Experts: On-the-job training isn't sufficient for today's case managers
A formal orientation and education program is a must
In the past, many nurses became case managers by the "poof method." One day they were a nurse, then poof: The next day, they were a case manager. Often, they receive minimal on-the-job training from another case manager who was trying to do his or her own job at the same time.
In today's complicated healthcare arena, on-the-job training may not be enough to prepare new case managers to handle documentation, care coordination, compliance, and discharge planning requirements. Payers and providers need a strong formal program to educate and train case managers, but it's not happening, says BK Kizziar, RN-BC, CCM, owner of BK & Associates, a Southlake, TX, case management consulting firm. "In every area of practice I have worked in, the organizations had a general employee orientation program but no case management-specific education," Kizziar says.
"The Affordable Care Act and other healthcare initiatives offer numerous opportunities these days for case managers to rise to the top, but it's become a real issue to figure out what the basic training should be," says Margaret Leonard, MS, RN-BC, FNP, senior vice president for clinical services at Tarrytown, NY-based Hudson Health Plan.
When people become case managers by the "poof" method, it's a disservice to patients and to case managers and the profession as a whole, Leonard says.
"The idea that people can float into this role is simply erroneous. There are practice standards that case managers should follow, resources they need to know about, and specific tasks they need to complete. If people are never exposed to them, they can't do the job their organizations expect them to do and produce the outcomes that organizations hope they have," she says. In addition to completing educational modules on case management offered by the Case Management Society of America (CMSA), Hudson Health Plan case managers are trained on motivational interviewing and how to work in an interdisciplinary team.
As she presents case manager training seminars across the country, Catherine M. Mullahy, RN, BSN, CCRN, CCM, president and founder of Mullahy and Associates, a Huntington, NY, case management consulting firm, frequently hears from participants that they never received any formal training in the process of case management.
It's not sufficient to hire someone, provide a week of orientation, hand them a manual, and assign them to a unit, Mullahy says. "New case managers can read books or take online courses, but until they experience working with families with problems, coordinating care for people with mental health issues, or collaborating with physicians, they can't know what the job is really like," she says.
Develop a core training program
Even experienced registered nurses who have been at the bedside still need a core entry level case management curriculum to start a foundational study of case management, says Wendy De Vreugd, RN, BSN, PHN, FNP, CCDS, MBA, senior director of case management services for Kindred Healthcare, West Region, with headquarters in Westminster, CA. De Vreugd developed an orientation and mentorship program for her region. The program includes four weeks of "onboarding" that involves the organizational mission and vision, as well as case management basics and standards of practice, followed by a mentorship period when case managers work one-on-one with a preceptor and gradually take on a bigger caseload. (For details on Kindred's program, see page 28.)
Nurses can't learn everything they need to be a case manager in an orientation program, adds Brenda Keeling, RN, CPHQ, CCM, president of Patient Response, Inc., a Durant, OK-based healthcare consulting firm. "New case managers need a true mentoring program so they understand the job and everything involved," she says.
The person training and mentoring a case manager should be someone who knows the job well, has proven competencies, and performs effectively, Keeling points out. "The new case manager will only be as good as what he or she is taught. If the person doing the training doesn't have the skills and competency to be a good case manager, the new hires won't know how to do the job and will continue the same sloppy practices as the trainer," she says.
As case managers become comfortable in the role, they tend to forget the basics that they perform automatically and they tend to leave them out when they're training a new person, Kizziar says. "The basic problem is that the people who end up telling the new person what their role entails often became a case manager the same way. This creates a vacuum in learning and competencies, and when you multiply this by 20 years of staffing, there's very little growth or innovation in the case manager role," she says.
Case managers need to learn how to handle a myriad of tasks that may differ according to the environment in which they work, Kizziar says. At the same time, there are so many strict compliance and discharge planning requirements that it's hard for new case managers to remember them all. That's why they need a lot of training and reinforcement, she adds.
Ongoing education for experienced case managers is also important, Leonard says.
"All the healthcare rules and regulations are changing so quickly that all case managers, even experienced ones, must be proactively seeking information to help them do their job, regardless of the setting in which they practice. It's the individual case manager's responsibility to know what resources exist and to see where opportunities lie," she says.
"Case managers need education and training. A good way to make sure you have the right person in the case management role and that they know what they are doing is to require that they become certified within two years. This improves the overall department and forces the staff to study and understand their job," Keeling says.
Sources for case management education
Professional organizations that support the practice of case management offer resources that include educational conferences, webinars, and online education.