A Day in the Life Series: Case Management

After dropping my youngest daughter off at school (something I could never do when I worked 12-hour shifts), I am off to work. I get to work around 8:05 am and head straight to the case management office. The floor nurses are already busy doing rounds, passing meds, and calling doctors. I walk into the case management office, let the doors close behind me, and turn my computer on. While my computer turns on, I put my stuff down, get my water bottle out, and check the census.

How many admissions did we get overnight? How many readmissions do we have? Have many discharges today? What do I need to follow up with from yesterday? I start my day by prioritizing tasks and patients, just like I did as a floor nurse.

What Is a Case Manager?

Case managers, or care coordination as it is called in some medical systems, specialize in the organization and collaboration of patient treatment by all care team members. Case managers advocate for the patient, the organization they work for, and sometimes insurance companies. They work tirelessly to ensure the patient's needs are met effectively and efficiently. They manage hospital resources and advocate for patients that may feel intimidated or unheard by busy providers. 

Case managers work with patients readmitted to the hospital within the last 30 days, and often with patients with complicated chronic conditions such as diabetes, heart disease, and COPD. Case managers work to identify the patient’s current needs and compare them to the available resources. They connect patients with the resources the patients want and need to provide a safe discharge from the hospital.

The Day Continues 

After checking my notes about patients from the previous day, I prioritize my day and the patients I need to see. First, I call a home health company to see if they have a start of care date for the patient being discharged tomorrow. The patient needs home health for physical therapy as well as education about their disease and medications. The home health company will admit the patient to their services the day after discharge.

     Next, I get a phone call from a floor nurse stating the family I spoke to yesterday about hospice for their mother, has decided on a hospice company. I gave them a list of 3 hospice companies, one of which included an in-patient hospice unit. I wanted to give them time to examine their options for this difficult decision. I reached out to the hospice company and coordinated with their company representative to come and speak with the family. I visit the patient’s room to give them an update and provide them with the representative’s name and information. The family is very appreciative, and I have one of those moments when I remember why I became a nurse. I love helping people. Case management allows me to fulfill my love for helping people through crises without the tiresome 12-hour shifts. 

 4:30 pm - Time to Head Home

    The rest of my day entails reaching out to patients and their families regarding possible discharge plans. I pay attention to who is a skilled nursing facility candidate, and those who may need IV antibiotics or home wound care. I track those who need to follow up with a specialty physician when they leave the hospital. I often help patients take full advantage of the insurance resources they never knew they had.

 Case management has allowed me to work in the hospital, with shorter hours and increased flexibility in my schedule. It has also allowed me to be kinder to my body, and still advocate for patients and nurses. I encourage the new bedside nurse to find their voice and call the physician, provide a hug or support when they need it, and a high five when they are rocking it.

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Keeping it Together

Organization is another critical skill necessary for the med-surg nurse. Getting organized requires critical thinking, reasoning, and clinical judgment. Med-surg nurses are brilliant at balancing priorities. This can also require flexibility, as the  plan for the shift at the start is always subject to change.Providing high-quality nursing care to adults means knowing that no two patients are alike.  Recognizing the different needs of each patient builds upon existing skills, and that starts with a good assessment. Assessment is the foundation of the data and information used to make clinical decisions. Nurses use reasoning and knowledge to make clinical judgments for the best patient outcomes (Cappelletti et al., 2014). One patient in pain may be very vocal, whereas another may withdraw.  Other examples include assessing for the appropriate response from ordered treatments and therapies. Patients need reassessment and ongoing collaboration with medical providers. Constant communication and organization keep a med-surg unit moving forward.

References:

https://nurse.org/resources/rn-case-manager/

http://www.acmaweb.org/forms/Standards%20of%20Care_Brochure_Case%20Management_2020.pdf

Brigette Quinn is a Registered Nurse with over 30 years of clinical experience. Her critical care, emergency, and perioperative nursing background built a strong foundation for undergraduate and graduate nursing education. For the past seven years, Brigette has continued to expand her career as a board-certified case manager and legal nurse consultant. While most of her writing experience has been in academic areas, she never stops building her skillset in honing the craft of writing for audiences in and beyond healthcare.

Author:

My name is Stacy Phillips, RN, BSN, CWCN, and I have been a nurse for over 20 years with experience in critical care, wound care, and case management. I am passionate about educating patients and health care workers on living their best, healthy lives.