New Role for Nurses: Unit-Based Care Manager
Serving as both a facilitator and mentor, the Unit-Based Care Manager serves as the unit’s “attending” nurse with respect to triage, communications, and all clinical needs. The Care Manager is staffed by a Clinical Nurse LeaderSM (CNLSM).
VA Tennessee Valley Healthcare System (TVHS) uses team nursing on the hospital units with an RN leader, an LPN and two aids caring for 15 patients. The nurse manager, charge nurse, and Care Manager support multiple teams. The Care Manager role does not reduce the need for RNs in acute care, but it helps to enhance the role of RN. The Care Manager provides education and mentoring to RNs and is available to help provide clinical care.
The Care Manager conducts risk assessments, helps evaluate quality outcomes, and identifies opportunities for the introduction of best practices and performance improvements. In addition, the Care Manager follows the progress of patients, helps with discharge planning, and interfaces with other disciplines.
The Care Manager reports to the Nurse Manager on her or his unit. The Care Manager and the Nurse Manager work collaboratively, with the manager handling most of the administrative issues and the Care Manager handling most of the clinical issues on the unit. The willingness to pitch-in and help with patient care goes a long way towards building trust and respect with the nursing staff.
TVHS still uses Clinical Nurse Specialists (CNSs), and the CNS plays a complimentary role to the Care Manager as the CNS works with a specific disease or patient population. When Care Manager does risk assessment, can call specialist and request consultation. In addition, the Care Manager works collaboratively with Nurse Educators, who provide education to new employees on core competencies.
Each Care Manager signs a performance contract and receives a quarterly review of her/his performance against specific targets for patient quality, safety and satisfaction measures. The measures and targets are customized based on the Care Manager’s unit and types of patients served.
