Integration of acute care CNS and case manager roles

To be effective in the new environment of managed health care, APNs must have a transformed outlook on providing nursing care. Accountability for day to day care that leads to shorter hospital stays and at the same time improves the quality of care is essential. The nurse's focus can no longer be on each small piece of care, but rather on a broad perspective of the entire continuum of care. The expert skills of the critical care CNS are still needed to manage the complex care required of patients in this setting. However, their focus needs to be broadened so that the larger picture remains in sight. Coordination of the activities of multiple care providers to achieve the ultimate goal of providing cost effective, quality care will be a primary responsibility of the CNS-NCM. This transition requires new thinking. Educational programs that include perspective transformation are needed for CNS role transition to become expert in the NCM role.