Litigation is a pervasive reality today. Unfortunately, however, many case managers seem to believe that they will never be involved in any litigation, or if it does happen, their employer will protect them. Incredibly, while we have standards of practice and processes in place to educate ourselves, far too many case management employees are lacking the kind of understanding that would keep themselves, their patients and, yes, their organizations safe from legal action. While we are aware of so many rules, regulations, guidelines and scope of practice that govern our respective licenses, how many of us — especially those of us in leadership positions — are ensuring more than an awareness, but rather the depth of understanding that would affirm a demonstration of adherence to those? As we hire individuals for case management positions, are we communicating the importance of our Standards of Practice (SOPs)? As we create or update position descriptions and performance evaluations, do we promote the adherence of those standards in employee orientation and foundational preparation and educational programs? We discuss the importance of “operationalizing” these standards, but that needs to be more than lip service, but rather an incorporation of these in our day-today practice. When more and more individuals are engaged in tasks far removed from the essential activities and core components of case management as our SOPs define them, we need to question just how the erosion of our practice has occurred. Regrettably, each of us bears some responsibility for that. Unfortunately, despite these very tangible guidelines, leaders within case management simply did not take a stand on two fronts. They did not speak up when the lines of their practice began to blur, nor did they push back when others started divvying up the case management role and then creating new titles for different functions. We hear from case managers who attend our seminars or who continue their contact with us long after our programs conclude saying that many leaders in employer organizations have never actually been case managers. This results in a certain lack of credibility and respect, not to mention an inability to really grasp the nuances of the case management role. The “…walk a mile in my shoes” really does make a difference. Too often, those who are managers or directors of case management departments have never actually functioned in a case management role, but instead are placed in those positions because of degrees in finance, business, informatics or administration. This doesn’t mean that those degrees aren’t important contributors in case management departments, but there really does need to be a career path for today’s case managers to move into leadership roles, Further, case managers need to be proactive in assuming responsibility for their own continuing education so that they can become the effective leaders of tomorrow. The ideal leader in case management has clinical experience in case management, as well as business-related knowledge and educational proficiency.
As healthcare continues to evolve, our ability to provide our intervention to individuals outside our communities evolves as well. While technology makes more things possible, and our employers in the provider and public sectors strive to offer case management services to more of their client groups across the country, we each need to accept responsibility to practice, not only within our case management scope of practice, but also within the licensing restrictions of our profession. The Nurse Compact legislation, now referenced as Enhanced Nursing License Compact (eNLC), requires state and federal fingerprint-based background checks. As of January 9, 2020, 34 states are part of the eNLC. It amazes me how many case managers incorrectly believe that their employers provide them with the kind of insurance that will cover them for any/all of their actions, or that they don’t need to purchase professional malpractice insurance. There are also individuals who, along with their employers, mistakenly believe that because case managers are typically no longer in “hands-on” traditional roles for nurses, but rather serve in consulting roles, that they are no longer bound by nursing licenses. All insurers, regardless of whether that coverage is provided by employers or the individual, will provide protection/insurance, but will only provide coverage for incidents incurred, if the individual is practicing within their scope of practice and license. So what does that mean? If a case manager is providing intervention on behalf of an individual who lives in a state where the case manager does not reside or has a license, then he or she is, in essence, practicing without a license! Case managers can find up-to-date information and guidance at www.ncsbn.org and www.cmsa.org.
In conclusion, at the heart of case management is the role of “advocate,” and while we understand this to be on behalf of our patients, we also need to be advocates for ourselves and our role as case managers. Gaining protection from potential liability extends to this self-advocacy as well.