By Amy S. Chartier MSN, BA, RN, CMGT-BC

“Room 410A would like hot sauce for his lunch.”
“We don’t have hot sauce; I don’t even know where to get some.”
“Ask the case manager, they’ll know.”

In the eleven years I’ve been a nurse case manager in an acute care setting, the case management department has been a catch-all.  Anything and everything related to a patient, and sometimes not, is asked of case management. I‘d love to use the saying “jack of all trades, master of none,” however I feel that for a case manager, it should read, “assumed (very likely) master of all trades,” which is pretty accurate, nurse case managers have acquired a depth of knowledge that in my opinion, isn’t learned in any other nursing field.  In 2024, Social Determinates of Health have become (finally) recognized as part of patient’s treatment plans. We are caring for patients in a post-COVID world, which has indefinitely changed the map of healthcare. Telehealth is one of the most significant adaptations from COVID; although it isn’t a new medium for patient care, it has become more mainstream.
Hospital capacity has been a consistent and steady challenge, with the shortage of skilled nursing facility beds, dialysis chairs, and increasing restrictions from insurance, to name a few barriers to discharge. Nurse case managers must adapt and become increasingly creative about discharge plans. How creative is too creative? We have a scope of practice, and working in an acute care setting, where the movement of patients is critical, how deep do we dig into our bag of tools? Sending a patient home with home care has become a challenge, with referrals being sent to over ten agencies before receiving an acceptance.  Familial relations seem more complicated; patients have more significant needs, but where does an acute care nurse case manager draw the line regarding readying a patient for discharge?

I recently did a presentation on readmissions and the role of the professional nurse case manager. The recent publication of “The Impact of Case Management on the Healthcare System” by CMSA inspired me to educate those disciplines around me about what we do. With that said, I realize it also affects this blog that I’m writing because while I have no difficulty discussing the role of the professional nurse case manager, I am again questioning how far is too far.  The profession has so much responsibility and knowledge to apply when preparing a safe discharge; this recent publication emphasizes the extraordinary care continuums that patients need to be equipped to navigate, not including the populations we serve and their disparities.
There is so much to think about, so many gaps to fill, and so many in need of aid that isn’t always immediately available, especially when discharged from a hospital setting.  Again, I’m asking myself and now my peers, how far is too far?

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Bio: Amy is a board-certified nurse case manager with 10 years of experience in case management, I also have an MSN in Nursing Education that I earned in 2020. I have worked in both acute care and community settings as a nurse and a nurse case manager. I have 6 years’ experience as a medical/surgical nurse where I developed a foundation of patient care, patient acuity, and patient relationships. I am highly motivated and very adaptable to change in healthcare. I am very passionate about nursing and am proud to be part of the profession. I value education whether it be through advanced degrees or webinars/conferences. I have a great desire to become a leader and help others develop skills that I have developed throughout my nursing career. I currently hold a position as the clinical educator for the Care Transitions Department at Lahey Hospital & Medical Center and am an active member of both CMSNE and CMSA.