CMSA Today - Issue 4, 2021

WWW.CMSA.ORG ASSOCIATION NEWS 7 CMSA today ™ ▼ ISSUE 4 | 2021 THE OFFICIAL VOICE OF THE CASE MANAGEMENT SOCIETY OF AMERICA INSIDE: LEGACY LEADERS 29

CLINICAL LADDER: REACHING PROFESSIONAL HEIGHTS IN CARE MANAGEMENT PROFILES IN PROFESSIONAL DEVELOPMENT

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TABLE OF CONTENTS

ISSUE 4 • 2021 • CMSA TODAY

IN THIS ISSUE ISSUE THEME: PROFESSIONAL DEVELOPMENT This issue is filled with stories about a profession that tackles complex situations and is leading the way in adapting to the challenges of today’s work environment. Patients and clients will continue to experience complicated healthcare scenarios, but case managers are adept at breaking through the complexities of ever-changing healthcare environments. Years of experiences, the way we value networking and the pursuit of continuing education make case managers uniquely prepared to restore hope in patients, revitalize workplace culture or re-brand oneself for new opportunities.

FEATURES

Staking a Claim in the New World: Global Perspectives 24

Case Management Workforce Needs are Driven by Supply and Demand 10 BY CHARLES WHITE, EdD, MBA The need for qualified case managers continues to expand across the continuum of care. Healthcare organizations, public health agencies, private employers and insurance companies are ramping up population health initiatives as our healthcare payment systems transform. Clinical Ladder: Reaching Professional Heights in Care Management 12 BY REBECCA L. COLLINS, MS, RN, CCM, CHPN, CENP Building an effective care management team is key to program growth and staff retention. One way to achieve a cohesive team is to highlight successes and provide opportunities for professional growth. A clinical ladder is a tool that can be designed to inspire and reward staff by honoring their contributions to the organization. Profiles in Professional Development 14 BY BARBARA LEACH, MS, BSN, RN, AND EDNA B. CLIFTON, MBA, BSN, RN Choosing to advance your career is a decision that requires significant planning. First and foremost, you need to identify your goals. Do you want to achieve a specific expertise in a certain area, or do you want to move to an entirely different career path? In this article we look at how two nurses grew in their careers and what contributed to their advancement. Embedded Nurse Case Managers in Primary Care: My Experience and Strategies for Success 16 BY KELVA EDMUNDS-WALLER, MSN, RN, CCM Integration of nurse case managers in primary care is an increasingly popular population health strategy to improve healthcare quality, reduce healthcare costs and improve the patient experience. Travel Case Management: A New Field for Millennial and Empty Nester Case Managers 20 BY JENNY QUIGLEY-STICKNEY, RN, MSN, MHA, MA, CCM, ACM-RN, CPHM Nurses and social workers have been drawn to the travel case management field during the pandemic to help fill a need to quickly transition trained case managers into vacant slots in acute care and throughout the continuum of care. COVID-19: Deepening the Conversation: Why Not Home 22 BY CORIN L. SCHNEIDER, MHA, MSN, RN, ACM-RN AND DR. TIFFANY VICTOR-CASTLEBERRY, DNP, MSN, BA, RN, ACM-RN The pandemic both created a need and highlighted the effectiveness of care delivery in non-traditional settings. The utilization of in-home telehealth monitoring and provider telehealth visits reinvigorated and accelerated the conversations around the concept of “Hospital At Home.”

BY FRANCINO AZEVEDO, PhD, MSN, RN; JOHANN ACHIM BEIßEL, MHA; MEGHAN MACDONALD, RSW, MSW; AND ANNA BOTTIGLIA, RN, BscN; AND CAROL GARNER, RN, CCMSA CMSA’s 2021 Conference theme is “Staking a Claim in the New World.” What better way to kick off the conference than by sharing experiences and best practices from our colleagues around the globe?

COLUMNS

PRESIDENT’S LETTER 6 Case Management in Bloom BY MELANIE A. PRINCE, MSN, BSN, NE-BC, CCM, FAAN We will not allow the pandemic, unexpected changes in the healthcare industry or personal/professional challenges to keep us stuck in the same place. LEGACY LEADERS 29 A Conversation with Suzanne K. Powell, RN, BSN, MBA, CCM, CPHQ BY SANDRA LOWERY, RN-BC, CCM Each month we will look at a case management leader recommended by a past CMSA president. The criteria for a nomination is that the professional has contributed to the practice of case management and has inspired others to step up to become leaders in their area of case management.

DEPARTMENTS

ASSOCIATION NEWS 7 • The Case Manager’s Professional Journey • Connect with the CMSA Community Online CMSA CORPORATE PARTNERS 9 As of 5.05.2021 INDEX OF ADVERTISERS 30

