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The Roles and Responsibilities of a Case Management Nurse
Introduction
Case management is a joint process that involves case management nurses working collaboratively with communities, and a vast array of medical and non-medical experts. Case managers promote quality health care both in hospitals and in communities. Occasionally, case managers work closely with community-based agents to deliver care services to clients who need extended care outside the hospitals (McCullough, 2009). Nurses working in case management are unique in the way they create rapport through effective communication. Thus, this commitment defines their roles and responsibilities towards meeting complex patient needs (Fero, Herrick, & Hu, 2011). These roles are as discussed below.
Coordinating Services
The primary goal of a case management nurse is to coordinate services and support an individual to live healthy in the community. In the context of a hospital, a case manager assists patients to access benefits and services available within and outside the hospital premises (Fero, Herrick, & Hu, 2011). A case manager coordinates all activities from assessment through to recovery by establishing areas of need to develop a treatment procedure jointly with the patient. A case manager coordinates doctors appointments and liaises with insurance companies for the best treatment plan in a cost-friendly way (Fero, Herrick, & Hu, 2011). Since case management might be a long-term process, nurses may be required to engage with the patient at optimal periods to ensure that they stay healthy even when they are out of the hospital. In this light, a case manager works hand in hand with individuals or groups of patients. S/he coordinates research to identify the latest treatment and procedures to the patients needs (Fero, Herrick, & Hu, 2011).
Patient Monitoring
Illness management and relapse prevention are very fundamental to patients, particularly those who experience a recurring trend of discharge and readmission. Therefore, monitoring of patients becomes crucial when determining the treatment process for a certain patient and ensuring that referrals to treatment services are appropriate (McCullough, 2009). Case managers have the responsibility to stay close, monitor the quality of care for their patients, and progress towards recovery (McCullough, 2009). It is through monitoring that a case manager can link benefits to patients in line with their needs. Monitoring facilitates the coordination of services at the optimal time possible (McCullough, 2009). Monitoring also helps to assess patients for home-based care and ease client consultations. Case managers also make follow-ups in the community upon patients discharge from the hospital (McCullough, 2009).
Planning
Planning is essential to avoid duplication or omission of a task. Case managers have the mandate to plan for care delivery, generate effective models for care implementation, and ensure they keep monitoring the clients progress (Woodward & Rice, 2015). Case managers collaboratively with the patient develop an inclusive care model that incorporates short and long-term objectives based on reaching and sustaining desirable health outcomes (Woodward & Rice, 2015). Planning should offer assertive guidelines that direct the follow-up of a treatment and ensure flexibility to accommodate changes deemed necessary during the healing process (Woodward & Rice, 2015).
Foster Communication
The case manager acts as an intermediary between the patient and the care providers. All stakeholders in the health sector harmonize for a common goal through communication (Rhonda, 2014). Case managers serve as the mouthpiece of the patient since s/he has the best understanding and relationship with the patient. Thus, s/he is a fundamental source of information for all stakeholders (Rhonda, 2014). The expectations are that the case manager should mobilize all experts needed, feed them with preliminary information, make consultations and uphold warm communications (Rhonda, 2014). The case manager oversees the healing process and links the whole system from a central position rather than from the top through communication. The case manager achieves such progress through effective communication and problem-solving techniques (Rhonda, 2014).
Provide Health Education
A case manager has the responsibility to establish rapport with the client to identify his/her educational needs. Consequently, case management plans the way forward with the consent of the patient or his/her family (Rhonda, 2014). A case manager seeks to ensure progress and reduced cases of relapse by providing health education and training to the client. Education and training help pass the information needed to sensitize communities on various health issues that affect them (Rhonda, 2014). Such issues include self-medication, medicine, and appointment adherence. Case managers also facilitate education across the multidisciplinary team thus fostering relations among the medical and the non-medical professionals involved in the clinical pathway plan (Rhonda, 2014).
Evaluating and Updating
Case managers often conduct an evaluation and update the patient care model following their health conditions. Evaluation provides new insights concerning the status of the client and helps develop an appropriate intervention approach towards positive health outcomes. Case managers also conduct evaluations with team members to ensure that they weigh to the standards, ethics, and morals expected within the scope of work (McCullough, 2009).
Conclusion
From this perspective, it is evident that case managers offer a vast array of benefits both to the institution and to the client. Case management helps nurses realize their roles and responsibilities by giving them the chance to exploit their expertise and potential. Thus, this delivery model is fundamental to promoting the roles and abilities of nurses.
References
Fero, L. J., Herrick, C. A., & Hu, J. (2011). Introduction to Care Coordination and Nursing Management. Sudbury, MA: Jones & Bartlett Learning.
McCullough, L. (2009). The Case Manager: An Essential Link in Quality Care. Creative Nursing, 15 (3), 124-126. Web.
Rhonda, A. M. (2014). New Roles and Shifting Priorities for Nurses. Frontiers of Health Services Management, 31 (2), 39-44.
Woodward, J., & Rice, E. (2015). Case Management. Transformational Tool Kit for Front Line Nurses, Nursing Clinics of North America, 50 (1), 109-121.
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