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Q&A with Case Management Nurse, Wendie A. Howland, RN, MN, CRRN, CCM, CNLCP


BestNursingDegree.com interviews case management nurse, Wendie A. Howland, RN, MN, CRRN, CCM, CNLCP. Wendie is a certified nurse life care planner and former case management nurse who launched her own health consulting business, Howland Health Consulting, Inc.

Below she discusses case management nursing and the importance of nursing education.



Q: What is your current position?

I am the president and owner of Howland Health Consulting.

Q: What is life care planning, and how is it different than other kinds of nursing?

It's dynamic. It's based on published standards, practice, comprehensive assessment, data analysis and research, which provides an organized plan for current and future needs for someone with a catastrophic injury or chronic care needs. Because nurse life care planners have a registered nurse license, we have the Registered Nurse Licensure Act behind us, and we are entitled and, in most jurisdictions, obligated, to assess and provide a plan of care in response to [someone's] illness or injury. I don't have to have a physician sign off on my nursing care plan, other [nursing] specialties do.

Q: How did you get started in this career?

I started out my life as a new nurse in critical care, and I did that for quite a long time and got my master's in critical care. I was working for a small community hospital after many years in academic medical centers, and the hospital closed its nursing education department. I figured in a few months I could get another teaching job. I was in my mid-40s at that point, and if you had told me that I was going to be beginning an entirely new career [in life care planning], I [wouldn't have believed it], but I did. I've never gone back to working in hospitals.

Q: What exactly is case management?

True case management influences the course of care from top to bottom. When you're a case manager you spend a lot of time assessing people, researching options, making a plan of care and collaborating with specialists. I started case managing in workers' comp, and I had to learn a whole new specialty, which was mostly ortho and neuro. You learn a lot about finding resources. You also learn a lot there about working in the insurance milieu.

Q: In your work what is an average day like?

In life care planning or case management, you can do cases for either the plaintiff's side or the defense side. I do cases for both. I find that there's a huge educational component to everything I do - in part because the patient doesn't understand the medical and therapy issues or the evaluations that are being contemplated.

I find that I get a lot of cases from lawyers who have no idea what the medical issues are. Sometimes I can just make it clear to them what documents or contacts they should be pursuing, or which medical specialists they should [contact] for expert opinions.

Q: In general, are there any specific traits that work well in this career?

If you want to prepare for doing case management, life care or legal nurse consulting, you need a very broad clinical background. This is not work for somebody who's a year or two out of school. You need to have a large body of knowledge and assessment algorithms, which you only get from years of practice.

You also have to be inquisitive because there's [always] so much more to learn. You learn all the legal and insurance aspects of the process. It's not that hard to learn it, but you have to know it, because if you don't, you're not going to [be able to] serve your employers or your patients. When you get to the point of wanting to work independently, you have to have a very strong sense of yourself as a nurse. People don't think of [case management] as nursing, but everything I do is really based on the nursing process.

Q: What are some of the challenges in your specialty area?

In my area, I think some of the biggest challenges are related to credibility. When you turn on the TV you can see House, he sees a patient on the floor and says, "Aw, clean up on aisle three, call a nurse!" Or if someone mistakes a female physician for a nurse on TV, all hell breaks loose. All of that coming together makes nursing look weak and subservient. It takes a lot to do what I do, and what my peers do. I think one of the biggest challenges we face in our present positions is explaining how much we know, how powerful our knowledge is, and how much we can help people.

Q: What kind of changes have there been in nursing over the last few years?

I review a lot of medical records. And, I have to say that it is depressing to see how bad nursing documentation is. So many people don't get a good education anymore. I read documentation from nurses who cannot spell and do not really give me a picture of what's going on with the patient. If somebody is very ill, [the nurse might] write something like, "Patient says that he feels like he's going to die." I want to see something more; that's just totally inadequate.

Q: What do you see for the future of nurses practicing in this area?

I would like to see higher expectations of nurses coming [into the profession], and higher standards to graduate. They tell me there are more people with master's degrees and doctorates in nursing, and that's helpful, but that's not at the bedside - they're not doing care.

Q: What should nursing students know before entering the field?

I think it would be really wonderful if more nurses could band together, unionize, organize, stand up for their rights, and stand up for their patients' rights.

[Students] should ask themselves whether they are prepared for a profession which requires a strong science background and an adequate math and algebra background. Do they see themselves as someone who can deal with people when they're at their worst? Can they stand up for their own rights and their own worth in the workplace?

Q: Any other recommendations for aspiring case management nursing professionals?

Life care planning and case management is really not a field for a new grad. Get a good education, prepare yourself for a time when you may not want to or be able to do the physical labor of bedside nursing; make sure that you prepare for that, because you're not always going to be in your 20s.