Strange as it may seem, case managers have become a target market for health care quality organizations pushing a dizzying assortment of case management credentials and degree programs. Popularity comes with a price, however, and many case managers are feeling the pressure to either seek an established credential or upgrade their education simply to keep pace in an increasingly competitive job market.

Indeed, Hospital Case Management’s 1998 salary survey (See HCM, November 1998) found that case managers with a master of science in nursing (MSN) earned an average of about $55,000, while case managers with a bachelor of science in nursing (BSN) earned about $40,000. Those salaries jump even higher when certification is added to the picture.

"Leaders in the case management field feel very strongly that qualifications must be set at the point where case management is readily recognized as a specialty practice and evolving profession," says Cynthia E. Whitaker, RN, BSN, CCM, president of RNS Healthcare Consultants in Sacramento, CA, and past president of the Case Management Society of America (CMSA) in Little Rock, AR. To that end, Whitaker is pushing for the BSN to become a minimum standard for nurse case managers.

"The bachelor’s degree in effect says that a person has demonstrated the communication and critical thinking skills so necessary for effective case management practice," she says. "Individuals are not always taught the ability to analyze complex situations in associate or diploma programs, which tend to focus almost entirely on clinical skills."

To some case managers, particularly those who came out of associate or diploma programs in the 1970s and hold a world of experience but no BSN, those are fighting words. Barbara A. Fuchs, RN, CPHQ, FNAHQ, director of case management at Sacred Heart Hospital in Allentown, PA, is a diploma graduate who went on to earn both a bachelor’s degree and a master’s — but not in nursing. "Unless you’ve been in the trenches, you don’t know what you’re talking about," she says. "Theoretical constructs are wonderful, but I would never hire anyone without experience just on the basis of some courses they had taken."

More important to Fuchs than a university degree is an established case management credential. To her, that proves a candidate has gone "one step beyond. It shows you don’t just clock in and clock out, because credentials have continuing education requirements attached to them."

Further, most certification examinations are based on actual practice, says Janet L. Maronde, RN, CPHQ, executive director of the Healthcare Quality Certification Board, which oversees the CPHQ credential. "We’re testing candidates’ practical, on-the-job skills, rather than their ability to memorize information," Maronde says. When someone gets a credential like the CPHQ, she adds, "then the employer knows that person has good judgement and an effective way of approaching problems and real-world situations. That’s the biggest strength, and it’s why employers are valuing [credentials] more and more."

Maronde adds that, in her experience, breadth of experience produces a higher pass rate than any other factor, including education.

Even so, credentialing organizations are considering toughening the education requirements they impose on prospective candidates. For example, the South Natick, MA-based Center for Case Management’s new Case Management Admini stra tor Certified credential requires either a bachelor’s or a master’s degree plus experience in the field. Meanwhile, the American Nurses Credentialing Center in Washington, DC, requires that candidates hold at least a BSN. (See HCM’s annual directory of case management credentials for complete eligibility requirements, p. 232.)

Do you have the wrong master’s degree?

Some experts, even those in credentialing organizations, say such educational requirements may go too far. Sharon Kemerer, executive director of the American Board of Occupational Health Nurses (ABOHN) in Hinsdale, IL, points out that her organization’s chairman would be ineligible to take the ANCC case management exam: "She has a master’s degree, but it’s not in nursing." That’s one reason why ABOHN isn’t likely to impose such requirements on candidates for its case management credential, which is now in development.

Similarly, officials at the Certification Boards, Perioperative Nursing (CBPN) in Denver have decided not to require the BSN for their CNOR exam in the year 2000. Diane Howery, executive director at CBPN, says the requirement was dropped in light of statistics showing that relatively few nurses actually hold a BSN. A 1996 study showed that 66% of graduate nurses came from associate and diploma programs. A full 53% of 1996 nursing graduates held associate degrees, while another 6% were diploma graduates. Of the current 30,000 CNORs, 63% don’t hold a BSN.

"It’s not that we don’t support [the BSN] as an entry-level requirement, but until the profession catches up with it, we feel that we have to represent our universe of candidates," Howery says.

She adds that talk of a recent trend toward the BSN and MSN among nurses and case managers doesn’t mesh with reality. "The situation hasn’t changed," she says. "From the figures I’ve seen, it hasn’t changed in 35 years. What has changed is that the nurses who are at the tables representing nursing in important committees, for example, all have advanced degrees. In many settings, a BSN is now required to rise beyond staff nurse."

Recently, Fuchs made inquiries at a major university to find out how she — a director of case management with a master’s degree and more than 15 years experience in health care — could get a BSN. She was told the university wouldn’t accept any of her courses from her hospital program. "I was going to have to challenge everything," she says. "Even if I had challenged everything successfully, they were still going to make me take two courses. It seemed to be all about money."

At this point, Fuchs says, "A BSN doesn’t really mean anything to me. I’d rather see what you’ve done." On the other hand, Fuchs says, the presence of a credential indicates to her that a candidate is at least interested in her profession and tries to keep current.

Lori W. Heiser, LSW, CMC, a case manager at St. Joseph’s Hospital and Health Center in Dickinson, ND, pursued a case management credential as part of a learning process about the field of case management. Although she had a moderate amount of medical experience, her background was predominantly social work. "I started noticing that social work was being sidestepped by nursing in terms of managing patient care," she says. "I wanted to see social work expand and take more responsibility in health care, which is a medical model-based concept."

Meanwhile, she began reading more about case management and concluded that the field "is very much like the basics of social work." From there, she enrolled in a certificate course in case management and went on to acquire the Care Manager Certified credential from the Hollywood, FL-based National Academy of Certified Care Managers.

Heiser’s example underscores the fact that case managers come to credentialing from a variety of backgrounds and for a variety of reasons. Fuchs says that as a director of case management, she isn’t biased toward or against a particular credential because of the field’s diversity. "I don’t say CPHQs are better than Certified Case Managers, or vice versa," she says. "But I will look at you a little more if you have a credential. It shows me that you’re out there, and you’re trying to get a broader base of knowledge than you have right now. And you’re trying to keep up with the trends."

For more information, contact:

Lori W. Heiser, LSW, CMC, St. Joseph’s Hospital and Health Center, 30 W. 7th St., Dickinson, ND 58601-4335. Telephone: (701) 225-7200.

Janet L. Maronde, RN, CPHQ, executive director, Healthcare Quality Certification Board, P.O. Box 1880, San Gabriel, CA 91778. Telephone: (626) 286-8074.

Barbara A. Fuchs, RN, CPHQ, FNAHQ, director of case management, Sacred Heart Hospital, 421 Chew St., Allentown, PA 18102. Telephone: (610) 776-4886.

Diane Howery, executive director of Certification Boards, Perioperative Nursing, 2170 South Parker Road, Suite 295, Denver, CO 80231. Telephone: (888) 257-2667.