Nursing case management in the 21st century: intervening where margin meets mission

Case management, the basic process of matching key resources to individual's needs, often carried out across time and place, has been a relatively low-profile function (under various levels) within society, business, and health care for many years. Nurses have been involved in case management since its beginnings in social service and public health. However, nurses only became prominent as case managers during the last half of the 20th century because of the need to establish medical necessity for health care payments and, eventually, the need to provide discharge planning. The 21st century begins with an evolving core for case management functions in health care, the specific models dictated by the margins and missions of the employing organization. Case management, in fact, is the nursing process applied at a system level. However, if case management is to remain an adaptable yet powerful strategy for patients and organizations across the continuum of health care, it will have to move beyond access and medical necessity functions to those functions that demand advanced nursing experience and skills.