The Rehabilitation Nurse as Case Manager

Introduction

In a healthcare climate with skyrocketing costs for basic healthcare, the case management role is valuable to patients, employers, healthcare providers, and insurance payers. This role requires well-prepared healthcare professionals with the knowledge and skills to navigate a complex healthcare environment. To achieve optimal effectiveness, today’s case managers should be proactive and holistic practitioners who are cognizant of patients’ needs and desired outcomes, concerns about cost containment, and the service options in the community. The rehabilitation nursing professional, acting as a coordinator of health services, an advocate for rehabilitation, and an expert on case management issues, is key to quality patient outcomes and cost containment.

Position

It is the position of the Association of Rehabilitation Nurses (ARN) that rehabilitation nurses are the most qualified healthcare professionals to provide case management services as they possess the education, background, and expertise needed to coordinate patients’ healthcare services from the onset of injury or illness to safe return to work and/or assimilation into the community as productive members of society according to their functional abilities.

To assist patients in achieving optimal outcomes, rehabilitation nursing professionals use their expertise in:

• collaborative communication between patient/family and members of the healthcare team across the continuum
• patient and family education to maximize health care benefits and outcomes and minimize disability
• optimum utilization of therapies and community resources
• integration of psychosocial factors using disease management concepts
• the trajectory of illness and recovery for complex medical issues
• the care continuum over the life span
• healthcare resources

Rationale

Rehabilitation nursing provides the foundation needed to practice the art and science of case management for patients with complex medical and psychosocial conditions. The nurse-patient relationship is unique  as nurses are central to the recovery and/or rehabilitation process, their role on the rehabilitation team is vital. Rehabilitation nurses’  assessment skills are holistic and address the physical, behavioral, spiritual, and psychosocial needs of the patient. From the first encounter with a patient in the case management process, rehabilitation nurses begin planning for discharge, using their expertise and communication skills within the clinical team to coordinate care, facilitate transitions to the appropriate care setting, monitor the patient through the rehabilitation process, and reinforce newly-learned skills to achieve maximum functionality. 

As case managers, rehabilitation nurses are equipped to organize complex treatment plans and establish clear, attainable goals for the patient. Rehabilitation nurses educate not only patients but also patients’ families and caregivers as well as provide the support and counseling that is central to the rehabilitation process.  As case managers, rehabilitation nurses use knowledge, creativity, adaptability, and flexibility to enhance resources, maximize healthcare benefits, outcomes and seek solutions to achieve long term success.

Professional Organization

ARN is the nursing organization that supports rehabilitation nurses and case managers by providing

• cutting-edge clinical education in patient management and disease management topics
• the foundation for best practice models that enable the case manager to assimilate and coordinate various treatment plans within an overall patient plan
• research articles in the Rehabilitation Nursing journal that can be immediately applied to the practice of case management
• information on navigating the healthcare system
• educational sessions and monthly updates on health policy, insurance, and funding issues that affect patients, families, rehabilitation nurses, and nurse case managers.

Approved by the ARN Board of Directors January 7, 2005, revised June 2006, revised March 2014, revised April 2017.