Inpatient nursing case management as a strategy for rural hospitals: a case study

Increasingly, hospitals are facing the dual challenges of cost containment and a nursing shortage. These challenges are especially problematic for rural hospitals where nursing staff must be recruited and quality standards maintained within the financial limitations of lower DRG reimbursement rates when compared with urban centers. Therefore, it has become necessary for rural administrators to find new approaches to maximizing the utilization of available nursing staff. Experts have proposed that one solution to the nursing shortage is redesigning the work of RNs to more fully utilize the knowledge and skill of nurses. Nursing case management--a system in which the registered nurse (RN) assesses patient needs, develops a plan of care, procures and coordinates needed resources, and provides ongoing evaluation of care--is one strategy for redesigning nursing roles which offers potential financial benefits to hospitals. Through daily coordination and evaluation of patient care activities, nursing case managers can ensure cost effective allocation of organizational resources and facilitate early discharge planning. This article includes a case study of a rural hospital that introduced the nursing case management system, the hospital's steps of planning and implementation, and examples of forms associated with the system.