What preparation do CMs really need?
Here’s one educator’s tough stance
If you think that bachelor’s- or perhaps master’s-level preparation isn’t necessary for case management professionals, consider this: Would you take your child to a physician with only two years of formal medical education?
"As a profession, nurses and nurse case managers must get beyond the debate over whether they must be bachelor’s prepared, if they want to be viewed as professionals," says Gregory L. Crow, RN, BSN, EdD, director of the leadership and case management programs for the school of nursing at Sonoma (CA) State University. "Every other professional group in health care has recognized this problem and addressed it. Physical therapists, respiratory therapists, and pharmacists have all addressed the issue of mandatory bachelor’s-level preparation for entry into the field. The time has come for nursing to do so as well.
"I’m not saying for one moment that associate-degree nurses aren’t good nurses. I started my own career through a diploma program. I am saying that the associate degree is the beginning point of our nursing education, not the end point," says Crow.
"The health care system in this country continues to go through a restructuring process. If we don’t have nurses who understand the financial implications of the systems they work with and within, they can’t affect change," he notes. "As nurses, we are simply shooting ourselves in the foot if we say education doesn’t matter." (For a quick look at qualifications hospitals look for in case managers, see box, p. 111. For one case manager’s view of the marriage between education and accreditation, see p. 113.)
Sonoma State was the first nursing program in the country to offer an RN-to-BSN program in the early 1970s, Crow says. Since 1995, the university also has offered a distance-learning case management master’s program for nurses delivered first via teleconference and now with the addition of Internet access.
Students in the case management master’s program are required to take courses in these areas:
• health policy;
• nursing theory;
• professional issues, including legal issues related to advanced nursing practice;
• financial management, including production of a business plan related to case management;
• systems theory;
• case management theory.
"Systems theory is a new requirement for the case management program," Crow says. "I have talked to too many case managers who found themselves plopped down into a system that didn’t support case management. The course is designed to help students analyze different health care system models from more than one perspective."
Students are required to take two semesters of case management theory. In the case management theory courses, students follow a patient population, such as congestive heart failure patients, and prepare an analysis based on the case management framework developed by the Case Management Society of America in Little Rock, AR.
"Students follow that population on a micro-level and come out of the first semester with a case study that includes outcomes and cost data relative to that population. They work with a mentor to solve case management problems or implement a case management program for a specific patient population. We encourage students to think broadly," says Crow.
In the second semester of case management theory, master’s program students look at the macro-level. "They look at systems of case management across the continuum of health and across the continuum of life — a horizontally and vertically integrated approach," he says. "When they graduate, they are exhausted. It’s a tough program."
The information age we’ve entered requires case managers to identify data-gathering needs and make fact-based decisions, he explains. "Those are skills I didn’t get from either my diploma program or my baccalaureate program. Those advanced skills go beyond knowing research and move into why and what and how to analyze data. There just isn’t time to develop those skills properly in most baccalaureate programs."
(Case Management Advisor has been following the debate over case management education and certification needs. See the following CMA articles for more discussion: January 1997, pp. 1-6; November 1997, pp. 191-195; December 1997, pp. 201-205; January 1998, pp. 1-8; March 1998, pp. 42-47; April 1998, pp. 57-60; December 1998, salary survey supplement.)
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