BY, EdD, MBA
CASE MANAGEMENT DEMAND FACTORS
A perfect storm continues to intensify because of our existing shortage of registered nurses, limited nursing faculty, BSN entry requirements and the effects of the pandemic. As Haas et al. (2020) described, the fragility and vulnerability of our nursing workforce have been exposed (p. 236). This, in turn, has had a trickle-down effect on the availability of nurse case managers and social workers to fill vacancies across the healthcare sector.
The U.S. Bureau of Labor Statistics (2021) predicted that there would be approximately 175,000 registered nurse openings each year for a 10-year period from 2019-2029. Healthcare social worker jobs are estimated to increase by 26,700 over a 10-year period from 2019-2029 (U.S. Bureau of Labor Statistics, 2021). The American Association of Colleges of Nursing (AACN) reports that there is a 94% placement rate for BSN graduates within 4-6 months of graduation (AACN Research Brief, 2020).
The need for qualified case managers continues to expand across the continuum of care. Healthcare organizations, public health agencies, private employers and insurance companies are ramping up population health initiatives as our healthcare payment systems transform. Expansion of accountable care organizations and value-based purchasing across the insurance sector (Medicare, Medicaid, employer-based plans, workers compensation and open market plans) continue to increase the demand for the case management function. Many organizations are supplementing their workforce with travelers in order to meet immediate needs.
And frankly, case management is no longer a Monday through Friday 9 a.m. to 5 p.m. job. Many organizations are expanding case management services to 24/7/365 days a year. Coverage is also being extended into outpatient settings and specialty areas.
CASE MANAGEMENT SUPPLY FACTORS
Of concern is the continuing vacancy rate of nurse faculty to train new nurses and nurse specialties. The AACN reports that there continues to be about a 9% vacancy rate for nursing faculty (Fang et al., 2020). In addition, 88.6% of nursing programs prefer or require that faculty vacancies are filled with nurses with doctoral degrees (Fang et al., 2020).
Now, let’s think about the effect of the pandemic on our current nursing students. As widely reported across the United States, our schools, colleges and universities have instituted tele-education. There have been limitations regarding nursing student placement and the continuation of clinical rotations during the pandemic. Many nursing programs were also not prepared for the increased demand for simulation-based training. The pandemic has also increased stress levels and elevated fears typically experienced by nursing students (Lovric et al., 2020, p. 200), causing some nursing students to take time off. One of my nursing students stated the following: “In high school, I’ve felt overloaded with stress because of the thought of not being able to go to college and situate myself in a safe job that pays enough for me to just survive, at the least. Today, I’m afraid of not being able to even continue going to school due to my family’s low income.” Undoubtedly, these stressors will result in lower than expected nursing graduation rates.
IMPACT OF TECHNOLOGY ON DEMAND
Telemedicine applications have been expanded in most healthcare delivery systems. The pandemic has resulted in an acceleration of the digital revolution within healthcare. Unfortunately, the use of technology has created a greater divide in care delivery to vulnerable populations who have limited access and/or limited knowledge on how to use the technology. Long-term care’s technology infrastructure continues to be problematic and has left gaps in implementing technological solutions.
Case management telecommuting and expanded voice and video communication with inpatients have exploded within our work. Will these changes continue, or will we go back to the way we were doing things previously? Will meeting expectations change from video conferencing back to face-to-face in-person meetings?
IMPACT OF MENTAL HEALTH ON DEMAND
The pandemic has resulted in significant isolation and withdrawal as never seen before (Rooksby et al., 2020). Unemployment and virtual learning have reduced access to mental health and support services. Escalation of social determinant inequities has caused a significant pent-up demand and flashpoint for the United States (Cenat et al., 2020). The pandemic has created a reaction similar to burning rocket fuel. Other non-healthcare sectors, like criminal justice and immigration services, may also have a significant impact on the demand for social workers, mental health workers and case managers.
HOW CAN WE RESPOND?
The easiest option is to do nothing. I would argue that this is the wrong response for a healthcare sector demanding more case managers to meet the needs. A “do nothing” approach allows the market to develop a solution and takes away professional case managers’ ability to lead change and innovation.
Nurses have long been told that it is important to work at the top of their license. Isn’t this the perfect time to consider how case managers might accomplish this? A number of healthcare organizations are incorporating unlicensed case management associates to assist with the referral process, acquisition of personal care equipment and home oxygen services and arrange transportation for clients. Medical homes and community outreach programs are also considering how they can ramp up to meet vulnerable populations’ mental health needs. As a profession, this may be the time to consider the development of certification programs for case management associates.
When confronted with change, we need to consider how to find ways of improving agility, capability and capacity. The development of training and certification programs for case management associates will help us meet the needs of our next crisis – mental healthcare. Delivery of value-based and aligned mental health services will continue to create increasing demand for care management services.
American Association of Colleges of Nursing (AACN). (2020). AACN research brief: Employment of new nurse graduates and employer preferences for baccalaureate-prepared nurses. Retrieved from: 2020 Data on Employment of New Nurse Graduates and Employer Preferences for Baccalaureate-Prepared Nurses (https://www.aacnnursing.org/News-Information/Research-Data-Center/Employment/2020)
Cénat, J., Dalexis, R., Kokou-Kpolou, C., Mukunzi, J., & Rousseau, C. (2020). Social inequalities and collateral damages of the COVID-19 pandemic: when basic needs challenge mental health care. International Journal of Public Health, 65(6), 717 – 718. https://doi.org/10.1007/s00038-020-01426-y
Fang, D., Keyt, J., McFadden, T. (2020). AACN special survey on vacant faculty positions for academic year 2020-2021. Retrieved from: Research & Data Center (https://www.aacnnursing.org/News-Information/Research-Data)
Haas, S., Swan, B., & Jessie, A. (2020). The impact of the coronavirus pandemic on the global nursing workforce. Nursing Economic$, 38(5), 231-6.
Lovrić, R., Farčić, N., Mikšić, Š., & Včev, A. (2020). Studying during the COVID-19 pandemic: A qualitative inductive content analysis of nursing students’ perceptions and experiences. Education Sciences, 10(7), 188-206. https://doi.org/10.3390/educsci10070188
Rooksby, M., Furuhashi, T., & McLeod, H. (2020). Hikikomori: a hidden mental health need following the COVID-19 pandemic. World Psychiatry, 19(3), 399 – 400. https://doi.org/10.1002/wps.20804
U.S. Bureau of Labor Statistics. (2021). Occupational outlook handbook. Registered nurses. Retrieved from: https://www.bls.gov/ooh/healthcare/registered-nurses.htm#tab-6
U.S. Bureau of Labor Statistics. (2021). Occupational outlook handbook. Social workers. Retrieved from: https://www.bls.gov/ooh/community-and-social-service/social-workers.htm#tab-6