Do you lose nursing skills as a nurse case manager?

nurseprnRN, BSN, RN · Mar 14, 2014

Only if you think that nursing skills are only the ones you do with your hands. You will be developing and strengthening the nursing skills of care coordination, communication, assessment, collegiality, judgment, documentation, and many more. You can be a CCM if your basic licensure allows you to make assessments, which, as an LPN, you can't, but as you gain your RN, you can.

LeavingTeaching4RN · Mar 15, 2014

You will learn new skills. However, I no longer fill comfortable starting IVs, but I was never great at that skill anyway. I don't know anyone who leaves bedside nursing and wants to return though. There is a CM in my department, who is in NP school. You will continue to have clinicals in school. Also, as a CM, you are assessing patients constantly. I am still a nurse. I still assess and diagnose people even in the grocery store.

toomuchbaloney · Mar 16, 2014

Nurse Case Managers who work in workers compensation or other insurance based positions do not provide nursing care. They do not assess patients. Those case managers advocate for their patients by coordinating care across the spectrum of treatment necessary to achieve a return to normal for the patient as quickly and cost effectively as possible.

If that is the type of case management you are pursuing you will likely experience a loss of the basic "clinical" nursing skills that you have worked hard to develop.

nurseprnRN, BSN, RN · Mar 20, 2014

Nurse Case Managers who work in workers compensation or other insurance based positions do not provide nursing care. They do not assess patients. Those case managers advocate for their patients by coordinating care across the spectrum of treatment necessary to achieve a return to normal for the patient as quickly and cost effectively as possible.
If that is the type of case management you are pursuing you will likely experience a loss of the basic "clinical" nursing skills that you have worked hard to develop.

Wrong-o. Of course we assess patients. We do different kinds of assessments than we did when we worked bedside, of course, because the patient population is different. For example, I may assess gait, endurance, range of motion, knowledge; I may determine several nursing diagnoses; I coordinate care with other providers and collaborate with them on the results of their treatment plans and my plan of care; I advocate; I document; I teach. The reason that telephonic case managers who manage cases across state lines have to have licenses for those other states is precisely because we are delivering nursing care, per the state boards of nursing there.

If you check out the nurse practice act or the ANA Scope and Standards of Nursing Practice, I guarantee you that the description of our responsibility will be congruent.

I stand by my opinion that the only reason you would think that you would lose "your nursing skills" is if you think the only ones that count are those done in bedside care. First, things like auscultating heart sounds and breath sounds, doing a peripheral perfusion check, and even sticking sharp or long tubular things into people are a lot like riding a bicycle-- you never really forget how to do them; if you don't do them for awhile you might be rusty but it comes right back.

There is so much more to nursing than bedside care, just as there are so many different kinds of physicians or therapists or teachers or architects or carpenters. The nursing skills of assessment, analysis, planning, implementing, and evaluating are different in different clinical areas-- think the differences between PICU, LTC, orthopedic clinic, high-risk OB, hematology, work comp-- and we all do them in different ways. Even though we are all nurses, that is why we don't say, "A nurse is a nurse is a nurse."

Since many people go to an expanded role like case management and don't come back, I don't see becoming rusty at bedside skills as an issue. Even if you aren't sure whether you like something new, you go into it not with anticipatory grieving for things you might never do again, but with a good attitude of, "What can I learn here?" You discover a whole new part of nursing (and yourself) you didn't know was there. It's not a thing to be afraid of, it's to embrace with excitement.

mclennan, BSN, RN · Apr 12, 2014

Thanks GrnTea, you are spot on as usual in your analysis of CM nursing skills. In 7 years I've done clinic and public health nursing & home health which both involved case management of complicated patients, and the last 2 years full time case management nursing, mostly telephonic coordination of post-discharge patients & some inpatient work.

I love it because I actually use the nursing theory, clinical judgement and critical thinking I learned in school. I have to assess my patients in a truly "wholistic" manner, rather than just focusing on their vital signs and physical state, or immediate illness. CMs also assess patients' mental, social, financial, spiritual and even sexual wellness and coordinate access to the care they need. We truly utilize the tenets of nursing theory and collaborate every day with every member of the team, docs, NPs, PAs, other nurses, social workers, utilization/reviewers, discharge planners, unit coordinators, pharmacists, DME & home health agencies. We make sure all these entities are communicating, to carry out the best treatment plan...and cut costs for everyone. We are the ultimate behind the scenes forces for good!!!! And I don't care about "losing" my hands on skills.....I know they'll come rushing back if I ever decide to use them again.

toomuchbaloney · Apr 12, 2014

As a workers comp RN I was not assessing patient as a nurse. Rather, I was assessing patients as an insurance employee using my nursing knowledge and background to facilitate good, timely, and effective treatment plans. Certainly my nursing experience informed my ability to assist in making plans which were patient centered and I believe that insurers who employ nurses to engage in this way improves their service to the insured. But coordination of those services does not require a nursing education and many who function as case managers are not nurses, unfortunately.

I prefer case management in a clinical setting, personally. Hospice was my favorite.

nurseprnRN, BSN, RN · Apr 13, 2014

As a workers comp RN I was not assessing patient as a nurse. Rather, I was assessing patients as an insurance employee using my nursing knowledge and background to facilitate good, timely, and effective treatment plans. Certainly my nursing experience informed my ability to assist in making plans which were patient centered and I believe that insurers who employ nurses to engage in this way improves their service to the insured. But coordination of those services does not require a nursing education and many who function as case managers are not nurses, unfortunately.

This reminds me vaguely of the younger women who say they aren't feminists or "women's libbers." Oh, don't misunderstand them-- they are all for equal pay for equal work, equal opportunity, equal education, the rights to sign their own contracts, initiate divorces, and all other benefits of work and citizenship afforded men-- but they aren't feminists, oh no.

Newsflash: You are nursing when you assess those IWs using your nursing knowledge and background to facilitate good, timely, and effective treatment plans. That's about as concise a definition of nursing as the ANA can write itself. They don't hire you because you're a better-educated adjuster with a facility for medical vocabulary-- they hire you because you're a nurse.

toomuchbaloney · Apr 14, 2014

I understand that, as I said, my nursing informs and improves my ability to plan for patients. Companies who do not employ nurses in this role do not provide adequate case management for the workers, in my view. It is true, however, that the job can be done (not as well) by a non-nurse.

nurseprnRN, BSN, RN · Jun 13, 2014

Well, hell, there are lots of jobs that can be done (not as well) by someone who doesn't know how to do it well. I could teach sailing, but I'm not a very good sailor. I could teach singing, and I have a decent voice, but I am not a trained singer teacher. I know how to use basic tools, so I guess I could build a shed, but not a very sturdy one. Nobody in his right mind would hire me to teach sailing, be a vocal coach, or build a tool shed.

And so your point would be?