Letter asserts value of case management
Letter asserts value of case management
(Editor’s note: Here is the text of the letter from Jeannie Boling, MSN, CRRN, CDMS, CCM, executive director of CMSA, on Aug. 24, 1999, to Doris Nuttelman, RN, EdD, executive director of the New Hampshire State Board of Nursing in Concord. At press time, CMSA had not received a response from the New Hampshire State Board of Nursing. We will continue to monitor the situation, as well as issues in other states that affect the practice of case management.)
Dear Dr. Nuttelman:
By way of introduction, the Case Management Society of America (CMSA), founded in 1990, is an international multidisciplinary professional organization. As such, it embraces individuals performing case management roles within the scopes of various disciplines including nurses, social workers, vocational counselors, occupational and physical therapists, and physicians.
This letter is in response to the recent concerns from our case manager nurses that their New Hampshire nursing licenses would not be renewed if they were practicing as case managers. Our understanding of the issue is that the Board of Nursing does not support nurses who were practicing their unique skill if another could perform the job. Please advise if this is the stated position of the Board on this issue.
CMSA wishes to submit the following information from our perspective as a national health care association to assist as you further explore this issue. As CMSA has found, case management requires a specific understanding of how each professional (whether RN, SW or other) may function in his or her position.
In 1995, CMSA developed The Standards of Practice for Case Management, which have been widely embraced in the health care marketplace. The major certifications and accreditations for case managers and case management departments recognize these standards as a primary source in defining the field. The American Nurses Association has developed similar standards for nurse case managers.
The CMSA Standards of Practice recognize case management as an advanced practice, one that is based on the licensure of each professional as well as more advanced skills gained through education and/or experience. Further, it presumes the professional will function within the scope of his or her professional discipline, education and experience, and personal expertise.
Therefore, it is the position of CMSA that nurses or other discipline professionals who would practice in a position in which other professionals might also function, should be of no consequence. While the nurse functions within her expertise in "assessment," for example, that does not mean that the social worker or vocational counselor will function in the same manner nor that the outcome would be the same. The social worker may focus primarily on the social needs of the individual; the vocational counselor may focus primarily on the vocational needs of the individual. Nevertheless, the job description may require "assessment" and each professional may function satisfactorily in that role.
Is the New Hampshire Board of Nursing focusing solely on the traditional clinical application of basic nursing rather than the community and health system application? If so, it would appear to be limiting nurses from applying their unique skills to other positions, a critical need for nursing as well as for consumers in the current healthcare atmosphere. How would the RN functioning in a case management position differ from an RN functioning as a supervisor or educator? Not one of the nurses in those roles would have a hands-on clinical role, a role which more fully employs the traditional unique clinical skills of the nurse. A physician or other licensed professional may fill the roles of supervisor or educator as well. Thus, to say that a case manager RN is not using the unique knowledge of an RN if the role may be performed by another would appear to be faulty logic. Not only would this position appear to be hindering individual nurses from creativity in practice, it would appear to further damage nurses’ capability to gain certification and to demonstrate competency in various specialties including case management. Further, the impact of this position on employers of nurses in the new health systems is dramatic, potentially affecting hiring practices, companies’ ability to meet accreditation criteria based on RNs performing in the roles in question, and eventually impacting the economic viability of payer and managed care entities. Most importantly, the key role the nurse case manager fills as patient advocate is in danger of being filled by a less qualified individual. Thus, the consumer is ultimately impacted by a decrease in service and quality.
CMSA sees this dilemma as an opportunity to offer information to health policy experts and legislators about the role of the nurse case manager. With this in mind, enclosed please find a copy of the CMSA Standards of Practice and a copy of Case Management At the Point of HealthCare’s Future. I am certain the Board does not intend harm to nursing or to the patients nursing serves. Please consider the foregoing information. If I can be of further assistance, I will be glad to be available as a resource.
Sincerely, Jeannie Boling, MSN, CRRN, CDMS, CCM
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