Looking Back on a Career in Nursing and Case Management

Source: CMSA Today


A career is defined as an occupation undertaken for ‌a significant period of a person’s life and with opportunities for progress. When I became a case manager in 1988, I remember thinking how case management closed the circle of nursing for me.

Here’s what I mean:

As a nurse, I had worked in the emergency department (ED) and respiratory intensive care (RICU) at a major teaching hospital in Philadelphia most of my career. I loved the fast-paced nature of these units and the critical nature of the patients we cared for.

Throughout my nursing career, I worked with great nurses. We worked as a team and supported each other. We were trusted by the doctors (attending, fellows, residents, interns and students). We didn’t always know the cause, but when we called the doctor from the ED or the RICU, they came because they trusted us.

The patients were very sick. In the ED, we worked on patients who were shot or stabbed so they could go to the OR for a chance to live. We had overdoses and rapes. It was a tough place to work, but I loved it and was good at what I did.

In the RICU, we took care of patients with ALS, respiratory failure, COPD and conditions that landed patients on ventilators for months. We got to know the patients (even those who were unconscious) as well as their families, who came to see them religiously. We worked with the doctors and were present when the plan of care was discussed with the family. We all worked from the same plan of care – we were a team. We stayed with the families watching their family members for days that turned into months. We educated them on what was going on and, when appropriate, prepared them for the death of their loved one. What I learned was never to give up on someone. People I thought would not survive, survived. Some went home right from our unit. These units tested my skills and taught me a great deal about life, death and the resilience of the human spirit.

Seeing the Other Side of the Equation

It was not until I worked as a catastrophic case manager that I realized how resilient people were and how those same people we thought would die, lived and could live well when they had the resources to meet their needs.

I learned as a case manager that my role was to educate, empower, break down barriers and find resources that would enable my patients to be with their families, return to work and live their lives. Many were not the same, but they were alive and, with my help, did well.

Case management became my second career, and I found it rewarding in a number a ways that helped me understand so many things. I learned that by working with the team, we could help patients that had catastrophic and chronic medical conditions to survive and transition to the next level of care on their journey safely and effectively.

I learned the importance of rehabilitation in helping people move beyond what they through they could do. I learned to be an advocate for my patients, their families and the healthcare team.

I learned the importance of communication and how to negotiate things my patients needed, that would help them to reach their maximum potential even if they did not have the benefits to cover them. I learned how to research community resources when the insurance policy did not cover a benefit.

I learned how to build relationships that allowed me to call a vendor at 4 p.m. on Friday afternoon and put together a discharge plan so my patient could be discharged to home.

I learned how the healthcare system worked and how to educate and empower my patients and their families so I could “work myself out of a job” because my patient and their family could use their own voice to get what they needed to be self-sufficient.

I learned how important case management could be in curbing escalating healthcare costs when I was brought in early on the case. I learned the important role case managers play in holding the team together during complex and stressful times.

I learned how important it is for the patient to have an advocate and what an advocate’s role was for those in need. I learned that it was my role to effect change because the status quo was not enough.

My nursing and case management careers taught me the importance of life-long learning and the value of belonging to my professional organization. When I actively participated and shared my skills and expertise as a mentor and a leader, I got much more back than I ever put in.

Where I am Today

Today, I am transitioning into my retirement years. As I look back on my careers, I am proud of the journey I have taken and the work I have done.

To those coming behind me, here are some tips:

  • Enjoy your work. Do what you love and love what you do.
  • Be curious and open to opportunities. They will come your way. Don’t be afraid to try something new.
  • Continue your education. It is never too late to go back to school, get your first, second or third degree! If it helps you in your career – do it!
  • Be the one who helps someone who is struggling.
  • Be actively involved in your professional organization.
  • Volunteer to be on a committee and work your way up to the local board.
  • Think about certification. Make sure it is one to meet your professional goals.
  • Attend your professional organization’s national conference.
  • Be a mentor. Take time to teach and share what you know.
  • Show the value you bring to your role every day, in everything you do.
  • Document, document, document.
  • Proper documentation explains the value you bring to your work and helps others understand your rationale for your work for those who come behind you.
  • Be mindful of your role, your scope of practice, the case management Standards of Practice and Code of Professional Conduct.
  • Get published. Share your experiences and innovative ideas.
  • Take care of yourself, your colleagues, your patients and their families.

In closing, enjoy your career! Be the best that you can be!

Anne Llewellyn, MS, BHSA, RN-BC, CCM, CRRN, has been a nurse for 41 years and a nurse case manager for 31 years. Anne is the author of several special reports that can enhance your career. Visit her website at https://nursesadvocates.com/resources