Published by 1430 Spring Hill Road, 6th Floor, McLean, VA 22102, 800-369-6220, www.naylor.com Publisher: David Freeman, Editor: Russell Underwood, Publication Director: Maria Antonation, Sales Manager: Kira Krewson, Project Coordinator: Tracy Venzen Sales Team: Tracy Goltsman, Beverly Grimme, Anthony Land, Scott Pauquette, Paul Walley, Layout and Design: Sharon Lynne, Cover Design: Dan Dahlin, Sharon Lynne For advertising questions, contact Scott Pauquette at 800-369-6220, ext. 3446 or spauquette@naylor.com. PUBLISHED MAY 2021/CMS-Q0121/2087 Cover Image Credit: MSTANLEY/SHUTTERSTOCK.COM is published for Case Management Society of America, 5034A Thoroughbred Lane, Brentwood, TN 37027, 615-432-0101/Fax: 615-523-1715, www.cmsa.org CMSA Today Editorial Board Chair: Anne Anne Llewellyn, MS, BHSA, RN, BC, CCM, CRRN; Co-Chair: Mary Beth Newman MSN, RN-BC, CCM, Melanie A. Prince, MSN, BSN, NE-BC, CCM, FAAN, Jose Alejandro, PhD, RN, FAAN; Mary McLaughlin-Davis, DNP, ACNS-BC, NEA-BC, CCM; Janet Coulter, MSN, MS, RN, CCM, Garry Carneal, JD, MA, Jenny Quigley-Stickney, RN, MSN, MHA, MA, CCM, ACM-RN, CPHM, Kelva Edmunds-Waller, MSN, RN, CCM, Benjamin Foster, MBA. Managing editor: Kelley Norris. ©2021 CMSA. All rights reserved. The contents of this publication may not be reproduced by any means, in whole or in part, without the prior written consent of the Association. CMSA today ™

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PRESIDENT’S LETTER

Case Management in Bloom BY MELANIE A. PRINCE, MSN, BSN, NE-BC, CCM, FAAN

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I always look forward to sharing my thoughts with each of you via the Case Management Society of America (CMSA) President’s message for CMSA Today. For this edition, I experienced a dilemma; strug gling with so many things to say, and yet not being able to choose the right thing to say. Spring is in full bloom, there is anticipation and expectation across the country for a “re-opened” world and plans are solidifying for family, work and play. I was stuck…but in a good way! I had so many “R” words dancing around in my head. I wanted to write about themes of Rebirth, Rejuvenation, Resilience, Restoration, Revitalizing, Rebranding and Rejoicing. I often write outside, on my patio, and this time I was distracted by the beauty and bravery of flowering bulbs. The bulbs were breaking through the still frosty soil to restore beauty to a flower bed stuck in the last gasps of winter. I realized the bulb shoots were not erupting from the place where I originally planted them. Yes, they were in the general area of the flower bed, but I know I didn’t plant a bulb within the holes of a

brick. And yet, this tulip bulb found its way up in spite of the barriers that could have held it back, that could have kept it stuck underneath the soil’s surface where it would have been a very late and small bloom or withered away completely. As you have probably figured out, I love metaphors! As I gazed at the budding trees and flowers around me and reflected on an email from a colleague about this issue’s themes of adversity and adapting to obstacles, I knew I had found the perfect metaphor for where we are as a case man agement profession. The year 2020 may have seemed like a long winter, but winters provide time to build up and store what is needed to rise up in the spring. Summer brings an opportunity to display the restored and revitalized version. This is our story as a profession and as an association. We will not allow the pandemic, unexpected changes in the healthcare industry or personal/profes sional challenges to keep us stuck in the same place. As case managers who may have experi enced personal losses or significant changes

to our professional careers, we have an uncanny ability to persevere. Our profes sion is rooted in the ideals of resiliency and restoration; we find a way to apply these concepts to our own lives. As a case man agement workforce, we have been spinning with more expectations, less time, new con straints and chaos. In some ways, it is like the spinning circle you see on a computer when a window tab is trying to open. That spinning circle appears to be stuck, but what do we do? We hit the refresh icon and try a different window. Case managers will find a way. This issue is exciting because it is filled with stories about a profession that tackles complex situations and is leading the way in adapting to the challenges of today’s work environment. Patients and clients will con tinue to experience complicated healthcare scenarios, but case managers are adept at breaking through the complexities of ever changing healthcare environments. Years of experiences, the way we value networking and the pursuit of continuing education make case managers uniquely prepared to

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ASSOCIATION NEWS

restore hope in patients, revitalize work place culture or re-brand oneself for new opportunities. It’s an exciting time as we pause and enjoy the beauty around us. Sometimes we must look in different places to find what is blooming, but the blooms are definitely present. The seasons of 2021 are filled with metaphors that depict CMSA evolving into full bloom. In addition to the inspirational articles in this issue, be sure to read about the annual membership conference that is just around the corner! I am SO excited about this year’s virtual conference. The online platform will give me the ability to experience much more that I could possibly achieve otherwise, and I can’t wait! The summer conference will be an explosion of “many blooms” as speakers share new information through our educational programs. Companies, vendors and organizations are excited to share their offerings and may just be the spark that re-ignites your passion for helping patients/ clients navigate a complicated system to manage complex care issues. Our partners are also ready to demonstrate how they can help and support our profession. This year’s conference will provide fun and unique ways of networking and collaboration. All I can say is that you must see it to believe it, so register now! Case managers continue to demonstrate how we can transform adversity into tri umph. In many ways, we are a beacon of hope and resilience for families who are traveling what may seem to be impossible roads to recovery. This is what we do, and I am inspired by our profession every day. Similarly, CMSA is poised to uplift the case management profession as it prepares for a healthcare arena of new possibilities. CMSA celebrates where we have been and boldly launches into a journey of uncharted waters to stake our claim in the evolving world of healthcare, public policy and a beautiful bouquet of partnerships. Are you ready? If not, be inspired by this issue…unstick… refresh…and let’s push on and upward! ■

THE CASE MANAGER’S PROFESSIONAL JOURNEY

CMSA supports the professional growth of our members and the entire case manager community throughout their career. Each destination in a case manager’s career is a critical step in their educational journey, with each step building upon the previous one, creating a pyramid of knowledge and skills to support success. CMSA is here to help at every destination and every moment in between. Enjoy your trip!

