By Jeni Miller
As the country begins to pull out of the COVID-19 pandemic, the opportunity for case managers to return to the bedside provides the welcome relief of meeting with the interdisciplinary team, patients, and families in person. But for many people, returning from a remote environment after several months is another challenging shift to experience. Working remotely offered staff flexibility with families, safety from exposure, and more time “on the job” with the elimination of long commutes. When shifting back to in-person work, it is important to recognize these team members are experiencing a real change in their daily routines.
Jean Maslan, RN, notes her experiences have shed some light on these struggles. As many hospitals have sent case managers home to work, teams may have reservations about effectively returning to the bedside.
For Maslan and other case management leaders, post-pandemic assignments added a new challenge. The concern is that for case management departments that largely carried out their work remotely, the importance of their role would be undervalued.
The strength of a case management team is illustrated at the bedside. This is when clinical assessments are performed and the opportunity to identify patient challenges and potential discharge delays are identified. When conducting remote patient interviews, there often are missed opportunities to recognize subtle challenges that could become significant as the patient moves closer to discharge.
A Plan to Turn It Around
When bringing staff back onsite, give them “ample time to get their affairs in order” so they can return to full-time work on site, Maslan notes. Easing staff into the routine makes for a smoother transition. Giving two months’ notice and then extending them a choice to work one day remotely for another two months if needed can help.
“One frequent challenge that I encounter is the morale of the staff,” Maslan says. “Staff needs to be reminded that they are essential and valued members of the interdisciplinary team. They were hired for an on-site position, and the right thing to do for the patient is to be on site and give the patient and family the face-to-face time they deserve.”
For case managers, returning to work means they might need to arrange child care or adult care. They may be fearful of contracting COVID-19. In many cases, staff was sent home to work remotely due to lack of office space and the need to remain six feet apart.
After staff returns to work, it will be important to support them through this change. One-on-one meetings with each worker to give them time to vent their concerns is important to boost morale throughout these changes. Case management leaders should “elevate the case management department to bring to light what great things they are doing,” Maslan says.
In the beginning, staff might request to continue to work remotely as much as possible. “It is important to try and be flexible with staff but make sure they do not take advantage of the situation,” Maslan shares. “Most case management departments are short-staffed, so when an employee calls in but offers to work remotely, it is sometimes necessary to allow so there is adequate staffing for the department. If you are not careful, you will be right back to having more staff remote than on site.”
Rebuilding Trust
“Case managers are great people and want to do the right thing, and they just need good leadership,” Maslan explains.
When inpatient case managers were sent home at the beginning of the pandemic, people believed they were not always considered essential workers, “when in fact they are,” Maslan says. “Case managers are essential workers and should not have been sent home to do their jobs during the pandemic. Of course, utilization review nurses were sent home to work remotely, and many remain at home. But for the inpatient case manager, their place is in the hospital with the team assisting with moving the patient through the continuum of care as efficiently and safely as possible.”
As many case management departments stayed home while other hospital staff members remained on site, case managers may have believed they were not as well respected.
“Some value may have been lost for the profession, and it may have made others feel that they did not need case management,” Maslan shares. “Even though there was a lot of work case management was doing behind the scenes, with them being out of sight — in some cases they lost their importance as a key member of the multidisciplinary team.”
Maslan’s concern is largely for the overall effect of these situations on case management. “Case management can make or break the bottom line of the hospital,” she says. “Administration might be just beginning to grasp the importance of the case management department, and then the pandemic hit. Those hospitals that chose to send their inpatient case managers home to work may have caused a step backward for the profession.”
The Significance of In-Person Interaction
After months of learning to work remotely and interact with patients, families, and providers virtually, the thought of returning to on-site work can be overwhelming. As virtual care seemed to become the new normal, the necessity of face-to-face care began to seem less vital.
Re-educating the staff on the dire value of in-person interaction is an important leadership responsibility. “Returning to face-to-face contact with the patient and family after doing their jobs remotely for nearly two years can be very challenging,” Maslan notes. “The impact was mostly on the relationship with the patient/family as well as the relationship with the on-site staff, such as doctors and nurses. Poor communication due to not being face to face can cause an increase in length of stay, delayed discharges, and decreased patient satisfaction. Physicians become frustrated that [case managers] were not on site and having to do rounds virtually.”
In-person contact with patients and families, Maslan says, is critical because “you can learn so much by walking into a patient’s room and seeing the patient and the family face to face. You could spend hours combing through a chart, but in five minutes you would have much more information by meeting the patient and family live. It is easier to communicate with physicians, nurses, and other ancillary staff in person, and phone calls can be minimized with the multidisciplinary team when you are on site.”
Hope for Struggling Departments
For hospitals working to manage staff members’ hesitancy to return to onsite work, Maslan recommends beginning with building trust with staff and leading by example.
“Don’t be afraid to get in and get your hands dirty, and definitely don’t ask the staff to do things that you yourself wouldn’t do,” Maslan advises. “See each person on your staff as an individual and take the time to get to know each staff member, learn their needs and goals, and understand what they would like to see change. It can be time-consuming at the start, but it is worth it in the long run.”
Maslan reports these efforts can lead to success both in the short term and long term, but only with hard work and tireless consistency.
“It can be tough on the staff for a while, especially when someone calls in and asks to work remotely, and you have to tell them ‘No.’ In my experience, there might be grumblings and threats to quit, but in the end, no one left,” she says.
The long-term effects will include a greater awareness of the importance of case management, and of face-to-face interactions with patients and families.