Readers speak out on profession debate
A debate is sweeping through the case management community like a wildfire. It began as a small spark of controversy but has been fanned into a blaze hot enough to melt the deepest winter freeze. This debate centers on the very essence of who you are and what you do. It comes down to one simple question: Is case management a profession?
In October, case and care management organizations held a summit to better define case management and its certification needs. Also in October, the American Nurses Credentialing Center (ANCC) in Washington, DC, held the first exam for its new case management certification. During an interview about that certification project, Carolyn K. Lewis, RN, PhD, executive director of ANCC, told CMA that ANCC views case management as a "role or task" of nursing.
Taking it to the streets
For years, the traditional stand of case management organizations and certifying commissions has been that case management was a "specialty practice of a health care profession." Still, many case managers and industry observers believe case management soon will meet all the criteria for a true profession in its own right. (For more on the criteria, see CMA, December 1997, pp. 201-205.)
CMA took the debate directly to its readers. We faxed an opinion poll to 564 subscribers in mid-November and received 106 completed surveys by return fax for a response rate of more than 18%. The majority of respondents agreed with the traditional definition that case management is a specialty practice. Yet a surprising number of respondents say they believe case management is a profession. Results are:
• 65% said case management is a specialty practice within a health care profession.
• 26% said case management is a profession.
• 9% said case management is a role or task of a health care professional.
"I think I’m well aware that this whole issue is up for discussion. My own background is in social work," says Patricia Meehan, LSW, interim director of clinical resource management and social work at the University of Pennsylvania Medical Center in Philadelphia. "I’m the interim manager of a department of nurses and social workers. I view case management as a function, one of several, that we perform at this time."
Lucretia Craft, MN, RN, CS, chairwoman of the Nursing Case Management Test Develop-ment Committee, in a letter to CMA, writes, "While case management has not been recognized as a specialty by the American Nurses Association’s Congress on Nursing Practice, the ANCC acknowledges the importance of this evolving role. Since [ours] is a nursing case management examination, and given that nursing is the umbrella for the profession, case management is, therefore, defined as a role within the profession. The ANCC believes that nursing case management is a role-related area of expertise that crosses all nursing specialties."
Catherine Mullahy, RN, CRRN, CCM, president of Options Unlimited in Huntington, NY, and author of The Case Manager’s Handbook, polled her staff on the issue. "I recently attended a summit meeting with several case management organizations, and since this topic has been receiving a good bit of discussion these days, I thought I would conduct a survey of my own case management staff," she says. Of 10 case managers in the office the day of her informal survey, eight said case management is a specialty practice of a health care profession, and two said case management is a profession.
"My own view is that for now I consider case management an advanced or specialty practice setting within one’s own profession. However, when one considers the deciding criteria that would define a profession,’ we may soon see that case management is considered as such," Mullahy says.
Others argue that because case management is so different from the profession they trained for, with its own distinct skill sets and knowledge base, it qualifies as an autonomous profession. "This is totally different from what I did as a nurse. It’s a profession I have pursued that is independent of nursing, and I don’t believe that my nursing license is required for what I do," says one RN, CCM, who is the manager of utilization, case management, and discharge planning for a managed care organization.
This debate is not merely an academic exercise. The professional identity of case managers determines the standards of practice and code of ethics to which they are held by the public and by the courts. If your profession is nurse, and case management is a task you perform, you will be held to standards established by the American Nurses Association (ANA) in Washington, DC.
If your profession is social worker, and case management is a task you perform, you will be held to the standards established by the National Association of Social Workers in Washington, DC. If your profession is case management, you will be held to the standards of practice and code of ethics established by the Case Management Society of America (CMSA) in Little Rock, AR. Finally, if you are a nurse by profession whose specialty is case management, you will be held to both the standards of the ANA and CMSA, which is where things currently stand.
It’s not a clinical role
"The discipline and specialty of case management is separate and distinct from nursing practice," says Marcia Diane Ward, RN, CCM, market segment manager for IBM Healthcare Solutions in Atlanta. "If that was not the case, nursing schools would be required to incorporate case management into their core curriculum just as they now include obstetrics or medical/surgical training," she says. "It would have to be a mandatory part of that core nursing training in order to be a task’ of the nursing profession. But it isn’t. Case management is not a clinical role. In many ways, the entire role of the registered nurse is transitioning into more of a business role. This may be difficult for many individuals to accept or recognize."
[Editor’s note: A copy of the opinion poll is inserted in this issue. If you did not already have a chance to respond, it’s not too late. Please complete the inserted survey and return it to us by fax to: Park Morgan, associate managing editor, at (800) 850-1232.]
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