Activities and Perceived Outcomes of Nurse Case Managers: Building a Case Management Model for Rural Hospitals

Abstract

The primary purpose of this study was to describe the activities and perceived outcomes of nurse case managers in a rural hospital setting and the relationship of nurse case managers' education, experience, and age to activities and perceived outcomes. Results of the study will be used to further develop and refine a portion of the investigator-developed model of Nursing Case Management for Rural Hospit~ls which served as the study framework. Nurse case managers in non-federal, rural hospitals listed in the American Hospital Association's (1995) guide to U. S. hospitals were surveyed using an investigatordeveloped instrument. Psychometric qualities of the instrument were determined as part of the study. The sample (N = 302) consisted primarily of white, middle-aged females. The majority were ADN or BSN nurses who averaged two to three years experience in case management and 16 years experience in nursing. Descriptive, correlational, and multivariate statistics were used to analyze the data. Results indicated that individual advocacy was the most frequent activity, and comments suggested that nurse case managers were becoming aware of the centrality of advocacy to their practice and job satisfaction. The second most frequent activity was teaching, with clinical practice third. The most frequent pattern of activities reflected assessment and coordination of community resources through an advocacy role for the client while performing managed care/quality assurance activities. The top ten perceived outcomes were: (a) increased patient satisfaction, (b) reduced fragmentation of care, (c) reduced length of stay, (d) increased job satisfaction, (e) increased job enjoyment, (f) increased quality of life, (g) increased functional health, (h) increased self-care, (i) increased autonomy, and (j) attainment of goals within the time-frame for reimbursement. Two-thirds of the nurse case managers thought their activities prevented delays in care and provided clients with a regular source of care, thus increasing access to care. Other significant (p ~ .05) findings indicated: (a) ADN, BSN, and MSN nurse case managers engaged in more teaching than nurse· case managers with diplomas, (b) system advocacy was higher for MSN than for diploma, ADN, or BSN case managers, and (c) experienced nurse case managers engaged in more clinical practice than inexperienced nurse case managers.