Agency Getting Rid of Case Managers

Our field nurses do thier own case management. It works for us as it's the field nurse that knows the patient the best. They make thier own calls etc, unless they run into an issue then call the Clinical manager for intervention. They seem to prefer it but then again I have a great group of field nurses who seem to love thier patients and thier job.

In my experience, it's best to hire case managers or train all nurses to case manage. Some agencies, very few, use LPN's to do field nursing and all RN's are trained to manage their own cases, i.e. Oasis SOC, ROC, and DC Oasis as well as Recerts. However, for the top hat, Case Managers should be getting much more pay (equal to PT's).

In our agency the field nurse is the case manager. It gets really hairy at times.

~Willow

Our field nurses do thier own case management. It works for us as it's the field nurse that knows the patient the best. They make thier own calls etc, unless they run into an issue then call the Clinical manager for intervention. They seem to prefer it but then again I have a great group of field nurses who seem to love thier patients and thier job.

We do this

Our agency has had field nurses and case managing nurses working together. Recently, the agency decided they are getting rid of the case managers position and the field nurses will be managing their own cases and doing the coordination of care (COC model). Has anyone gone through this change? Advice?

My first HH job was this way....CM's were in the office and had ultimate responsibility for client, but field nurses did the visits and had to make sure everything was done when they saw patient (MD calls, correct meds, oasis, communicating w/ CM's, ect) Then once a week we had case conference.

I left this position and went to a company were field RN's did case manage their own patients and had a VERY difficult time. It felt like I was working 2 jobs and 3 mos into the job I requested to be the admissions nurse so I wouldn't have to case manage any longer. I liked my new admissions nurse role and did it for about 6mos, until I got sick and quit (I have multiple sclerosis).

reflecting back ....I wasn't ready for the extra stress or the learning curve of becoming a case manager. Plus they started me out case managing 14 patients and kept adding to the list daily.

Good Luck!

Well, I've done it both ways in Home Health. The most recent job I had was as a case manager and was the one I just left because of being overloaded with on-call, driving really really far between patients, and being overwhelmed with constant changes because that agency had just switched to having their field nurses do the case management piece and they just didn't have a good process worked out for the switch before implementing it. Many of their old nurses quit - most of their new nurses had NO home health experience or experience with OASIS forms (one lasted only a few months) - what a disaster. I had a lot of experience with both and still thought it was impossible to do a really good job wearing either hat - i.e. field nurse or case manager. So I think a lot, if not ALL, depends on how high your case load is and how large your territory is (and this agency was very very vague about those two things during the hiring process . . . oh boy what a mistake on my part) . . . also whether or not you will be on a computer, which can be a nightmare if they are using a bad program. So I would suggest that anyone contemplating being an on-the-road case manager must do their homework really well and find out what other nurses are being expected to do, BEFORE you get all excited at the wondrous title of "Case Manager." I personally did not find the wondrous title at all worth the $15.02 per hour that I figured out I was making when I tracked my actual time for one two-week period. Live and learn. At this point, I don't think I will ever do it again. I actually got to the point that I woke up one morning saying to myself, "I don't ever want to be a nurse again. Ever." Which is quite a statement for someone who considers nursing her calling.

Right now we have 2 RN's and a case load of about 147 patients. Some are PT only but we still do the Recerts. It is tough.

Willow