By Karen Hooven RN, BSN, CRRN, CCM

Are you an Assertive or Aggressive Case Manager, or a combination of both? Or do you consider yourself  "firm"? Does it matter?  

It does matter. Whether you are Assertive or Aggressive could significantly influence your patient's transition of care and patient experience. Many case managers are a combination of both. However, it's crucial to understand that assertive communication, when used effectively, can empower you to advocate for your patients and improve their outcomes. How we present ourselves verbally, emotionally, and professionally impacts our role as case managers.  

According to Google, being assertive means having a confident and forceful personality and communicating with others directly and honestly without intentionally pursuing our aims and interests. Google defines aggressiveness as unfavorable, forceful behavior, boldness, and pushiness.  

There is a fine line between being too assertive and needing to be more assertive. An example would be that your patient is ready for discharge, but the doctor is reluctant to discharge because the family says, "Can't we discharge tomorrow? We're not ready at home". As a case manager, what is your inclination? I would call the doctor and explain that if the patient is medically ready to discharge, then the patient should be discharged. I would meet with the family and explain this. This demonstrates honesty and directness, two traits of assertiveness. I would not recommend calling the doctor and saying, you are wrong to coddle this family. The patient is medically ready, so write the discharge orders. I suggest not meeting with the family and telling them they must leave without an explanation. This example displays aggressiveness, forceful behavior, boldness, and being pushy. Would you agree?  

Maybe you wouldn't say anything to the doctor, let the discharge happen when the family wants it.  

Which scenario would you pick? The scenario you choose is the assertive one.  

Speak up if the patient is indeed medically cleared and the family clearly just wants to wait another day. We are obligated to improve throughput and decrease LOS.  

It can be challenging not to be aggressive with some families and patients. It is frustrating when we know the family is stalling and the doctor is capitulating to the manipulative family. It is time to put on your assertive hat, investigate the circumstances, and discuss with the Physician. Include the Nursing team also whenever possible.  

I have found that as I continue to grow and develop as a case manager, the manner in which we resolve issues, speak with Physicians, etc., changes. I firmly believe that the circumstances are different for each patient scenario. Sometimes, we need to be more aggressive than assertive, and vice versa.  

I would strongly encourage all case managers to empower themselves by engaging in thoughtful reflection on topics such as assertiveness and aggressiveness. This self-reflection is not about labeling yourself but about understanding your communication style and its impact on patient care. It's a journey of professional growth and continuous improvement.  

Live Webinar Next Week! Register for this vital webinar on "Ethical Considerations in Surrogate Decision Making: Family Meeting Guide" with presenter Alixis Van Horn, RN, MSN, APRN, ACPHN: 🔗 WHEN: Thursday, May 16 at 12pm ET - Pre-Approved CEs: 1 hour RN, SW, and CCM Ethics. Surrogate decision-making poses complex ethical challenges. Learn to navigate legal, cultural, and personal biases while conducting patient-centric meetings. Don't miss this essential discussion! Free to Members.

Bio: Karen Hooven RN BSN CRRN CCM is the manager of the Care management dept at Cleveland Clinic Medina Hospital. She has over 25 years of case management experience-Acute and Rehabilitation. She is the co-founder of the Cleveland Chapter of CMSA, now 8 years old, and is the current president of the chapter.