When Peggy Rossi, BSN, MPA, CCM, ACMC-RN, CMAC, an independent case management consultant, works with hospitals throughout the country, the biggest problem she encounters is the lack of detailed job descriptions for case managers and social workers.
“Job descriptions are not clear. In many hospitals, they don’t even begin to describe what the staff should be doing,” she says.
To compound the problem, there are no policies and procedures that outline who is responsible for what tasks, she says. “That’s why there is so much confusion about the roles,” she adds.
Some hospitals don’t have job descriptions at all, while others use almost the same verbiage for RN case managers and social workers, reports Patrick Hernandez, DBH, MSW, LMSW, CPRP, management consultant for Berkeley Research Group. Case management leadership should develop clear roles and responsibilities for each discipline and make sure everyone in the department understands them, he adds.
“In some places, there is little difference between [the] case management role and the social worker role,” Hernandez says. “I’ve been in hospitals where the department just divides the units down the middle and the social worker and the RN case manager provide the exact same discharge planning activities, safety assessment, and care planning in spite of the fact that they are two completely different disciplines. These clinicians do great work, but the landscape is changing and indistinct lines of responsibility will be problematic.”
Hernandez suggests that case management leadership delineate the roles and responsibilities with the intention of separating the disciplines so there is no duplication of work. Look at patient needs and determine the division of work based on the skill sets of the two disciplines, he suggests.
Rossi recommends that case management leadership meet with the staff, determine what work each discipline performs every day, and make sure that the job description matches the duties of each role. Then, write policies and procedures that make clear each role’s responsibilities.
Be clear on the roles and responsibilities of both disciplines and share the information with the rest of the staff, says Toni Cesta, RN, PhD, FAAN, partner and consultant in North Bellmore, NY-based Case Management Concepts.
“The goals of the leadership should be to help the social workers and case managers understand a clear definition of what their roles and responsibilities are and to prepare them to articulate their roles to other staff in the organization,” she says.
There always will be some overlapping of work with patients being cared for by nurses, hospitalists, and therapists, as well as case managers and social workers, Cesta point out.
“This is normal, but there shouldn’t be so much of an overlapping of roles that everybody is doing the same thing. Team members should clearly understand their individual responsibilities,” she says.
Clearly defining the roles of both disciplines is critical as CMS and other payers enact more rules and case managers get busier, Hernandez says.
Nurse case managers and social workers need to understand each other’s skills and work together as a team, rather than operating in silos and participating in turf battles, says Vivian Campagna, RN-BC, MSN, CCM, chief industry relations officer for the Commission for Case Management Certification.
“Each person should communicate with the other and know when they need their colleague’s expertise,” she says.