Case Management Advisor

The 9 phases of CM transition

By Toni Cesta, PhD, RN, FAAN
Senior Vice President
Lutheran Medical Center
Brooklyn, NY

As case management leaders, you will be looking for the next generation of case managers to come from the bedside. The following information will review the process you might consider using to facilitate recruitment of staff to your department.

• Phase One: Considering transition from staff nurse to case manager.

During this phase, the staff nurse might be thinking about making a career move. They might see the case manager role as a promotional opportunity for them. During this "consideration" phase, you should explore the methods by which you market your vacant case management positions. One strategy might be to have your current case managers "talk up" the department and the positions. When staff members hear from their peers about the pros and cons of the position, it will go a long way in informing their decision-making process. Be sure your staff understands the pros and cons that a staff nurse might be considering. Review these with them so that they can provide objective and consistent information.

• Phase Two: Spending time with a case manager.

The staff nurses who are considering a position in case management might want to spend some time with case managers, so they can see how the role works. Once members of the case management staff have spoken to the staff nurse interested in a position, they also might want to provide them with the opportunity to "shadow" a case manager. See if the more seasoned case managers will provide this opportunity. The staff nurse might want to shadow a case manager for all or part of a day. Ensure that the staff nurses are provided with a positive experience that will reinforce their interest in a case management position.

• Phase Three: The interview.

Job interviews provide a dual purpose. They provide an opportunity for the employer to evaluate the candidate, but they also provide an opportunity for the candidate to evaluate the position. The applicant should be provided with the goals of the position as well as the goals of the department. The interviewer should explain in detail the elements of the position for which the candidate will be accountable. A standard list of interview questions should be developed so that the interviews are consistent across applicants. In addition, other members of the case management team should be given the opportunity to interview the candidate.

Be careful not to overwhelm the candidate. Group interviews can be particularly intimidating, especially to a staff nurse moving from a bedside position. Consider carefully before you plan any group interviews. You might not see the best side of the applicant.

During the interview, review the basic roles and functions of the position, and highlight the strengths that a staff nurse brings to the position. Be sure to also explain that it might be a difficult transition and that the position might take months to master. Reinforce the fact that the orientation will be geared toward their progression in learning their new roles and functions.

• Phase Four: Decision to accept the position.

As the staff nurse makes the decision to cross the bridge to the next level of her nursing career, they will have some confidence that the right decision was made. The opportunity will be present to shadow a case manager, to ask the right questions, and to weigh the pros and cons. We hope he or she will have dealt with any concerns about becoming a case manager.

• Phase Five: Accepting the position.

Once the position has been officially accepted, it is time for celebration. Consider scheduling a lunch or breakfast for the new staff member. Have the incumbent staff share welcome notes with the new employee. Take time to remind the new case manager that accepting the position means that she will be experiencing a significant professional focus change and that they will be moving from a position of experience to a position of novice. For a bedside nurse who has been a staff nurse for several years, this can represent a period of significant insecurity.

Take time to review the job description with the new case manager once again. It might have much more meaning now that it is a reality.

• Phase Six: The initial 30 days.

During the first 30 days in the position, several specific areas should be the focus. This time should be one of the new case managers becoming acclimated. Have an expert case manager or case management leader review policies and procedures as well as any specific rules and regulations that the new employee might need to become familiar with.

A useful strategy is to solicit the help from employees in other areas in the hospital to assist with orientation. Examples of these might be finance, quality management, patient relations, medical records, emergency department, admitting office, laboratory, and radiology. Exposure to these areas can be quite helpful to the new case managers and add significantly to their knowledge base.

Other points of discussion should include information systems such as the case management software, bed control software and discharge planning software.

Allow the case manager to shadow a social worker so that they will have first-hand experience in the roles and functions of social work. They will be referring patients to the social worker and will need to have a very clear understanding of the differences in roles and functions between the nurse case manager and the social worker.

Provide the case manager with an organizational chart of the case management department. Remember that this might be their first organizational chart and you might need to explain it.

Finally, meet every Friday afternoon to discuss and review goals achieved for the week and areas that might need additional focus. Taking the time out to do this will pay off in the end as you will have a better prepared and more effective employee.

• Phase Seven: First 90 days.

During the first 90 days in the life of a new case manager, communication skills should be developing. Learning how to communicate while juggling a variety of tasks can be daunting at first, but it should get better with time. The new case manager must change their relationship with the patient from one shift to the entire acute care episode. This change in orientation to the patient and family is critical. During this time, the case managers are learning how to communicate ever-changing information to the rest of the interdisciplinary care team, but they also are learning how to receive information. This information might have to be sought out and might require extra effort on their part.

The interdisciplinary care team now moves beyond the walls of the nursing unit to include ancillary departments as well as care providers in the community. Community interfacing will include clinicians as well as non-clinical professionals such as payers, regulatory bodies, and intake clerical staff. It will be important that the case manager build relationships with patients, families, players, care providers, and physicians, and that they mature in their new role.

• Phase Eight: First six months.

Toward the end of the first six months, the case management leader should be assessing the level at which the new case manager is functioning. At this point, the case manager should be able to set goals with the patients, as well as the families. They should be able to understand reimbursement systems as well the hospital's payer mix. They should be able to articulate the hospital and the case management department's goals and status toward meeting those goals. They should be able to explain how their role impacts the achievement of the goals and the specifics.

The case management leader should be reinforcing the new case manager's growth and achievements. Specifics as to their impact can go a long way in helping them feel confident in their new role and have a sense of job satisfaction. The leader should be encouraging them to move toward a higher level of autonomy and flexibility in their role.

• Phase Nine: First year.

By the end of the new case managers' first year, they should be well established in the department's culture. They should identify and see themselves as case managers and no longer as staff nurses. At this point, the case management leader should feel comfortable in assigning them more challenging work. Examples might include training a new orientee or joining a committee or task force.

Following a structured process and working through it with your new case managers will help you to retain them by increasing their job satisfaction and ensuring that they feel that they are a valued member of your department and your organization.