What is the difference between the hospital CM and SW?

nurseprnRN, BSN, RN · Jun 19, 2014

Case management, by definition and for purposes of this discussion, influences the delivery of medical care. Social workers can be case managers but they aren't nurse case managers. The nurse case manager is going to have a more clinical focus, although she too will be involved in the nuts and bolts of discharge planning. Real case mgmt has a lot more going for it that just discharge planning-- coordinating services, looking at utilization, patient teaching, referrals to other specialties, interacting with multiple providers to make things easier and more streamlined for the patient, and more.

As a matter of fact, if all someone does is discharge planning, his/her job description doesn't meet the criteria for sitting the certification exam (either CCM or RN-BC).

And there are many, many case managers who aren't in hospitals at all, but direct and coordinate care in other settings, like outpatient, insurance, clinics, assisted living, and others. Note, sometimes VNAs call all their RNs "case managers," and sometimes they are and sometimes they aren't. Ask.

You can go to the ANCC and CCMC websites and check the exam blueprints for an idea of what a case manager does.

nursechris1 · Jul 17, 2014

Where I work, the nurse case managers don't do any patient teaching. We do initial assessments to find out what the patient's support systems are, what their baseline was at home for ADLs. We coordinate with the therapists and the physicians to determine what the person's discharge needs are. We don't always have a SW working with us, so we also set up discharge referrals. We fax clinicals to insurance companies. We are supposed to be looking at the pt status, inpatient or observation, make sure they are in the right status. We are supposed to review the chart to make sure they meet inpatient criteria upon admission and ongoing. I have found most of our day is spent doing initial assessments and discharges. Some patients are easy, you walk in, they need home health, you find out who they want to use, then you set it up. Other situations are complex. We had one patient that needed to be placed. She had behavioural issues. We called 44 facilities, nobody would take her. She was with us for 3 months. Finally discharged her to the homeless shelter.

Stripes311 · Jul 22, 2014

Thank you both for your responses, I appreciate it the insight.

RN010101 · Jul 27, 2014

Where I work, the nurse case managers don't do any patient teaching. We do initial assessments to find out what the patient's support systems are, what their baseline was at home for ADLs. We coordinate with the therapists and the physicians to determine what the person's discharge needs are. We don't always have a SW working with us, so we also set up discharge referrals. We fax clinicals to insurance companies. We are supposed to be looking at the pt status, inpatient or observation, make sure they are in the right status. We are supposed to review the chart to make sure they meet inpatient criteria upon admission and ongoing. I have found most of our day is spent doing initial assessments and discharges. Some patients are easy, you walk in, they need home health, you find out who they want to use, then you set it up. Other situations are complex. We had one patient that needed to be placed. She had behavioural issues. We called 44 facilities, nobody would take her. She was with us for 3 months. Finally discharged her to the homeless shelter.

Hi everyone. I'm a new case manager. Any advice on how to fit all this in a working day? I've been working 12 hour days 5 days a week instead of 8 hour days. Any advice on how I can prioritize? Do you assess all the patients? If not, how do you determine if a patient needs an assessment? Is working overtime everyday the norm?

SummerGarden, BSN, MSN, RN · Jul 28, 2014

Hi everyone. I'm a new case manager. Any advice on how to fit all this in a working day? I've been working 12 hour days 5 days a week instead of 8 hour days. Any advice on how I can prioritize? Do you assess all the patients? If not, how do you determine if a patient needs an assessment? Is working overtime everyday the norm?

Are you salaried? If so, yes it is the norm to work 12 hour days 5 days a week and not get paid OT, but it is NOT legal. In fact, there are class action law suits of recent that, if I were you, I would point my employer too. They are based out of California on behalf of nurse case managers. The CMs won the law suits, so maybe your employer will wise up rather quickly??? If not, you must set boundaries...

Stop working OT and get out on time! If major things do not get done in a timely manner, then it is your employer's fault and not yours. You department is understaffed and/or under trained and this needs to be corrected ASAP!

As for your other questions, assessments are important but it depends on the unit. I work in EDs. Within some EDs I will do every assessment and some I do not. The bigger EDs I do not because there are too many other things I need to do and I cannot get all of the assessments done. UR, discussions with doctors, and safe arrangements for discharge are priority (those patients get assessed, BTW) compared with every other patient that will be admitted and discharged many days from now.

On the other hand, when I work on the floor units, assessments are naturally priority and so are the current patients up for complicated discharge. So prioritize the patients that are leaving today and tomorrow and circle back to cover the new admission assessments in-between other things you do. Low priorities are patients who may not discharge 2 days or more from now and who are not admitted today.

Now, given that a unit is dynamic you will be hit with fires all the time! Fires only take priority over your other priorities on a case-by-case basis. Learn to talk to your unit staff and physicians to guide the discharge rather than have them guide you. You will find that you may have fewer fires to put out in the future.

