"It's like a whole different world..." narratives of transition to the nurse case manager role .
Date
2024
Authors
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Volume Title
Publisher
University of Delaware
Abstract
Work role transitions in nursing have dramatically increased in the last five years. The rate of RN turnover in 2023 was 18.4%, well above the pre-pandemic rate of 15.9%. A nursing work role transition is a critical point in time for the nurse and for the organization. Because nurses may experience negative feelings like frustration, being overwhelmed, and a loss of confidence as a result of the challenge of learning new things and developing new relationships, there is a risk that they may leave their new role before completing the transition process. This is costly to healthcare organizations, which must then recruit, screen, interview, hire, and train another nurse to replace the one who was lost. The average hospital spends $3.9-5.8 million annually due to nurse turnover. There is a clear indication for evidence-based interventions for reducing turnover in nursing, the development of which has been recommended by the National Academies of Science, Engineering, and Medicine. To create such interventions, the experiences of nurses who undergo work role transitions must first be understood. ☐ The experience of role transition in nursing can differ depending on the originating specialty and the destination specialty. The bedside RN-to-hospital nurse case manager is one example. It is unique because of the highly variable nature of nurse case management practice. The goals and objectives of case management in a payer environment (i.e., health insurance company) are very different from those of a hospital or a community-based program. ☐ Case management functions support every part of the Institute for Healthcare Improvement’s Quadruple aim: improving care, promoting health, reducing costs, and supporting patient and caregiver well-being and satisfaction. Various types of role transitions in nursing have been examined in the literature, but the bedside RN-to-hospital nurse case manager role transition remains unexplored. ☐ The aim of this dissertation was to address the knowledge gap regarding the bedside RN-to-hospital nurse case manager role transition through the exploration of the experiences of nurses who have recently experienced such a transition. A review of the literature (Chapter 2) evaluated and synthesized findings of existing literature on nurse case manager role transitions. The findings indicated that since 1985, only two studies, published over four research articles, examined role transitions to case management. None investigated the experiences of bedside RNs as they transition to hospital case manager roles. Additionally, ambiguity surrounding the concept of nursing case management was noted during literature searching and screening. ☐ A concept analysis (Chapter 3) analyzed and clarified the concept of nursing case management. The results identified six attributes representative of nursing case management and yielded an evidence-based description of the concept: Nursing case management is a collaborative, patient-centric process rooted in evidence and governed by rules and laws. It is applied across the continuum of care by nurses using the nursing process to facilitate the resolution of problems experienced by patients and healthcare entities. ☐ A qualitative research study using narrative inquiry methods (Chapter 4) explored the lived experience of seasoned bedside nurses who have recently transitioned to the hospital nurse case manager role. Interviews with 6 RNs with between 3 and 22 months of experience in the hospital nurse case manager role were interviewed and the transcripts were analyzed using a narrative analysis approach. Three resonant threads that represented their experiences were uncovered: The twilight of disenchantment and letting go, consisting of themes related to leaving the bedside and choosing nursing case management; finding their way through the darkness, containing themes related to facilitators and inhibitors to successful role transition; and finally, the dawning of a re-formed identity, capturing themes of new beginnings. Findings from this research provided the first glimpses into this previously unexplored nursing work role transition and created a foundation on which future research can be built. ☐ Findings from this dissertation indicate that little was known about the RN-to-nurse case manager role transition and that the concept of nursing case management was used inconsistently in the literature. These findings were addressed by clarifying and describing the concept, and by exploring and seeking to understand the experiences of bedside nurses who recently transitioned to the hospital nurse case manager. This understanding that resulted from this dissertation represents the first contribution to the literature on this type of nursing work role transition. It opens the door to future research toward a broader grasp of this transition experience, ultimately leading to evidence-based interventions to promote successful transitions to the nurse case manager role.
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Keywords
Case management, Case manager, New-to-setting, Role transition, Health insurance company