By Sandra Zawalski, MSN, RN, CRRN, CCM, ABDA, MSCC
If someone had told me 40-plus years ago that my nursing career would take a different avenue from direct patient care, I would have laughed at them. I loved working with patients and their families and thought there was no better way to continue my love for nursing.
Then, in 1987, I met Carol, a workers’ compensation case manager, who came into the brain injury rehab hospital where I was the director to attend a patient conference. It was here I learned what a case manager was. Remember, back then, not many had even heard of the title Case Manager, let alone know what one did. There was no code of ethics, practice standards, or certification tests!
Carol and I began to talk about her role and why she liked it. Six months later, I found myself being mentored and coached by her in the field of workers’ comp case management. The autonomy, flexibility, and sense of making a bigger impact in healthcare had a strong pull on me. Thirty-six years later in case management, I have never looked back.
Although I do envy my friends and colleagues who remained at bedside nursing, especially knowing how the role of the nurse has changed throughout the years, I have no regrets about the path I have chosen.
My case management expertise expanded into catastrophic case management, senior, and everything in between. The conversations between a case manager and physician are much different than being in direct patient care. It is here, as a case manager, that I truly find myself being able to be a patient advocate.
When discussing with new nursing grads what a case manager is, the statement, “So you are no longer a nurse,” is like hearing nails on a chalkboard. The response is, “I will die a nurse, my path in nursing just took the path less traveled!"
I find my days as a case manager are ever-evolving, just as healthcare is. Keeping up with new treatments, medications, etc. is one of the most difficult parts of this position. The other part is finding community resources to further assist my clients. Client cases are becoming more complex as the world changes. Social determinants of health, although they have been in existence for some time, appear to be making a stronger impact on recovery. Inflation, difficulties with paying bills, purchasing medications, and the list goes on, make a case manager’s role even a bit more difficult.
But, to return to the question, “Why case management?” For me, it is to make an impact on the clients I serve. To be their advocate when they can’t advocate for themselves. To help them understand what healthy living is, and to empower them to become better health care consumers. To never have them stop asking questions, no matter the situation. I like to feel that when I close a case on a client, I have helped them in some way to be better. Be better with decisions and choices, be better as their own advocate, and perhaps have them teach others what they have learned.
I am a nurse and will always be one. But I am also a case manager, going strong as a case manager for over 35 years, and would not change my path to this profession!
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Bio Sandra Zawalski, MSN, RN, CRRN, CCM, ABDA, MSCC, is a registered nurse with almost 40 years of experience in a variety of clinical settings that include orthopedics, brain injury rehab and neonatal intensive care. Currently employed by MCG Health, she has extensive experience in case management leadership positions including owning her own case management consulting business. Sandra has a master’s in nursing, is a board-certified case manager through CCMC, certified rehabilitation nurse, certified as a Medicare set aside consultant, a member of the American Board of Disability Analysts and a designated ATD Master Trainer. She has published numerous articles in case management professional journals and is a regular contributor for Just Begin magazine. Sandra is a former commissioner for CCMC, a former chair and has had the privilege of speaking at multiple case management national conferences.