provide much-needed support to patients and help healthcare facilities control treatment and care costs.