Nursing shortage takes toll on CM departments
What can we do to combat the nursing problem?
By now, news of the country’s shrinking nurse work force probably has reached all points on the health care map. An extensive review of population data, published in the Journal of the American Medical Association, confirmed that within 10 years, the average age of registered nurses will rise to 45.4 — with 40% of the work force older than 50.1 Hospital Case Management’s annual salary survey shows that among hospital-based case managers, age is shifting the same way. (For the complete report, please see HCM’s salary survey article in this issue.)
But how does that affect hospital case management departments, and what is being done to solve the problem? Judy Homa-Lowry, RN, MS, CPHQ, president of Homa-Lowry Health-care Consulting in Canton, MI, says that in some organizations, RN case managers are shared with other departments.
They perform both case management and on-the-floor patient care. Sometimes that causes higher stress levels and increased burnout rates, with case managers performing double-duty and doing extra paperwork. Whereas the traditional case management role was largely "Monday through Friday," it now includes evenings, weekends, and holidays, she adds.
"If you’re in an area with a lot of shortage," Homa-Lowry says, "your professionals are going to be doing a lot of things, and that will affect what you’re doing in the case management department."
State of transition
The shortage of personnel "makes the role of the case manager even more important," she says, but it also "puts the hospital case management department in a state of transition." Your success depends on your organization’s philosophy of case management, she says. The department, and the role of each person within it, should be clearly defined in order to bridge the current trends.
"Roles are evolving because of the nursing shortage. We need a value-added analysis [of the case manager’s role] to determine what functions they should retain and what should be eliminated."
Homa-Lowry says one hospital tried to deal with the problem by investing a lot of money in case management. It hired a lot of high-level individuals and absorbed the hospital’s utilization review staff as well. "Still, it is not able to execute." For that hospital, case management looks great on paper, but striking the right balance between patient care roles and management roles has been difficult.
During this time of nursing shortages, organizations need better definitions of case manager responsibilities, continuing staff education, good monitoring, and staff compliance with their defined roles, in order to achieve success, she explains.
What’s being done about it?
Enrollment trends at U.S. nursing colleges haven’t helped the current situation. "Nursing schools across the nation purposefully have downsized their programs and reduced the number of students they admit, in part, because there aren’t enough nurse faculty members to go around," and also because of a lack of interest from young people, says Lucy Leusch, director of graduate admissions at Emory University’s Nell Hodgson Woodruff School of Nursing in Atlanta. Admissions professionals are doing what they can to reverse the shortage for future generations.
"We’re doing some innovative things in partnering with hospitals, both to recruit students and to help them employ nurses," Leusch says.
One such program is NEAT, or Nursing Employment and Tuition — a partnership with the university’s health system, Emory Healthcare. The system pays 50% of tuition for 20 incoming students (BSN) per six-month semester, and in return, those students agree to work within the system after graduation for an equal six-month period.
Renewable each semester, NEAT can lead to up to two years of nursing employment for the hospital system. Other colleges have similar programs with their neighboring health systems.
Nursing faculty members also are interested in visiting secondary schools, and even elementary schools, to educate young people about the positive aspects of health care careers. And the American Association of Colleges of Nursing in Washington, DC, has assembled a new national task force to advise its members about recruiting more nurses and keeping them in the profession.
"What case management does for nursing is to create a career adjunct, similar to advanced practice fields, that provides nurses with another career option, explains Diane Huber, PhD, RN, FAAN, CNAA, associate professor at the College of Nursing at the University of Iowa.
"Seen as an attractive advancement, case management is a positive recruitment mechanism for potential new nurses. It is a way to showcase skills in expert clinical judgment, critical thinking, problem solving in complex situations, and advocacy across the health care continuum," she says.
Lack of communication is the real issue affecting the work of case management, Homa-Lowry continues. "It’s not necessarily the number of bodies; it’s that various disciplines [within the care continuum] aren’t complementing each other and sharing data. When you’re planning care, the unit manager or head nurse and the case manager need to be on the same page," so that effective care can be administered, Huber says.
Often, the lack of sharing is not by design, but the case management department needs to make a conscious effort to meet with other departments, in terms of similar information needs and outcomes, she says.
In addition, people need to know about the good things case management is doing in patient care, Homa-Lowry asserts. "It would be nice to measure good patient care outcomes, not only pathway adherence or payment measurement. That will take some work on the part of case management."
For more information, contact:
Judy Homa-Lowry, RN, MS, CPHQ, President, Homa-Lowry Healthcare Consulting, Canton, MI. Telephone: (734) 459-9333.
Diane Huber, PhD, RN, FAAN, CNAA, Associate Professor, College of Nursing, The University of Iowa, Iowa City. Telephone: (319) 335-7122.
Lucy Leusch, BS, Director of Graduate and Professional Admissions, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta. Telephone: (404) 727-6674.
Reference
1. Buerhaus PI, Staiger DO, Auerbac DI. Implications of an aging registered nurse workforce. JAMA 2000; 283:2,948-2,954.
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