I think that as an ethical obligation, I would tie up as many loose ends as I can then verbalize my concerns to both the clinical manager and the new case manager (maybe even the MD office). I would hate to be on the receiving end of a "problematic" case that absolutely jack was done to resolve any current issues. I definitely would feel bad if this patient where to be passed around like a game of hot potato and Im sure when the satisfaction survey comes in the mail to them, they would also complain about lack of consistency on the RN behalf; perhaps a discussion needs to be made to address possible safety issues/liabilities for both RN/agency or patient!