Standard of Practice for Nurses Case Managers

Standardof Practice for Nurses Case Managers

Standardof Practice for Nurses Case Managers

Casemanagement encompasses a broad scope of practice from thecoordination of healthcare, financial organization and resourceutilization with the main aim of ensuring the best patient outcomesthat are all-around cost-effective. The primary criticalinterventions for nursing case managers include financialstewardship, safe transitions of health, assessment of patientadherence and constant communication between relevant stakeholders.The ultimate objective of the standards of practice is to facilitatethe smooth movement of the patient through the process of healthcaredelivery. As such, nursing case managers perform a practice thatencompasses various disciplines but integrated together for a mutualinterest.

Standardsof Practice for Nurses Case Managers

Clientselection process

Itis paramount to ensure that client selection has been carried out ina way that provides maximum benefit. Usually, high-risk principles ofassessment are put into use, and they may include aspects such asage, history of chronic diseases, social issues such as physical andemotional abuse, socio-economic problems and poor nutritional status. Other numerous standards can be followed as long as the outcomeguarantees that the patients selected are those who will benefit themost out of the program.


Consumervaluation is an exercise that involves the comprehensive examinationof the physical and psychosocial aspects. In this regard, the nursecase manager must take into account both the cultural and linguisticneeds of clients using the necessary standardized tools. Thesecriteria may include psychosocial behaviors, physical conditions,self-care capabilities and history of substance use. The standardsused depend on particular setting. In addition, there is an aspect offinancial management that focuses on establishing the relationshipbetween resource allocation and the available provider options thatwill benefit the patient or client. To obtain this information, thenurse case managers must conduct comprehensive interviews with theclient, family members, previous medical records and any othersources of information that may be deemed essential.

Problemor opportunity identification

Thisfacet is founded on the recognition of issues and prospects that maybenefit from the intervention strategies to be implemented. In thiscase, the identified opportunities and problems need to be agreedupon by the client, family or guardian. The selected interventionopportunities may include the use of several healthcare providers,underutilization of services, health limitations, support systemsthat are not working adequately and compromised client safety. Otherscenarios may present increased costs of injury and morbidity,financial barriers to the achievement of health and complicationsthat are associated with medical, psychosocial and functional issues.


Earlypreparation and arrangement are one of the vital components forachieving the best possible outcomes of an intervention. Due to thischaracteristic, the identification of immediate and ongoing needsmust be taken into consideration. This means that the manager mustpinpoint the short term and long term requirements to create theappropriate stringent measures that sufficiently address the goalsand objectives of those needs. Planning is thus demonstrated byobtaining documented evidence from interviews and research, recordsof client diagnosis and prognosis, the outcome goals, developinggoals and indicators that can be measured, and incorporatingproblem-solving and conflict resolution measures. Consequently, thecustomers` outcomes must be prioritized through the allocation ofresources and services as well as ensuring adherence to the paymentexpectations.


Observationinvolves the use of continuous assessment throughout the process withthe main aim of measuring the response of clients to the plannedcare. Collaboration and verification of the project are critical toidentifying any possible areas that may need to be revised to achievesuccessful implementation.


Theresult of the program is based on the best possible health outcome,wellness, safety and self-care of the client. This should be aboutquality case management, the level of satisfaction of the customerand cost-effectiveness. Mainly, the care service must demonstrateeffectiveness, efficiency and appropriateness that is reflected bythe clients’ level of satisfaction.

Terminationof Case Management Services

Thereare existing guidelines that should be used by the nurse casemanagers on the procedures to be undertaken for the closure of thecase management. Appropriate termination may involve theidentification of the main reasons as to why care has to bediscontinued. The factors may range from client refusal to theprogram, loss of eligibility and death. It is important to havedocumented agreement by the appropriate parties indicating the reasonand period for termination.

Facilitation,Coordination, and Collaboration

Agood communication network is essential for a successful careintervention. Similarly, collaboration fosters knowledge, skills andexperience between organizations and the relevant stakeholdersleading to achievement of maximum client outcomes.

Legaland Ethics

Adherenceto the stipulated laws and regulation is crucial in patient care.This observation prevents the interference of the managers with theright and freedoms of the clients. The codes of ethics are enjoinedwith legal aspects since they both have the same underlyingprinciples of autonomy, respect for individual rights, justice, andfidelity. In the case of any outcry regarding client-providerconflict, managers should seek further consultation from otherprofessionals.

ResourceManagement and Stewardship

Monitoringand evaluation are the backbones of good resource management.External and internal assessments can be of great assistance todemonstrate areas that need improvement regarding finances andservice delivery and thus informing on the ways that outcomes can beimproved. Research utilization is also a docket of resourcemanagement. Case managers should, therefore, be able to put to usethe information obtained from research to create best practices.


Case Management Society of America. (2010). Standards of Practicef or Case Management. Arkansas: CMSA.