New to the field - Acute ER case manager needs advice on typical workflow


Hello everyone!

I need some advice from all the ER case managers out there about how to be a good ER case manager. No previous experience in the ER or case management but i have experience working in the academia as a professor, nurse in a nursing home, worked for a busy doctors office, and currently working in an acute magnet hospital in a med surg/ step down unit.

Can anyone please describe a typical workflow of case managers especially in the ER? What skills do you need to survive in the field?

Specializes in ED, ICU, MS/MT, PCU, CM, House Sup, Frontline mgr. Has 15 years experience.

You need business, nursing/clinical, and communication/leadership skills to be effective as a Nurse CM in the ED. To be a good one, you need to know your resources and think fast on your feet to problem solve. What is expected of you will depend on your employer. The work flow can be very hard if you are expected to do everything, there are very little resources, and you do not have a Social Worker to deal with the things that have nothing to do with nursing because it will suck up your time.

For example, without a social worker, you will be dealing with complicated non-skilled social discharges like the frequent flyer homeless person seeking a shelter or an elderly person who has no idea who he/she is or where he/she lives but is in the ED and ready to go home. Or a family abandoned (this is not legal) your patient in the ED who has no reason to be in the hospital but has no support system at home.

If you have a social worker, you will then be very involved with the nursing aspect of this job. You will be involved with admissions and complicated skilled discharges from the ED. For example, you will order equipment and arrangement for delivery, send patients with skilled needs to SNFs or Acute Rehab, you will evaluate admissions and discuss cases with the MDs, and you will arrange for support or Home Health for patients that need this to discharge. Basically, you are involved with safely discharging patients from the ED and/or admitting appropriate or blocking the admissions of inappropriate patients to the floors.

Therefore, if there is no social worker, advocate for one! Demand that there be one available so you can do your clinical job. Doing both jobs in the ED is not a cost-effective way of using nurses. Inappropriate admissions will happen more often than not if the nurses are not available to work with the MDs and the patients for clinical reasons. Good luck!


10 Posts

Thank you for giving a very detailed information. I think we do have social workers in the ED. Do I need to be certified in PRI, etc. before I start orientation? But I would guess that they will provide that avenue for the certification. I just want to be prepared and have all the tools before I start orientation so I can keep up with the pace. Do you also recommend attending seminars about the field of case management? and if so do you know any good ones? Thanks again you've been very helpful.

Specializes in ED, ICU, MS/MT, PCU, CM, House Sup, Frontline mgr. Has 15 years experience.

I think your organization has an obligation to get you up to speed. It is admirable that you want to learn as much as you can prior to starting work, but it is not only unnecessary, it will be confusing because not every environment is the same.

As for seminars, the best ones I have attended were through my employer. Your employer is able to connect to training organizations and they pay for them! :) However, outside of work a good place to start to find informaton regarding case management in your area is through your local chapter of the Case Management Society of America. Case Management Society of America > Home