As I meet colleagues working in case management, clear themes emerge as to how or why we found our way to working in this specialized area of practice. The common reasons include wanting more consistent work hours to meet family demand, needing a less physically demanding job, burnout in rendering direct patient care, taking a career direction that veered more toward administration than clinical, wanting to make a more significant impact in health care, and the list goes on. But for some, working in case management can best be seen as an honest-to-goodness calling. We found our niche and continuously strive to reach the best outcome in situations that caused others to throw their hands up in frustration.
Those of us who carry case loads know the real highs and lows of working with people who are considered to be at-risk and/or high risk. The challenges faced seem insurmountable at times but we do not give up. We love what we do and cannot imagine doing anything else. As we work through each barrier to care with our clients and their care teams, we find a rewarding sense of satisfaction that gives us that reason to do keep on trucking.
As varied as the reasons we had for undertaking a case management career are, so too are the educational paths we took in preparation for our case management jobs. As noted in my Remington Report article, “Currently, there exists significant variation in the educational background of case managers. Nursing and social work are tributaries that feed into the case management river. Their inherent differences contribute to the subsequent disparities seen downstream. In addition, nursing education includes many paths which can lead to registered nurse licensure. The combination of these factors helps explain the current situation” (January, 2011).
We may begin to see some movement in this area of variance over the coming years. The release of the Future of Nursing report in 2010 included four key messages. Key message #2 stated, “Nursing education at all levels needs to provide a better understanding of and experience in care management, quality improvement methods, systems-level change management, and the reconceptualized roles of nurses in a reformed health care system” (Institute of Medicine). Let me restate that in case you didn’t get it the first time… “a better understanding of and experience in case management”. In addition to the above key message, the Institutes of Medicine (IOM) committee also recommended three other key points, which are: nurses practice to the full extent of their education and training, nurses should be full partners, with physicians and other health professionals, in redesigning health care in the United States, and effective workforce planning and policy making require better data collection and an improved information infrastructure (2010).
I believe the variation in education and experience is holding back the progress of case management in its desire to be accepted as a profession. We are missing a unifying focus on which to garner the broad agreement of all key stakeholders. The important messages that need to be heard outside of our ranks seem to be getting lost. The failure to create a focused and broadly accepted message about case management is an issue that needs to be addressed. For professional viability, we have to pull it together or we will ultimately fall short of the goal that we are all so intently trying to accomplish – gaining professional recognition and respect for case management.
So what will it take?
It starts with a sincere dialogue involving pertinent professional organizations, accreditation/certification bodies, academic institutions, and major employers in order to define the basics that will shape the curriculum of case management study at both baccalaureate and graduate degree levels. Each group brings an important perspective to this discussion and we need to coalesce our considerable forces so that,
- professional organizations that have historically defined widely accepted, cross-continuum standards of case management practice continue partnerships with accreditation/certification bodies and agree upon the who, what, where, why, and how of case management
- accreditation and certification bodies respond in kind with open minds and an authentic desire to make the most of these partnerships in creating paths of professional advancement for case managers to follow
- academics collaborate with actual practitioners in order to shape realistic curricula that produces knowledgeable, capable professionals to enter the health care sector workforce, and
- major employers accurately apply job titles, set goal-driven compensation structures, and provide organization-specific training that springboards off of the individual’s existing skill and knowledge base in order to provide optimal benefit to their members/clients.
When each of those things gains some traction, the united front of professional case management will experience the true engagement of state and federal regulators and legislators in establishing protection for case management as a highly desirable health care career path. In the end, we all wish to dedicate our considerable skills and knowledge to the improvement of care coordination, health condition education, client advocacy, and ultimately enhance health care quality.
Institute of Medicine. (2010). The Future of Nursing: Leading Change, Advancing Health. Washington, DC: National Academies Press.
Treiger, T. (2011). Case management: Prospects in definition, education, and settings of practice. Remington Report,19(1), 46-48.