The first step in a case manager’s journey is to know and understand the guidelines and expectations for patient/client advo cacy and care coordination regardless of practice setting. Adoption and adaptation of the CMSA Standards of Practice for Case Management are the foundation for growth as a professional case manager and should be a requirement for all professionals new

to case management or organizations inter ested in standardizing case management practice. RESOURCE: CMSA Standards of Professional Case Management Practice Course : This is a 32-hour online course that examines all 15 Standards in detail and pro vides a professional video vignette of the Standard at each module’s conclusion.

Here, the novice case manager can hone their skills to become more proficient in communication and documentation; com fortable with industry standards, quality measures and reimbursement models; and grow as a professional learner to manage conflict, comfort the grieving and commit to life-long learning. Many in-demand skillsets and hands-on practical experience are not learned or available early in a case manager’s

career, and there exists a need to improve practice and competence sooner than later. RESOURCE: CM Bootcamp : This is an inter active program that uses activities similar to real life for a more genuine experience. Key topics covered include professionalism, communication, regulatory issues, reim bursement, advanced case management processes, emerging trends and finding a mentor. Release date – Fall 2021.

Melanie A. Prince, MSN, BSN, NE-BC, CCM, FAAN President of the Case Management Society of America

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ASSOCIATION NEWS

THE JOURNEY IS ONGOING AND NEVER REALLY OVER Case managers are life-long learn ers, and CMSA not only supports the case manager early in their career but throughout. CMSA brings educa tional programs that provide innova tions and best practices, helping case managers stay on top of trends and provide CEs to support accreditation. VISIT CMSA.ORG : Discover additional resources and training including: • Over 130 accredited courses and recorded webinars in the CMSA Educational Resource Library • Monthly live webinars on diverse topics to keep up on current trends • Member-submitted resources housed in the CM Toolbox • Guidance specific to case man agers in the assessment, care planning, and intervention devel opment for the individual chal lenges with opioid use disorder in the Opioid Use Disorder Case Management Guide • Coming soon! Caseload Calculator tool available Summer 2021. CMSA is committed to support ing you in at every destination and throughout your entire professional journey. Visit www.cmsa.org to find out more!

RESOURCE: comMIt : Comprehensive Motivational Interviewing Training for Health Care Professionals. This is an 8-hour online course that centers around motiva tional interviewing, which is an evidence based, effective method for improving adherence to health behaviors.

As part of growth and enhancement of communication skills, case managers can support their patients/clients in adhering to treatment and making different health behavior decisions by taking advantage of one in-demand skillset – motivational interviewing

As case managers continue their jour ney, seeking more of the desired in demand skillsets, information about how to better support patients can be found. Resources and best practices to support adherence, patient engagement and acti vation, patient-centered care, medication

financial resources and assessment of SDoH are necessary. RESOURCE: Case Management Adherence Guide 2020: This adherence guide will be published with a compan ion webinar series. Release date – Late Summer 2021 .

At this point in the journey, case man agers have experience and feel reasonably confident in their abilities, but there is always more to learn. And there are those patients/ clients who challenge our abilities. They have multiple comorbid conditions, social chal lenges and perhaps behavioral conditions. They are in and out of the hospital and emergency department. The case manager is in need of enhanced engagement and retention strategies to improve the most complex and vulnerable adult and pediatric

populations. This destination provides the confidence and skills needed as the primary case manager for an individual, to address all their conditions, and coordinate all of their needs without any hand-offs to another professional. RESOURCE: Integrated Case Management Training Program : This course provides advanced skills in risk assessment, targeted care planning, and engagement and retention strategies. ICM is a 30-hour course of online and instructor-led training.

CONNECT WITH THE CMSA COMMUNITY ONLINE If you’d like to communicate with other case managers and health care industry professionals across the country, connect with CMSA on LinkedIn™, Facebook, and Twitter!

Facebook: /cmsanational

Twitter:

@CMSANational

LinkedIn:

Search “CMSA” ■

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CMSA CORPORATE PARTNERS

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WORKFORCE

CASE MANAGEMENT WORKFORCE NEEDS ARE DRIVEN BY SUPPLY AND DEMAND BY CHARLES WHITE, EdD, MBA

CASE MANAGEMENT DEMAND FACTORS

of care. Healthcare organizations, public health agencies, private employers and insurance companies are ramping up pop ulation health initiatives as our healthcare payment systems transform. Expansion of accountable care organizations and value based purchasing across the insurance sec tor (Medicare, Medicaid, employer-based plans, workers compensation and open market plans) continue to increase the demand for the case management func tion. Many organizations are supplementing their workforce with travelers in order to meet immediate needs. And frankly, case management is no lon ger a Monday through Friday 9 a.m. to 5 p.m. job. Many organizations are expanding case management services to 24/7/365 days a year. Coverage is also being extended into outpatient settings and specialty areas.

