Registered Nurse Essay

Nursing Case Management
Kelly Leann B. Richard University of North Carolina at Greensboro
NUR 541

I have abided by the Academic Integrity Policy on this assignment
In partial fulfillment toward the MSN degree
Leann B. Richard 11/ 7/11

Abstract
Case Management has a rich history that has evolved over time to meet the needs of patients, attempt to control rising healthcare costs, and provide high quality care. Multiple roles, responsibilities, and skills are required to be successful in this position. Some of the roles of the case manager are communicator, educator, and patient advocate. Collaborating with other team members and healthcare entities is essential for case managers. Models that are classified as “Within the walls” and “Beyond the walls” help to determine the case manager’s roles, population, and where the care falls on the healthcare continuum. Skills and knowledge of the marketing process allows the nurse case manager to venture out as a consultant, entrepreneur or intrpreneur. Case management has shown great strides over the years. Case management’s ability to reduce cost, improve healthcare quality and improve patient satisfaction will enhance its credibility and growth.

Nursing Case Management The term nursing case management is fairly new to healthcare, but the actual role and job has been around since the 1800’s. The title is misleading because the resources and services are actually what are being managed (Fero, L. J., Herrick, C. A. & Hu, J., 2011). Organizing and arranging patient care is a daunting task. The role of the case manager encompasses several jobs and skills sets. This role has evolved significantly since its beginnings in the 1800’s. A small percentage of patients with chronic conditions use the largest portion of the resources and account for the largest costs (Howell, S., Coory, M., Marting, J., & Duckett, S., 2009). The goal of case management however has remained constant, coordinating patient care while minimizing cost and maximizing quality health care across the healthcare continuum. Managed Care The evolution of Managed Care and Case Management is due to several historical events. The Industrial Revolution in the 1800’s brought large populations of immigrants into American cities. This is an issue that the United States struggles with even today. Kullgren (2003) identifies concerns of undocumented immigrant populations in today’s society as adding risk to the general population, depleting resources, adding to healthcare costs and lack of health insurance (Carr, D.D., 2006). With any population explosion comes the need to reorganize and manage healthcare resources. The process of case management can be traced back to the 1860’s when the population of the United States grew and created fragmentation and duplication of health services (Kersbergen, A. L., 1996). The 1900’s were times of great turmoil. Men returning from the wars in the 1900’s often had many physical and mental health issues (Fero et al., 2011). Brown (1944) stated that wartime psychiatrists and nurses provided education to lay people about “personality wounds” and validated that they were as significant as physical wounds (Silverstein, C.M., 2008). The establishment of Veterans Administration healthcare centers all over the country created a desperate need for case management programs (Fero et al.). These programs helped coordinate services and prevented duplication during this time of healing In the turn of the century Verheijde (2006) noted that medical waste and economic pressure were large contributors for the evolution of managed care and case management (Fero et al., 2011). The identification of fraudulent claims to Medicare and Medicaid became a motivating factory to maintain high standards of care, validate skills by obtaining certification and tracking tools to insure compliance. These healthcare mandates changed the healthcare perspective from process

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