Also, just because a patient and/or his/her family members think something is an emergency, does not make it so. Thus, do not allow low priority patients (based upon when he/she was admitted or is to be discharged) suck up a lot of your time. Get really good at getting out of conversations and doing things for patients that will reduce your productivity and efficiency on your unit for the day.

In addition, if you are waiting for return calls, bug the recipient! In other words, significantly reduce the number of things you are willing to wait to occur. For example, do not wait for a vendor to return your call beyond 30 minutes or so. If you gain a reputation that you are impatient, outside vendors and organizations will learn that you are a Case Manager that wants and needs things to happen now or you will go with someone else. If he/she wants your business, they will learn quickly to be quick.

Good luck. Hopefully some of what I have written helps. Again, set boundaries on the OT... In fact, stop doing it! :)

RN010101 · Jul 28, 2014

Thanks so much for the advice MBARNBSN! I've been struggling since I'm new to CM. The UM, discharge planning, obs vs inpt, MD and staff coordination, etc. has just been overwhelming. I feel there is not enough time in a day to finish everything. I'm trying my best to learn the skills of a CM and trying to train myself to have the mindset of a CM. Thanks again for the great advice!

Paul B · Jul 30, 2014

I would recommend going to some of the career and job websites - and looking at the descriptions of the CM role and qualifications. This will give you a good overview of a variety of CM jobs - their environment, their specific duties, etc. I would also consider whether you want to work on a provider vs. a payer side. If you really want a job in case management - consider taking a certificate of certification course - this will help you to understand this new career path you are considering and will also give you an advantage when applying for a job. Some people even consider getting a case management certification - you can find such info by doing a search using some of these keywords - qualified case manager certification RN. hope this helps.

nursechris1 · Jul 9, 2015

So it has been a year since I posted on this thread. I can genuinely say case management is the worst job I have had in my nursing career. It is probably one of the least appreciated jobs. I don't feel good about what I do. I am the mean one who has to walk in the patient room and tell them they no longer meet criteria to stay, that they don't meet inpatient criteria or the 3 night stay needed to go to rehab. Sorry, you will have to private pay for rehab. We are the ones who go in after the doctor admits them to the hospital for placement and has to tell them that's not how it works under Medicare. Or the when doctor tells them they will get a 3 night stay for ankle surgery. We are the nurses who struggle to find placement for the underinsured homeless alcoholic and get the heat when the patient is still in the hospital a week later. We get to tell patients or their families that they are no longer safe to return home. We have to tell families of dying patients, I am sorry your loved one can't die here, we have to transfer him somewhere else (unless they might die on route).

Now the hospital system is cutting staff. People are quitting. At least 10 people have quit our department in the 17 months that I have been there. Several of those positions have not been replaced. Staff call in sick frequently.

I really thought it would be a job that would be low stress, boy was I wrong!!

Libby1987 · Jul 9, 2015

So it has been a year since I posted on this thread. I can genuinely say case management is the worst job I have had in my nursing career. It is probably one of the least appreciated jobs. I don't feel good about what I do. I am the mean one who has to walk in the patient room and tell them they no longer meet criteria to stay, that they don't meet inpatient criteria or the 3 night stay needed to go to rehab. Sorry, you will have to private pay for rehab. We are the ones who go in after the doctor admits them to the hospital for placement and has to tell them that's not how it works under Medicare. Or the when doctor tells them they will get a 3 night stay for ankle surgery. We are the nurses who struggle to find placement for the underinsured homeless alcoholic and get the heat when the patient is still in the hospital a week later. We get to tell patients or their families that they are no longer safe to return home. We have to tell families of dying patients, I am sorry your loved one can't die here, we have to transfer him somewhere else (unless they might die on route).
Now the hospital system is cutting staff. People are quitting. At least 10 people have quit our department in the 17 months that I have been there. Several of those positions have not been replaced. Staff call in sick frequently.
I really thought it would be a job that would be low stress, boy was I wrong!!

I would take your experience and head over to home health as a patient care case manager. (Or intake coordinator if you're trying to stay away from patient care and driving). Both are hard work but IMO it's much better to be hero of the day then messenger of bad things. (I've worked in UR so have an idea of what that's like).

SummerGarden, BSN, MSN, RN · Jul 10, 2015

So it has been a year since I posted on this thread. I can genuinely say case management is the worst job I have had in my nursing career......
I really thought it would be a job that would be low stress, boy was I wrong!!

Thank you for checking back in and updating us on your progress! Yes, Case Management in the hospital setting is very very challenging for the reason you posted. Are you planning to stay? If not, as another posted, you may find case management in a different setting a better fit.