rate for nursing faculty (Fang et al., 2020). In addition, 88.6% of nursing programs prefer or require that faculty vacancies are filled with nurses with doctoral degrees (Fang et al., 2020). Now, let’s think about the effect of the pandemic on our current nursing students. As widely reported across the United States, our schools, colleges and universities have instituted tele-education. There have been limitations regarding nursing student place ment and the continuation of clinical rota tions during the pandemic. Many nursing programs were also not prepared for the increased demand for simulation-based training. The pandemic has also increased stress levels and elevated fears typically experienced by nursing students (Lovric et al., 2020, p. 200), causing some nurs ing students to take time off. One of my nursing students stated the following: “In high school, I’ve felt overloaded with stress because of the thought of not being able to go to college and situate myself in a safe job that pays enough for me to just survive, at the least. Today, I’m afraid of not being able to even continue going to school due to my

A perfect storm continues to intensify because of our existing shortage of regis tered nurses, limited nursing faculty, BSN entry requirements and the effects of the pandemic. As Haas et al. (2020) described, the fragility and vulnerability of our nursing workforce have been exposed (p. 236). This, in turn, has had a trickle-down effect on the availability of nurse case managers and social workers to fill vacancies across the healthcare sector. The U.S. Bureau of Labor Statistics (2021) predicted that there would be approximately 175,000 registered nurse openings each year for a 10-year period from 2019-2029. Healthcare social worker jobs are estimated to increase by 26,700 over a 10-year period from 2019-2029 (U.S. Bureau of Labor Statistics, 2021). The American Association of Colleges of Nursing (AACN) reports that there is a 94% placement rate for BSN gradu ates within 4-6 months of graduation (AACN Research Brief, 2020). The need for qualified case managers continues to expand across the continuum

CASE MANAGEMENT SUPPLY FACTORS

Of concern is the continuing vacancy rate of nurse faculty to train new nurses and nurse specialties. The AACN reports that there continues to be about a 9% vacancy

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damages of the COVID-19 pandemic: when basic needs challenge mental health care. International Journal of Public Health, 65 (6), 717 – 718. https:// doi.org/10.1007/s00038-020-01426-y Fang, D., Keyt, J., McFadden, T. (2020). AACN special survey on vacant faculty positions for academic year 2020-2021. Retrieved from: Research & Data Center ( https://www.aacnnursing.org/News-Information/ Research-Data ) Haas, S., Swan, B., & Jessie, A. (2020). The impact of the coronavirus pandemic on the global nursing work force. Nursing Economic$, 38 (5), 231-6. Lovri ć , R., Far č i ć , N., Mikši ć , Š., & V č ev, A. (2020). Studying during the COVID-19 pandemic: A qualitative induc tive content analysis of nursing students’ perceptions and experiences. Education Sciences, 10 (7), 188-206. https://doi.org/10.3390/educsci10070188 Rooksby, M., Furuhashi, T., & McLeod, H. (2020). Hikikomori: a hidden mental health need following the COVID-19 pandemic. World Psychiatry, 19 (3), 399 – 400. https://doi.org/10.1002/wps.20804 U.S. Bureau of Labor Statistics. (2021). Occupational out look handbook. Registered nurses. Retrieved from: https://www.bls.gov/ooh/healthcare/registered nurses.htm#tab-6 U.S. Bureau of Labor Statistics. (2021). Occupational outlook handbook. Social workers. Retrieved from: https://www.bls.gov/ooh/community-and-social service/social-workers.htm#tab-6

HOW CAN WE RESPOND? The easiest option is to do nothing. I would argue that this is the wrong response for a healthcare sector demanding more case managers to meet the needs. A “do nothing” approach allows the market to develop a solu tion and takes away professional case manag ers’ ability to lead change and innovation. Nurses have long been told that it is impor tant to work at the top of their license. Isn’t this the perfect time to consider how case managers might accomplish this? A number of healthcare organizations are incorporat ing unlicensed case management associates to assist with the referral process, acquisi tion of personal care equipment and home oxygen services and arrange transportation for clients. Medical homes and community outreach programs are also considering how they can ramp up to meet vulnerable popula tions’ mental health needs. As a profession, this may be the time to consider the devel opment of certification programs for case management associates. When confronted with change, we need to consider how to find ways of improving agility, capability and capacity. The develop ment of training and certification programs for case management associates will help us meet the needs of our next crisis – men tal healthcare. Delivery of value-based and aligned mental health services will continue to create increasing demand for care manage ment services. ■ REFERENCES American Association of Colleges of Nursing (AACN). (2020). AACN research brief: Employment of new nurse graduates and employer preferences for bacca laureate-prepared nurses. Retrieved from: 2020 Data on Employment of New Nurse Graduates and Employer Preferences for Baccalaureate-Prepared Nurses ( https://www.aacnnursing.org/News-Information/ Research-Data-Center/Employment/2020 ) Cénat, J., Dalexis, R., Kokou-Kpolou, C., Mukunzi, J., & Rousseau, C. (2020). Social inequalities and collateral

family’s low income.” Undoubtedly, these stressors will result in lower than expected nursing graduation rates.

