Case Management Corner: A Nurse Case Manager or a Social Work Case Manager?
By Kelly Bilodeau
Nurse case managers and social workers were once a natural pairing, working in tandem to support the patient.
“The idea was that nurses would handle medically complex issues while social workers would focus on social needs,” said Tiffany Ferguson, LMSW, CMAC, ACM, CEO of Phoenix Medical Management Inc.
However, due to changing paradigms and a more challenging patient population, case managers and social workers today often find themselves stepping on each other’s toes, and it’s becoming increasingly clear that it’s time to rethink traditional roles, she said.
A Changing Role
Case management is undergoing a transformation, thanks to patient and care-related changes. “Length of stay is shorter. We’re more efficient,” Ferguson said. “Patients are simultaneously medically and socially complex.” A case manager needs to be able to handle both aspects.
While case management was once primarily the domain of nurses, who perceived the job as a step up from the bedside, that changed during the COVID-19 pandemic. Hospitals were forced to make nursing jobs more appealing to retain and attract staff members during the crisis.
“Now the incentives for a floor nurse are way better than they are for a nurse case manager,” says Ferguson. Not surprisingly, fewer nurses are making the shift. Instead, when many floor nurses decide to leave the bedside they are selecting remote positions or to pursue advanced training to become nurse practitioners, she said.
At the same time, case management has become increasingly appealing to social workers. “There’s an ample pool of social workers who are coming into the marketplace and want to work in healthcare,” Ferguson said. They’re stepping into roles at hospitals that are either a split nurse/social worker model. “Or they could be doing the same exact job as a nurse case manager,” Ferguson said.
Rethinking Hiring
To solve these issues, directors need to stop thinking about whether it’s best to hire a nurse or a social worker and instead start hiring the individual with the most potential as a case manager. This is someone with solid social skills who works well at the patient’s bedside and can communicate effectively with floor nurses, physical therapy staff, and physicians. “They have to be a go-getter, really autonomous at filling their day and getting everything accomplished with patients. They have to have good boundaries, and be skilled with technology,” Ferguson said.
From there, training can fill the gaps.
For a social worker, an onboarding program might focus on how to handle the medical complexities of the role, anticipating care pathways, medication protocols, and navigating prior authorization requirements.
Conversely, a nurse may need more education on social factors. However, as nursing becomes increasingly specialized, these candidates may perform some, but not all, aspects of care. They may also need additional training on how medical conditions and care plans translate to proactive transitional needs for the patient. For example, at many facilities, discharge and admission are handled by separate team members, so a bedside nurse may no longer be as adept at performing a history and physical or in anticipating the patient’s post-acute needs.
“It's not like it used to be where one nurse did all of it,” Ferguson said.
Onboarding and orientation should be tailored to the individual. “You can't assume based on the person's professional license that they're going to come in skilled enough and know how to do the job,” Ferguson said. The job has grown so challenging that even an adept case manager requires continual ongoing training to stay up to date, she said.
Overall, hiring decisions should no longer be about choosing between a nurse and a social worker. It’s about identifying adaptable, skilled professionals and giving them the tools they need to succeed, Ferguson said.
Case Management Corner is your go-to source for insightful discussions on relevant topics in case management. Through an engaging interview-style format, our team members share their expertise, experiences, and best practices to keep you informed and empowered. Whether you're looking for industry updates, practical strategies, or real-world perspectives, we bring you valuable conversations designed to enhance your knowledge and support your professional growth. Stay tuned for expert insights straight from the field! Kelly Bilodeau has been a longtime writer for HCPro’s Case Management Monthly.