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Internship program fills slots with experienced CMs
Hospital system develops training program
Morton Plant Mease Health Care in Clearwater, FL, has found an effective way to fill case management vacancies with qualified candidates.
The four-hospital health system has created its own case management internship program, an intensive four-week training program that teaches qualified RNs how to be effective case managers.
"About a year and a half ago, we had a 14% vacancy rate in the case management department at one of our hospitals. We knew that the traditional way of trying to hire experienced case managers would be difficult because there aren't that many out there. We decided to look at things a little differently," says Jackie Munro, MS, ARNP, director of development and practice for Morton Plant Mease, who was case management director for the system at the time.
"We had a lot of people leaving for a variety of reasons. We had a lot of interest in the positions but few of the potential candidates had a lot of case management experience," adds Diana Cripe, manager of case management for Morton Plant Hospital and Morton Plant Northwest Hospital.
The hospital system was named the 2007 winner of the Franklin Award of Distinction for its case management program by The Joint Commission and the American Case Management Association.
The internship program was highlighted as one of the achievements that qualified Morton Plant Mease for the award. The program includes topics such as the history of case management, payer rules and regulations, discharge planning, evidence-based measures, clinical documentation, and communication with physicians, nurses, and ancillary services personnel.
Candidates spend four weeks learning the multifaceted case management functions at Morton Plant Mease. The education includes both classroom sessions and clinical experiences. The course also includes instructions on how to use the case management web-based computer program.
During a portion of the internship program, the case manager candidates work in the hospital half a day, putting what they learned in the classroom into use. They are closely followed by experienced case managers who act as preceptors and oversee the new case managers for a year.
The first class of 13 case management interns finished the program in October 2006. A second group completed the classroom portion of the program in early May.
Before starting the internship program, the case management team spent about a year creating the program and developing the curriculum.
"We sat down and looked at the multiple roles and responsibilities of the RN case managers — their job descriptions, feedback from the team and reviewed orientation experiences from candidates that we hired in the past when we designed our curriculum. As we established the curriculum, we kept in mind what nurses truly need to be case managers," Munro says.
For instance, the team knows that case managers must have good communication skills in order to effectively work with other disciplines in the hospital.
"We developed a class on crucial conversations between case managers, nurses, physicians, and managed care companies and emphasized that communication is a vital part of the role," Munro adds.
The team pulled in the physician advisors to case management, consultants, and experts within the case management department to assist in curriculum development.
"We had a lot of experts within our own discipline and within the Bay Care Health System who could help us develop the curriculum," says Randi Ferrare, director of case management for Morton Plant Mease.
After the program was designed, the management team sent it to the experts for validation, and reviewed it with the case management staff.
The hospital system opened the program up to all of the hospitals in the Bay Care Health System and recruited team members from other campuses to help with the training, Ferrare says.
The hospital system initially received about 50 applications for the first internship program. The team narrowed it down to 20 candidates and hired 13 people for the first class.
"We had a lot of people who were interested in auditing the class who didn't necessarily want to work for us. We haven't opened it to them yet," Cripe says.
Candidates for the program must be licensed as registered nurses in the state of Florida and have worked in the acute care environment for at least two years.
Before the team started interviewing applicants for the program, it developed standard interview questions.
"We wanted to make sure that we were comparing apples to apples and that the candidates would be the right fit for our work environment and health system values," Cripe says.
Few of the interview questions involved case management skills. Instead, the team chose to focus on behavioral questions, such as how a candidate would handle a situation in which he or she had to resolve a conflict.
"Case managers are the leaders on the nursing units. They are like the air traffic controllers and must be able to work in a team environment and make sure that all the disciplines work together," Cripe says.
After all the candidates were interviewed, the interview committee sat down and talked about which candidates would best fit into the health system.
In combination with the internship program, the hospital system developed a preceptor program to make sure that new case managers received appropriate experience in the hospital.
Top performers in the organization were chosen to be preceptors and went through on-line training.
After they finish the program, the new case managers go through an extensive orientation program required of all new employees of the hospital system.
They work closely with their preceptors for a period of about four to six weeks, until the preceptor signs off on an 11-page document that outlines the skills and competencies the new case manager must complete.
After the initial period, the preceptor works more as a mentor to the new case manager and continues the role for a year.
Program popular among staff, patients
The program has had positive results and gets high praise from existing staff as well as the new case managers, Munro says.
"The new case managers are working out wonderfully. They came in with more knowledge than anyone we have previously hired and have immediate buy-in to the program. The team welcomes them because they come in with that measure of experience," Cripe adds.
The case management team scores about 10% higher than the rest of the health care organization on satisfaction surveys given to new employees.
Based on input from the first group of case managers, the team has tweaked the curriculum in addition to updating the content, Munro says.
The didactic portions of the course are available to all Bay Care Health System employees through the organization's on-line learning center.
"The program represents an opportunity to bridge the relationship between the bedside nurse and the case management team. It contains a lot of information that bedside nurses need to know. We all went to nursing school to learn how to care for patients, but these days, it's very important for nurses to be informed about how the hospital gets paid, why we are concerned with length of stay, and other issues," Cripe says.
In addition to recognizing Morton Plant Mease for its case management internship program, the Franklin Award evaluators cited the hospital system for its culture of cooperation between case management and the senior leadership team, physician advisors, and patient services, and medical records also were cited in the awards presentation.
"When a member of the case management team identifies an opportunity for improvement or a patient in need, the team member can directly contact senior management. We don't work in silos. Working together as a team across disciplines is an integral part of our culture," Cripe says.