IMPACT OF TECHNOLOGY ON DEMAND

Telemedicine applications have been expanded in most healthcare delivery systems. The pandemic has resulted in an acceleration of the digital revolution within healthcare. Unfortunately, the use of tech nology has created a greater divide in care delivery to vulnerable populations who have limited access and/or limited knowledge on how to use the technology. Long-term care’s technology infrastructure continues to be problematic and has left gaps in imple menting technological solutions. Case management telecommuting and expanded voice and video communica tion with inpatients have exploded within our work. Will these changes continue, or will we go back to the way we were doing things previously? Will meeting expectations change from video conferencing back to face-to-face in-person meetings? The pandemic has resulted in signifi cant isolation and withdrawal as never seen before (Rooksby et al., 2020). Unemployment and virtual learning have reduced access to mental health and sup port services. Escalation of social deter minant inequities has caused a significant pent-up demand and flashpoint for the United States (Cenat et al., 2020). The pandemic has created a reaction similar to burning rocket fuel. Other non-healthcare sectors, like criminal justice and immigration services, may also have a significant impact on the demand for social workers, mental health workers and case managers. IMPACT OF MENTAL HEALTH ON DEMAND

Charles White, EdD, MBA, has more than 25 years of healthcare leadership, governance and systems improvement experience. He holds a bachelor’s in

hospital administration and planning from the University of New Hampshire, a master’s in business administration and planning from Southern University of New Hampshire and a doctorate in education from Capella University. Dr. White has a passion for engaging stakeholders in innovative change, operational results and hardwiring system change to improve the delivery of patient care to vulnerable and at-risk populations. He is faculty in the Department of Public Health at California State University Fullerton.

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PROFESSIONAL DEVELOPMENT

CLINICAL LADDER: REACHING PROFESSIONAL HEIGHTS IN CARE MANAGEMENT BY REBECCA L. COLLINS, MS, RN, CCM, CHPN, CENP

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C are management has proven to be an integral part of patient centered care mod els throughout the healthcare continuum. (AHRQ, 2018) Building an effective care management team is key to program growth and staff retention. One way to achieve a cohesive team is to highlight successes and provide opportuni ties for professional growth. A clinical ladder is a tool that can be designed to inspire and reward staff by honoring their contributions to the organization. Clinical ladders help to feature the skill set of the individual staff member as well as promote the care man agement team overall. An added benefit is that clinical ladders have a halo effect that extends outside of the team (Coleman, Desai, 2019). In this article, I would like to share my organization’s implementation of a clinical ladder to encourage the use of this approach in the care management setting. The steps involved in this innovative model benefit programs and elevate leaders in care man agement teams. We found that utilizing a clinical ladder also fosters a higher level of

interprofessional collaboration within the entire organization.

mentorship, enhance morale and empower our care managers and staff. We recognized the need for an option that would increase retention rates, staff satisfaction and provide a hiring benefit to compete in the field with other medical organizations. Our next step was to explore the use of clinical ladders to achieve organizational goals. A clinical ladder was a sensible solution to increase workforce engagement, thus allowing for star employees to be recognized and pro vide a needed opportunity for disengaged employees to engage again. We started with a foundation of Benner Theory of Expert to Novice and included the Dreyfus model of skill acquisition (Peña, 2010). Dividing skills into pillars or categories allowed for focusing on the specific skillsets (Stubblefield, 2005). The development of the program was built around these foundational elements. FIRST STEPS After having the foundational guidelines and researching evidence-based practice articles, we sought real world experience. We reached out to other organizations that had experience with implementing clinical

WHAT ARE CLINICAL LADDERS? Clinical ladders have been utilized in differ ent forms since the 1970s, and most models are based off the Benner Theory of Expert to Novice approach to obtaining skills (Smalies, Bookless & Blumenauer, 2017). Clinical lad ders have a history of being used in the nurs ing profession to increase job satisfaction and honor the nurses working at the bedside (Kacik, 2019). Even though the clinical ladder had its beginnings in nursing, the clinical ladder program can translate very easily to other disciplines. The best use of clinical lad der programs is when it is reflective of the organization’s priorities and values (Nelson, Sassaman & Phillips, 2008). Clinical ladders can be implemented for those involved in healthcare systems ranging from ambula tory settings, hospital systems to that of post-acute care workplaces (Ko, & Yu,2014). WHY A CLINICAL LADDER Our organization wanted a way to fos ter professional development, increase

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3. PROGRAM DEVELOPMENT/ CORE COMMITTEE Taking suggestions and input helps to build self-determined, measurable criteria that translate into clinical ladder points. Building upon the organization’s mission helps align criteria into categories. This is a perfect opportunity to involve leadership in the development of the categories and application of criteria. In the IMAP pro gram, criteria used for points are grouped under Pillars (Baptist) Education, Service, Leadership and Quality Improvement. Input from the Leadership Committee helps to bring together the factors needed and organize the program elements Leadership is also needed to provide support for awards given at completion of the program. Awards for completion range from an increase in hourly pay to a lump-sum award. Also, some clinical ladders have options to obtain levels, or titles, based on the completion of the program. 4. PROGRAM LAUNCH The more information provided the better when launching a clinical ladder program. Assess what is best for your organization. Some suggestions are using the organiza tion’s intranet, having time set aside in all team meetings to discuss, having a point person in leadership to help with any questions. Also, having a frequently asked questions (FAQ) sheet available helps to start conversations and provide information in general. Make sure the clinical ladder packet is readily available and not difficult for staff to find. Clinical ladders are a great tool to pro vide recognition to care managers who go above and beyond their duties. It promotes advancement and pride in their chosen career. Involvement of staff and leadership in development provides opportunity for connections between all levels of the orga nization as well. The results can lead to a positive culture change, increased morale and highlight all that care managers con tribute to the success of an organization. ■ REFERENCES Bourgeault, R., & Newmark, J. (2012). The power of engagement: implementation of a career ladder program. Radiology management , 34 (2), 27 – 39.

