Many discussions have taken place over the years as to whether case management is a profession or a practice. Years ago, I would have told you it was a profession. Today – I say practice. But why?
Think about this for a minute. As a nurse, occupational therapist, or social worker, you come into case management with a set of skills and expertise. In most cases, it is a state requirement to hold a license in our chosen practice area. Case management is based on your primary discipline, but you need a base of specific skills to be successful.
When I worked oncology in a hospital, I would not have said oncology nursing was a profession. Today, I realize it is a specialty practice of nursing. Therefore, today my theory is that case management is a specialty practice of nursing.
But wait a minute – let’s look at definitions. If you look up the word “profession” in the dictionary, you will see words such as “career,” “employment,” and “occupation.” “Practice,” on the other hand, is defined as “pursuing a profession, especially law or medicine.”
So here is the question: Are we an advanced practice in a widely known profession? If a nurse specializes in wound care, is this an advanced practice in nursing? I expect many of you are saying these are simple questions and wondering why you are reading this article. In our changing healthcare landscape, we must define who we are and what our role in healthcare represents.
As a nurse, I am committed to a standard of practice found at the state board of nursing where I live and, if I do telephonic work, where the patient lives. As a nurse case manager, I am held to both the nursing standards of practice and the case management standards of practice. Both are important to know and follow in the work we do.
What is your role in today’s healthcare? How do you respond to someone who asks, “What do you do?” If you are like me, you respond, “I am a nurse.” I don’t go into my role because they likely wouldn’t understand, so the “nurse” response is more straightforward. I am thrilled when they ask where I work because I can expand on my role as a nurse case manager. This allows people to see the link between nursing and case management. I can often see in their face that they understand and realize they have interacted with a case manager at some point in their career or personal life.
The next question is, “Which hospital do you work in?” At this point, I go more in-depth and discuss the multiple fields in which case managers work, including workers’ compensation, which is my practice choice. As a practice, we should not get pigeonholed in one setting. Today, case managers are found in every sector of the broad healthcare system, and many healthcare disciplines are working in case management. The key is to follow the standards of your primary profession and the Case Management Standards of Practice. To read the Case Management Standards of Practice, go to www.cmsa.org/sop.
MY JOURNEY
My experience as a nurse case manager started when my mom was working for an insurance company. She told me about a pair of ladies who came into her office frequently with what she said was a new nursing role. Being a single mother working two weeks of nights, swinging to two weeks of days, and then back to two weeks of nights again was killing my children and me. I needed a day job. I started with a case management company doing major medical cases, and I loved it! It encompassed everything that was nursing rolled up in a ball. The assessment and planning called to me. Thirty years later, it still appeals to me, and there is nothing more fulfilling than advocating for someone. Who would have guessed that I would discover this job that would become my lifelong calling based on the need to get a day job?
The bottom line is, I am a nurse (profession) case manager (practice). You may be able to combine your primary discipline with case management if you are looking to broaden your career!
Perhaps I am a professional nurse case manager. What is essential is to know who you are and what you do. Not only is this important to folks asking what you do, but it is also vital to keep you safe and compliant with your state practice guidelines.
If you cannot define yourself to the C-suite in your work setting, they will not understand when you need time off for professional continuing education. As noted, there are standards for practice for those who call themselves “case managers.” Taking the time to know them allows you to better explain who you are, what you do, and the expectations of the role you perform. If you don’t know them or cannot clearly convey them to your managers, your job expectations and goals may differ significantly from those standards.
Case managers have evolved to become multifaceted professionals. Perhaps you may be speaking with another nurse about becoming a case manager. Being able to define yourself and discuss the role you play succinctly and understandably is something we all need to be able to do. So back to the question, is case management a profession or practice? Does it matter? Let me know what you think.
, RN, MSN, CCM, has thirty-four years of experience as a nurse case manager in various settings to include workers’ compensation, catastrophic medical, and entrepreneurship of a direct to consumer model. She served as president of the Case Management Society of America in 2005-06 and was the national Case Manager of the Year in 2010. Susan has extensive experience in adherence and medication management to include composing portions of CMAG. To reach out to Susan, email her at [email protected].
