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Faced with the increasing cost and complexity of health care and a growing number of patients who need case management, your boss may be considering hiring less educated assistants to help case managers handle their duties. If that's the case, it behooves you to take an active role in setting the job description of the new person to make sure the essential duties of a case manager aren't watered down.
"The cost of health care is increasing, [and] the population is aging and in need of increasingly complex health care," says Jeanne Boling, MSN, CRRN, CDMS, CCM, executive director of the Case Management Society of America (CMSA), based in Little Rock, AR. "Those pressures may lead to an attempt to reformat the case manager's job, an attempt to delegate part of the job to non-licensed personnel." The current nursing shortage is likely to speed up any plans for case management assistants at your place of business, Boling adds.
"With a shortage of nurses, when we move patients from one level of care to another, it's not assured that we get the kind of care that the patients need to keep them safe," adds Catherine Mullahy, RN, BS, CRRN, CCM, president of Options Unlimited in Huntingdon, NY, and new president of the CMSA. Case managers need to understand their scope of practice. They need to look at their licenses and what it allows them to do and not to do, Mullahy says. "Case managers have a role and a responsibility, as well as standards of practice they must follow. That means you shouldn't automatically accept a change in your job description," she adds.
Case managers are advised to be absolutely certain that this kind of delegation will not lead to fragmentation of their contact with patients, Boling says. "You cross the line when the assistant gets involved in the case manager's interaction with the patient and family. Even what would appear to be simple communication in my opinion shouldn't be delegated," Boling says.
Case managers may pick up on something that will help them manage the case during the most routine encounter with patients and their families, she points out. "Even though the encounter may be a mundane activity, the case manager may pick up an expression that helps them gain information or offer some subtle, effective information. It's something a clerical person wouldn't pick up," Boling says.
You can't expect your boss, especially if he or she is an accountant or risk manager, to automatically understand how complex a process case management is without educating them your role. "Sometimes they can easily minimize what it is we do if they don't come from that professional discipline," Mullahy says. That's why Mullahy advises case managers to take a proactive role in setting the job description and hiring any case management assistants. "We do a disservice to ourselves and our patients by assuming a passive role," she says.
If your boss suggests hiring a nonmedical person, you can explain by illustration what can happen when a professional vs. a nonprofessional looks at a similar scenario. "A case manager can do certain things because of our knowledge and experience," Mullahy says. "A nonprofessional person may increase risk and liability by doing the same things without professional knowledge." If you use concrete examples of how case managers work vs. how nonprofessionals work, you can explain risk management and liability to your boss and have the potential to change a hiring decision, Mullahy says.
Here are some other suggestions on coping with the situation:
• Get involved with setting job descriptions for any assistants you hire. "Case managers have to be extremely careful that they retain that part of their job that involves interaction with patients. The heart and soul of case management is interaction with the patients. If you're not interacting with patients, you're not doing case management," Boling says.
• Make sure the new job description preserves the role of case managers.
• Bring to your boss's attention the things that can be delegated, but be firm about the tasks a case manager must retain.
• If you're not comfortable with what's going on, contact your professional organization.
"That's why such organizations exist. One individual faced with an issue doesn't feel like he or she can make a difference. Professional organizations can help you find resources for solving these problems," Mullahy says.