ladder programs. Learning from their suc cesses and approach helped to further define the program and goals for clinical ladder development. Learning from best practices and expected outcomes allowed for setting achievable expectations. Reoccurring themes of success and missed opportunities allowed us to build upon or steer clear of similar situ ations in our new clinical ladder program. CONSIDERATIONS IN CLINICAL LADDER PROGRAM DEVELOPMENT AND IMPLEMENTATION Timelines to plan, develop and implement a clinical ladder program can range, but our program was able to be implemented in less than 2 years from the idea phase to the actual roll-out of the program. Our clini cal ladder was named IMAP-Individualized Mission Achievement Program. Below are steps that have proven successful in imple menting a clinical ladder program in our organization. Four steps to consider when starting a clinical ladder program at your organization: 1. EMPLOYEE ENGAGEMENT Success of a program involves buy in from the employees. An employee advisory committee can provide input, direction and support of the clinical lad der program. Inviting staff to participate in the structure of the program avoids it being viewed as a program that leader ship alone developed. 2. LEADERSHIP SUPPORT As you take the program from idea to development, having leadership sup port is a crucial element. Clinical ladders can positively change an organization’s culture. The return on investment is measured in both staff benefit and orga nizational benefit. Requirements are spe cific and can include quality improvement projects, research, publications and vol unteer work that all expand the organiza tion’s brand as well as the leadership skills of the employee. Staff retention, recruit ment and staff satisfaction scores are increased as well (Murphy, 2012). Overall about 5% of employees will participate, but the halo effect branches out to others that are aware there is a program option (Pierson, Liggett, & Moore, 2010).

Benefits of a Clinical Ladder Nursing Program (July 22, 2020). Health Stream https://www.health stream.com/resources/blog/blog/2020/07/22/ the-benefits-of-a-clinical-ladder-nursing-program Care Management: Implications for Medical Practice, Health Policy and Health Services Research, (publica tion 15-0018-EF), August 2018, AHRQ, https://www. ahrq.gov/ncepcr/care/coordination/mgmt.html Coleman YA, Desai R. (2019) The effects of a clinical ladder program on professional development and job satis faction of acute care nurses. Clin J Nurs Care Pract .; 3: 044-048. DOI: 10.29328/journal.cjncp.1001016 Kacik, A, (2019) Health systems redefine training to reen ergize employees, Modern Healthcare ; https://www. modernhealthcare.com/labor/health-systems redefine-training-re-energize-employees Ko, Y. K., & Yu, S. (2014). Clinical ladder program imple mentation: a project guide. The Journal of nurs ing administration , 44 (11), 612 – 616. https://doi. org/10.1097/NNA.0000000000000134 Korman, C., & Eliades, A. B. (2010). Evaluation through research of a three-track career ladder program for registered nurses. Journal for nurses in staff develop ment : JNSD : official journal of the National Nursing Staff Development Organization , 26 (6), 260 – 266. https://doi.org/10.1097/NND.0b013e31819b5c25 Moe, J. K., Lonowski, L. R., & Yancer, D. A. (1994). Combining a clinical ladder and performance appraisal system as a reward strategy: the EXCEL clinical ladder program. Seminars for nurse manag ers , 2 (3), 175 – 182. Murphy, D. (2012). Novice to Expert: Clinical Ladder Programs as a Recruitment and Retention Tool. Ohio Nurses Review, 87(5), 16-17 2p Nelson, J., Sassaman, B., & Phillips, A. (2008). Career ladder program for registered nurses in ambulatory care. Nursing economic$ , 26 (6), 393 – 398. Peña A. (2010). The Dreyfus model of clinical problem solving skills acquisition: a critical perspective. Medical education online, 15, 10.3402/meo.v15i0.4846. https://doi.org/10.3402/meo.v15i0.4846 Pierson, M.A., Liggett, C., & Moore, K.S. (2010). Twenty years of experience with a clinical ladder: A tool for professional growth, evidence-based practice, recruitment, and retention. The Journal of Continuing Education in Nursing, 41(1), 33-40. Smailes, P., Bokless, H., Blumenauer, C., (2017) Clinical Research Nurse Career Advancement Using Clinical Ladder Programs, ACRP, DOI: 10.14524/CR-17-0038 Stubblefield, A (2005) The Baptist Health care: Journey to Excellence, John Wiley and Sons, Hoboken, New Jersey.

Rebecca L. Collins, MS, RN, CCM, CHPN, CENP, is a certified nurse in care management with more than 25 years of nursing experience. Rebecca has

led teams in disease management, program development, leadership development and community outreach. Rebecca is currently the director of Care Transitions at Pure HealthCare.

