Q&A: Merging care coordinator and RN roles

Q: Should we merge the care coordinator role in nursing with the RN case manager role in order to upgrade nursing care?

A: There are two immediate approaches.

1. Nursing has to do all it can do to keep nursing going, and you are understaffed in case management by at least two-three case managers. This is not the time to merge roles. However, it is a time that the case managers can assert themselves more as clinical team leaders, helping keep the focus on patient progressions and family involvement. The nursing staff will rely on you more than resent you for this focus because you have the experience and credibility.
2. Since you don’t have avoidable day data, on one day take a snapshot and ask all the case managers to estimate how many patients should have been ambulated by someone, how many potential days that creates, and what kind of quality issues it involves. Ask for the directors of nursing and physical therapy to join a brief task force with you, both to discuss the data and propose an ambulation campaign. Work out with PT and nursing which patients actually need PT and which patients nursing should be ambulating. Work out how timing might be different, so that at least one PT is available first thing in the morning to do those all-important evaluations necessary for transfer. Consider training some of the nurses’ aides on each unit as “mobilizers”.

For more information, see Hospital Case Management Models.

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