Q&A: Social workers and RNs as case managers

Q: I am still not sure whether I need RNs or social workers or both as case managers. Is there any evidence to help me make a decision? I want everyone to be effective, work together well, and be respected as a service.

A: Social workers and nurses are not interchangeable professionally and don’t really want to be. Both RNs and social workers have been used as case managers in acute care and are often cross-trained to do UR and discharge planning. They are sometimes given the same title of case manager to rectify the very imbalanced national salary structure for social workers, who usually have masters’ degrees but are paid much less than RNs.

When the care coordination function is expected to be central to the role in medical-surgical settings, it makes more sense to use RNs as case managers. Admittedly, with some exceptions, nurses have much more knowledge and experience with medical and surgical clinical conditions than social workers do. Because of this reality, the social worker should be used for crisis intervention (the crisis of the hospitalization, the crisis of the illness and diagnosis, the crisis of continuing care needs, finances, grief, etc.) rather than as a case manager. Similarly, RNs are typically not trained for using in-depth psychosocial skills while managing more than one person at a time. They can handle difficult situations to a point, but not as extensively as a social worker can.

Evidence includes the following:

• “Combining hospital case managers and social workers to create a team effort has proved effective in many models. It must be recognized, however, that the cost of this FTE-intensive model should be offset by substantial gains or else it may be at risk as hospitals seek ways to economize” (Daniels & Ramey, 2005).
• From anecdotal reports, it is very helpful to have social work and RN case managers share office space on their units, as well as in the central office (if there is the luxury of both).
• There is no measurable evidence that points to whether social workers or RNs make better case managers, and in what situations.

Since there is no measurable evidence available, the anecdotal evidence will have to suffice. There does seem to be a trend, although no data is available, toward moving away from using social workers as case managers if the case manager role is structured for more than providing discharge planning. There is also a trend in some areas toward using a social worker with a bachelor’s of social work (BSW) degree for initial screening and making discharge arrangements, but not for the determination of the next level of care.

Editor's note: For more information, see Case Management Models: Best Practices for Health Systems and ACOs. Need expert advice? Email your questions for consideration in the Revenue Cycle Daily Advisor. Note: We do not guarantee that all questions will be answered.