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PROFESSIONAL DEVELOPMENT

PROFILES IN PROFESSIONAL DEVELOPMENT

BY BARBARA LEACH, MS, BSN, RN, AND EDNA B. CLIFTON, MBA, BSN, RN

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L earning does not stop when you finish your degree. It must be a lifetime com mitment for you to continue in your career no matter what path you choose. Choosing to advance your career is a decision that requires significant planning. First and foremost, you need to identify your goals. Do you want to achieve specific expertise in a certain area, or do you want to move to an entirely different career path? In this article we look at how two nurses grew in their careers and what contributed to their advancement.

this point, I realized I needed more education to hone my teaching skills. I enrolled in a series of courses at the University of California Berkeley extension and obtained my community college teach ing credential. These classes were so influen tial on my success as a nurse and educator. This program required me to teach in my area of work (nursing) to my classmates who were auto mechanics, photographers, artists home economists, etc. As a result of this training, I had the chance to do education and administration on a full-time basis. This is just another example of how courses that may not lead to a degree can provide a boost to your career. When the first associate degree (AA) to bachelor of science in nursing (BSN) program in the state began, I was first in line. I knew having this BSN was an important credential that would open more doors and increase my success in achieving more advanced posi tions in nursing. I completed my BSN, and it wasn’t long until I was eligible for a director position. This provided an incentive for me to resume my learning initiative. I continued

BARBARA LEACH, MS, BSN, RN There was never anything else I was going to be other than a nurse. I loved the idea, and I was so lucky to go directly into a nursing program right out of high school. I had wonderful teachers, and they were such great examples, showing me the road to take every opportunity to learn and take chances, and I’ve done that all of my career. My first job was as a pediatric staff nurse on the evening shift. In this role, I quickly became responsible for orienting new staff because I loved teaching and with this, I had to continue my learning. When the opportu nity came up to become a cardio-pulmonary

resuscitation (CPR) instructor and teach hos pital staff, I jumped at it. Through continued study, I worked my way up to becoming an instructor trainer. That opportunity to teach CPR led to my first business venture outside the hospital. I established a company that provided CPR training in the community. I taught courses in parks, preschools, dentist offices and other venues. That business flourished for over 20 years! Soon after I was asked to teach CPR in the hospital, the opportunity opened for me to become the shift educator. In that role, I coordinated orientations for all shifts, which included teaching the required pharmacol ogy class to licensed vocational nurses (LVNs) who were learning to give medications. At

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my studies and achieved American Nursing Credentialing Certification (ANCC) as a nurse executive. For several years, I held the role of special project coordinator. This position offered a variety of learning and teaching opportuni ties. I learned how to develop early versions of electronic health records (EHRs), which encompassed order entry and charting. I was also exposed to a variety of jobs. I even had the opportunity to teach adult educa tion for the local school district, where I taught classes for health unit coordinators. The opportunity to move to case man agement became available, and I was ready for a change of pace. My hospital system needed a manager and leader for its case management department. The responsibili ties included budgeting and staffing across three hospitals in our system. In this new role, I realized I needed to learn more about case management (CM). I joined profes sional organizations and took every CM EDNA B. CLIFTON, MBA, BSN, RN When setting your career goals, it is help ful to engage a mentor. This is an individual who is a seasoned professional that holds values similar to yours. This person can pro vide guidance for certifications and educa tion you need to achieve your goals. They also can assist you in exploring available opportunities and financing. I was fortunate to be able to attend a bachelor’s in nursing (BSN) program right after high school. I had a cousin who was a nurse and served as my mentor. Her advice to me was take the time to get my bach elor’s early in my career as it would open opportunities in the future. I happily took her advice and completed my BSN. I started my nursing career in a large teaching hospital that offered educational tracks to train us for specialty areas. I opted for the critical care track, specific to medical and coronary critical care. These courses provided me with the training needed for me to function effectively in these areas early in my career. After two years working in these areas, I had the opportunity to begin teaching nurses to prepare them to work in the critical care areas. I also developed a

education course I could find. Since CM was a totally new role for me, I knew I had to develop my expertise and obtain creden tials to support that. I did take the ANCC RN-BC and the ACM exams to establish my role as a leader in CM. As a result of my certification work, I was instrumental in developing systemwide policies that offered rewards and benefits to certified staff in every department who earned their certifications. After several years as the director of case management, I had an opportunity to move to the corporate education office. The hos pital system needed someone to develop a CME certification process and to support the ANCC programs. With my background in education and case management, I was a prime candidate for this position. Here I learned how to develop programs on a learning management system platform and influence education programs across the health system. This also allowed me to use mentoring program that assisted new gradu ates to transition into the role of a profes sional nurse. Having the bachelor’s and the expertise gleaned from continued education courses opened opportunities to lecture at state and national seminars. After 5 years of teaching, I began to become frustrated because I was teaching the ideal to students, but the systems in which they worked needed to change, and the only way that could happen was for me to move into administration where I could influence those changes. At that time the bachelor’s was adequate to be eligible to take on an administrative position. However, it did not take long before that changed, and to maintain that role a master’s was required. I began to explore programs that would best prepare me to continue in administration, which was my professional goal. In choosing how to advance my career, I explored several master’s programs and evaluated how they could help me achieve my goal to broaden my business and finance experience to solidify my role as a nursing leader and an integral member of the execu tive team. I looked into master’s programs in nursing, business and public health. I began my studies in public health, but after taking several courses, I realized the curriculum did

my adult learning skills that I learned when I obtained my teaching credentials from the University of California. My advice is to take advantage of every education opportunity even if it does not directly apply to your current position. The things you learn qualify you for tomorrow’s job, or they may add a new idea for a better way to do today’s job. You never know.

