Summary
Contents
Subject index
This volume provides an in-depth and global study of nursing as a profession. The contributors project patterns about nursing now in to the future and present their views on how the profession should go advance. This volume contains 78 original chapters by 105 contributing authors, many of whom are elected Fellows of the American Academy of Nursing.
Case Management: Tomorrow's Vision
Case Management: Tomorrow's Vision
Since the mid 1980s, case management has exploded as a form of professional nursing practice in the United States and is gaining momentum in a growing number of other countries. Nurses for many years have used the case management process within community health nursing and other segments of the profession. However, tremendous growth in the number and variety of nurse case managers (NCMs) has occurred primarily in response to new and unmet needs for the delivery of high-quality, cost-effective health care. In the United States, multiple environmental factors have influenced development of nursing case management significantly. Causes include but are not limited to movement from fee-for-service to prospective payment methods for obtaining health and illness care, technological advances, and demographic changes in society. Today, the concept of nursing case management, although not well defined, is accepted as an essential nursing role within the health care delivery system.
When we as nurses think about the future of case management, three questions come to mind. Where are we now? Where are we going? And, how in the world do we get there? Although case management practice is interdisciplinary in nature and is practiced by multiple disciplines, in this chapter I focus on case management within nursing. First, I define nursing case management within the context of current practice. Then, believing that ongoing change is a necessary condition and expecting that the future can be shaped proactively, some thoughts are offered about the future of nursing case management.
Nursing Case Management: Context and Definition
Historically, case management has been recognized as an interdisciplinary field of practice within the health care delivery system, with the majority of case managers having educational and experiential backgrounds in social work, rehabilitation, occupational health, psychiatric–mental health and the like. With the advent of prospective payment for health services in the 1980s and the growth of managed care that followed, nurses have become an increasingly large part of the evolving case management industry and nursing case management has become a specialty within nursing (Mullahy, 1998).
Professional nurses have a unique knowledge and skill set that has added value to provision of quality care in a cost-contained and resource-constrained environment. Hence the unanticipated demand for nurse case managers escalated very quickly; they have been employed in large numbers, far beyond the reasoned expectations of nurse administrators and educators. As a result of the unexpected and generally unplanned expansion of the NCM role, almost any nurse today can be called a “nurse case manager” and nursing case management is practiced in nearly as many forms as there are nurse case managers. An axiom within the field of case management is: “If you have seen one case manager, you have seen one case manager.” The same is generally true within the practice of nursing case management.
Over time, nursing case management has been described as a system, role, technology, process, and service (Bower, 1992); strategy (Flarey & Blancett, 1996); care delivery innovation (Lynn & Kelley, 1997); and practice structure (Smith, 1993), among others. The Case Management Society of America (CMSA), the nations largest case management association, has defined case management as “a collaborative process that assesses, plans, implements, coordinates, monitors and evaluates options and services to meet an individual's health needs through communication and available resources to promote quality, cost-effective outcomes” (Case Management Society of America [CMSA], 1995, p. 8). Today consensus is developing whereby nursing case management is considered a process (Cesta, Tahan, & Fink, 1998; Mullahy, 1998; Rossi, 1999).
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