New LTACH case managers are mentored

Curriculum prepares for complex patients

Case managers who will work in a long-term acute care hospital (LTACH) in Kindred Healthcare's Western Division go through a two-part mentoring program — a four-week "onboarding" program at a centralized location followed by an individualized six month to one year preceptorship at their assigned hospital.

"The four-week onboarding period helps the new case managers adjust to the role, learn about the organizational culture and acquire the necessary knowledge, skills and behaviors to become effective in their new role. We want to ensure that they have all the knowledge and tools they need for success in managing the care of their complex patient population," says Wendy De Vreugd, RN, BSN, PHN, FNP, CCDS, MBA, senior director of case management services for Kindred Healthcare, Western Region, Hospital Division with headquarters in Westminster, CA.

To fill openings, De Vreugd recruits students who are graduating with a master of science in nursing (MSN) degree with a specialization in case management, as well as bedside nurses who already work for Kindred who may want to transition into case management.

"MSN graduates have extensive education on case management theories but little clinical experience. The bedside RNs have clinical experience and are familiar with the company but have little case management knowledge. We had to develop a program to successfully onboard them together," she says.

The onboarding curriculum includes modules on interpersonal communication and negotiation skills, such as dealing with different personality types, Kindred's computer system and electronic medical record, and financial-related issues including managed care and other payer requirements.

The new case managers receive instruction in utilization review, discharge planning, care coordination, clinical documentation improvement, and patient advocacy. They spend time with clinicians who provide complex care, including respiratory therapists, a wound care nurse, and an infection control nurse, and they spend a day with a bedside nurse to learn about the challenges of providing care for patients with multiple complex conditions in a long-term acute care setting, where lengths of stays average 25 days.

After the month-long training program, new case managers go to their assigned hospital and work with a preceptor. During the first month with the preceptor, the new case managers sit down at the end of the week, reflect on the week's events, and conduct a SWOT (strengths, weaknesses, opportunities, and trends) analysis.

"The first year as a case manager is challenging. We encourage reflective thinking about where their strengths and weaknesses are, what their opportunities are, and where they feel threatened, such as if they are frightened to approach physicians or in dealing with more experienced colleagues. This helps get them in the habit of analyzing and thinking about how they are doing on a regular basis and how they may approach a situation differently to attain a positive outcome," she says. The weekly SWOTs also give the trainees a "diary of sorts" which they can reflect upon and realize their progress later, she adds.

The case managers initially are assigned two to three cases and work on them under the supervision of the preceptor. "We start them with a small caseload and watch how they perform and gain proficiency. As they progress, we add patients to the caseload for a maximum of 15. This usually takes from one to three months. It is at this point that they start rapidly gaining experience. Mentorees are encouraged to constantly research new diagnoses they encounter," she says.