Barbara Leach, MS, BSN, RN, is a registered nurse with a master’s degree in case management.

She currently is an independent CE/ CME consultant as well as director of curriculum management for Athena Forum Institute. Prior to that, Barbara worked for 45 years in many education and clinical positions for Sutter Health. Feel free to reach out to Barbara via email at barbara.leach@athenaforum.net . not offer the business and finance courses I felt I needed. So, I enrolled in a program to complete my master’s in business adminis tration. I do admit this transition was quite challenging. The course of study was very different and difficult, but I knew this pro gram clearly met my professional goals. When I finished my master’s in business administration (MBA), I chose to move into a different healthcare setting. I began work in the field of hospice. I was fortunate to meet their chief financial officer, who saw the value of having a nurse with a busi ness degree because of how the hospice Medicare benefit regulated payment for care their patients received. In this role as director of reimbursement, I had to dig into the Medicare regulations governing hospice payment and I had to educate insurance case managers to how hospice functioned and how it differed from home health. This role allowed me to apply my clinical and financial skills. The MBA program also had a strong qual ity improvement component. After gradua tion, I kept in touch with the professor who taught the course. Since he knew my interest in this topic, he referred me to the local school system’s Quality Academy. This was a Continued on page 18

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PRIMARY CARE

EMBEDDED NURSE CASE MANAGERS IN PRIMARY CARE: MY EXPERIENCE AND STRATEGIES FOR SUCCESS BY KELVA EDMUNDS-WALLER, MSN, RN, CCM

I ntegration of nurse case managers in primary care is an increasingly popular population health strategy to improve healthcare quality, reduce healthcare costs and improve the patient experi ence. Case managers are intuitive thinkers able to assemble information from various sources and quickly see the “big picture.” This type of thinking enhances their ability to connect relationships, develop strategies to solve problems and modify plans as situ ations evolve and change. Case managers are also analytical thinkers and use data from multiple information sources to identify and prioritize patient care challenges and be deliberate and focused in finding solutions to new and reoccurring problems. Intuitive and analytical thinking, clinical experience and using case management processes and stan dards of practice make nurse case managers an excellent fit as embedded case managers in primary care. CLINIC PROFILE I have been an embedded case manager in a primary care resident clinic at an aca demic medical center for approximately 2 years. The clinic has 71 residents who rotate through the clinic and 13 attendings provid ing resident supervision. The interdisciplinary team includes registered nurses, licensed practical nurses, medical assistants, clini cal pharmacists, psychology fellows, social workers, a diabetes educator, an outreach worker, two medical directors, a nurse man ager, a clinical coordinator and administra tive staff. The clinic provides care to over 1,800 patients. Approximately 62% of the clinic population is Black, 28% white, 10% comprise American Indian-Alaskan, Native

Hawaii/Pacific Islander and unknown ethnici ties. Hypertension, heart failure, diabetes, CKD and COPD are among the top diagnoses seen in the clinic. Like many primary care clinics, patients often have several co-morbid conditions impacting their health. Limited health and reading literacy and other social determinants of health, including mental health, are additional factors that contribute to a moderate to highly complex patient population in the clinic. A TYPICAL DAY IN PRIMARY CARE The primary goals for embedded nurse case managers include chronic disease management and avoidance of hospital readmissions. I currently manage about 55 patients in the resident clinic. On a typical day, I begin by reviewing discharge reports, including patients discharged following an ED or inpatient admission. Transition of care (TOC) assessments account for 50% of my workday. On average, I complete TOC assessments on five patients per day. Assessments are comprehensive and focus on reviewing discharge instructions, medica tion review and management, scheduling follow-up with the primary care and spe cialty providers and coordinating recom mended diagnostic tests and procedures. Screening for social determinants of health is also a component of each assessment. Social determinants that frequently impact the patient’s ability to follow the care plan include access to care, income insecurity, limited reading and health literacy. Medication management involves resolv ing medication discrepancies, assisting patients in obtaining medications, teaching patients about each medication’s purpose

and how to self-administer medications. Due to income insecurity or payer require ments, a call to the provider may be neces sary to communicate that a medication is not covered or unaffordable for the patient. If an alternative medication is not available, I initiate prescription assistance program applications and follow up to help patients obtain prescribed medications. If a patient cannot self-administer medications indepen dently, I engage appropriate family members for assistance. Some patients come into the clinic for assistance with reading prescription labels to fill pill boxes correctly. Medication management also involves following up with patients after a scheduled appointment to review any medication changes. Typically, providers do not have time to follow up with patients to ensure adherence to medica tion changes. So, this is an essential role of embedded case managers. It may be necessary to coordinate post acute care services (i.e., home health, remote patient monitoring) following a hospital discharge. Involvement of post acute care services requires ongoing fol low-up and collaboration to evaluate the care plan’s effectiveness and make revisions as needed. To reduce or prevent hospital readmissions, I follow up with patients or caregivers weekly during the 30-day transition periods to assess the patient’s health status and proactively manage any problems that may negatively impact the care plan. Regular communication with the primary care provider and other team members occurs to ensure that the team has updated information on the patient’s health status. Referrals to psychology, social work and community outreach to address social

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