1

Running head: ANALYSIS OF A NURSE CASE MANAGER

Analysis of a Nurse Case Manager Christine Demler NURS 440

2 ANALYSIS OF A NURSE CASE MANAGER Analysis of a Nurse Case Manager Being a Nurse Case Manager is a relatively new position in the health care field. It is a position that has become more and more popular over the last 10-15 years. Case managers are expected to ensure seamless, quality, cost-effective patient care across specialties. (Nalley, 2012) Camille Stuedemann was the first Nurse Case Manager that I have encountered and now I have the privilege of call her my supervisor. Camille graduated from the Bronson Hospital Nursing Program with a diploma in Nursing, not an associates degree. She is also a Certified Nurse Case Manager (CNCM). She has been a case manager for 10 years. We work together for Right Consulting Group, Inc. She has worked there for 4 years. She has been a supervisor for the last calendar year. Camille has many duties to perform as a supervisor. She supervises 8 nurse case managers. The main clients that she deals with are catastrophic accident victims. She performs a wide range of duties. She must collaborate with doctors offices, attorneys, insurance adjusters and many other agencies to assure the patient gets the best care. Job Duties Main duties The main duties that Camille has are managing patient care, taking referrals, assessing new clients, assigning clients to each nurse and doing quality control of all paperwork. Managing patient care has many components. Managing the care of the patient includes arranging all doctors appointments and attending them with the patient, as well as arranging for transportation for clients who dont have the means to get there

3 ANALYSIS OF A NURSE CASE MANAGER themselves (Stuedemann, 2013). Evaluating the doctors care plans for the clients and getting the necessary equipment and/or services to put those care plans into effect. Doing home assessments, assessing the environment and the psychological aspects of the living arrangements, is part of the duties of the nurse case manager. Communicating between the attorneys and the insurance adjusters as well as generally being an advocate for the patient is one of the main duties she performs as a case manager. Miscellaneous Duties Camille has many other duties as well. Some of these duties are based on a case to case need. She helps the homeless clients find shelters and food banks. She helps clients fill out paperwork for Medicaid, Social Security, Social Security Disability, and other government services as another job function however one that is only required in some extreme cases. Other duties include taking complaints from any of the clients about their assigned nurse. When a specific nurse cannot be reached for some reason, Camille is the next person to call. She can answer the question or take a message and pass it on to the nurse once they are available. She has many job functions. Many of those are not needed on a day to day basis. Collaboration Other Organizations Being a supervisor in this instance there are no other departments to collaborate with. In this instance there are only other organizations to work with such as coordinating the doctors offices, labs, transportation, attorneys offices, and insurance

4 ANALYSIS OF A NURSE CASE MANAGER adjusters to all work together to get the patient the best care possible. Im not in a facility setting; I work with facilities to advocate for my clients. (Steudemann, 2013) Having a good working relationship with all of the individual organizations helps to make this collaboration work better for all the parties involved. Co-workers Collaboration between co-workers is taken very seriously. Having nurses spread throughout the state makes it very helpful for them collaborate together. Teleconferences are instrumental in getting everyone to work together and help each other in solving issues. When one nurse needs something from a specific place, Camille can act as a middle-man and direct that nurse to another one who can help them get the information that they need to obtain the services that client requires. Collaboration in this specific job is a must. Managing Legal or Ethical issues Managing legal and ethical issues is a high priority for supervisors. One of the main legal and ethical issues that being a case manager handles is having a client who acts out and breaks the behavioral contract they have signed. When a client is admitted and are non-compliant with the doctor's plan f service, they have to sign a behavior contract between themselves, the nurse case manager and various team members. If they break it then they can be discharged. However, if the client is in a medical crisis they cannot be discharged from the service until they are in a stable condition. Making sure the clients are being cared for properly and not being left in a crisis situation is definitely

5 ANALYSIS OF A NURSE CASE MANAGER one of the ethical issues we deal with all the time. Right now we dont have any ethical or legal issues we are working on but it can happen at any point, Camille stated. Use of Power and Influence Camille uses her influence to help the new nurses in the company. She uses her years of expertise to help any of the nurses that are new to case management to become accustomed to their roles. Coaching nurses to improve their performances is an exercise of power, (Yoder-Wise, 2011). She also has a sizable number of contacts she has developed through networking over the years and can draw on this to help the new nurses as their mentor or coach. The coach uses expert, position, perceived, and information power to influence the orientee not only at that moment but also perhaps over the span of a career, (Yoder-Wise, 2011). With the knowledge she has gained over the years that she has been a case manager, she is the most knowledgeable resource a new nurse can ask for. Decision-Making and Problem Solving As a supervisor, strong decision-making skills and problem solving skills are a necessity. When we have issues with our clients that an individual cannot solve, we have a teleconference and get everyone involved to brainstorm how we are going to fix this issue (Stuedemann, 2013). Assure all the information that is typed into the electronic medical record (EMR), is correct and compliant with the Federal laws helps when training the new nurses on how to use the EMR. Helping to create a training program for the new nurses to learn the EMR, Camille had to know which documents

6 ANALYSIS OF A NURSE CASE MANAGER were needed by the doctor's offices, hospitals, attorneys offices and which were needed by the insurance companies. Knowing the difference in forms each needed, helps to reduce problems when trying to get the client the care that they need. Management and Resolution of Conflict Being as this is not a facility, the management structure is very different. There is only the CEO, then Camille and then the nurses she supervises. Conflicts that arise are when there is a difficult insurance company not wanting to pay for services, or a difficult client. Camille acts as mediator when conflicts between insurance companies and the attorneys offices arise so that everyone is happy with the ending. When nurses are overloaded it is Camille who steps in and delegates some of the work to others, who have less of a load to help. Camille Stuedemann is my nurse Case Manager Supervisor. She has many years of experience as well as a great number of contacts in the health care field. She has a very diverse job, with many different types of duties to perform. In addition to normal duties as a case manager she is also the supervisor of 8 nurses and has more duties to perform. Her duties include: managing patient care, acting as mediator between insurance companies, attorneys and clients.

7 ANALYSIS OF A NURSE CASE MANAGER References Nalley, C. (2012). Evidence-based Case Management. Advanced healthcare network. Retrieved from http://nursing.advanceweb.com/Features/Articles/EvidenceBased-Case- Management.aspx Stuedemann, C. (2013, September 23). Interviewed by C Demler. Nurse Manager Interview Yoder-Wise, P. (2011). Leading and Managing in Nursing (5th ed.). St. Louis, MO: Elsevier Mosby.