Source: CMSA Today
PROFESSIONALISM AND CASE MANAGEMENT
According to the U.S. Department of Labor, professionalism is communicating effectively and appropriately while always finding a way to be productive. In addition, professionalism involves the soft skills of integrity, responsibility, accountability and excellence (U.S. Department of Labor, n.d.). Fidelity is one of the seven ethical principles from The Nursing Code of Ethics that all nurses must comply with. Fidelity means being faithful to a person, belief or cause. Fidelis behavior involves being faithful to a profession while honoring the responsibility of providing safe, competent and effective care (Faubion, 2022). Without increasing knowledge, one may ask how safe, competent, evidence-based care occurs.
As a case manager with a nursing background, my default starting point is looking at the discipline of nursing for background. A study by Ohio State University revealed that nurses with a higher level of education, whether a master’s degree or above, were more competent in evidence-based practice and what it can do for the nursing profession (Ohio State University College of Nursing, 2018).
The American Association of Colleges of Nursing (AACN), the national voice for academic nursing, deems education as having a significant impact on the knowledge and competencies of the nurse and all healthcare providers (American Association of Colleges of Nursing, 2021). Nurses, leaders and employers automatically become obligated to uphold the charge of accountability when caring for patients. Accountability includes the “Lifelong dedication to learning: Given the increasing rate of clinical advancements, nurses need to continuously educate themselves on new methods of care” (Smith et al., 2018).
According to White et al., nurses cannot rely on their clinical experience alone to provide quality care. Nurses need to apply critical thinking, the foundation of evidence-based practice, when implementing and evaluating the nursing process (White et al., 2016).
From a social work perspective, the Social Work Dictionary (6th edition) offers the following definition: “Professionalism: the degree to which an individual possesses and uses the knowledge, skills and qualifications of a profession and adheres to its values and ethics when serving the client. The National Association of Social Workers (NASW) requires that social workers uphold their ethical responsibility to the profession, including upholding the profession’s integrity, evaluating policies, and participating in research that contributes to the development of knowledge” (National Association of Social Workers, 2021).
EDUCATION AND THE NURSING PROFESSION
The complexity of the healthcare delivery system has revealed five essential components that challenge health clinicians. One of these components is due to the growth of new knowledge and the delay in implementing this new knowledge. The longer the time from graduation, the poorer a person’s knowledge (White et al., 2016).
This revelation can be expanded so that case managers, regardless of discipline, should continuously strive to gain knowledge through continuing education, certifications and obtaining advanced degrees. Continuing education classes and obtaining certifications are relatively simple. Obtaining advanced degrees requires more time, commitment and money.
Sibandze and Scafide (2017) reported that a systematic review revealed that a nurse’s level of education plays an essential role in developing awareness and integration of professional values into practice. The report’s findings should not minimize the professionalism of nurses who choose not to pursue advanced degrees; however, it should act as a catalyst for those considering pursuing an advanced degree. John F. Kennedy eloquently stated, “The goal of education is the advancement of knowledge and the dissemination of truth.”
Additionally, the Commission for Case Manager Certification Code of Ethics states in Principle #5, “Board-Certified Case Managers (CCMs) will maintain their competency at a level that ensures their clients will receive the highest quality of service” (Commission for Case Manager Certification [CCMC], 2018). Competency requires knowledge, which is obtained through experience and study.
This brings us back to the purpose of this article. Does an advanced degree increase the level of professionalism in case management?
As nurses and social workers, we can agree that the state board exams are challenging. All nurses and social workers are capable, practicing individuals regardless of their degree. To support this statement, let us review the national NCLEX passing rate for 2021. It was reported to be 82.48%. This result includes receiving a diploma, baccalaureate degree, associate degree and invalid or special program codes (National Council of State Boards of Nursing, Inc., 2021). The clinical exam pass rate for social workers for 2021 was reported to be 75.8% (Association of Social Work Boards, 2022).
IMPACT OF ADVANCED DEGREE COURSEWORK
An advanced degree allows a person to think differently, be open to problem-solving and look for long-term solutions. Graduate school elevates individuals to another level of learning.
Regardless of the discipline or program, graduate-level coursework teaches students how to become leaders, collaborate and implement strategies that impact the patients and populations we serve. Whether the student is a recipient of a masters or doctoral degree, it allows that person to elevate their practice to the next level.
Again, the healthcare delivery system is complex. With complexity comes the need for rapidly changing healthcare solutions based on research and evidence. As an example, the National Academy of Medicine (NAM) released The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity to address the role nursing has in improving health equity and patient outcomes. NAM identified nine recommendations, with three of the recommendations outlined in the use of technology to integrate data and the strengthening of nursing education to meet the future requirements of the nursing profession (National Academies of Sciences, Engineering, and Medicine, 2021). The complete report is available at https://nap.nationalacademies.org/25982.
The AACN refers to Knowledge for Nursing Practice as Domain 1 (American Association of Colleges of Nursing, 2021). This domain states, “Knowledge for Nursing Practice provides the context for understanding nursing as a scientific discipline. The lens of nursing, informed by nursing history, knowledge, and science, reflects nursing’s desire to incorporate multiple perspectives into nursing practice, leading to nursing’s unique way of knowing and caring” (American Association of Colleges of Nursing, 2021).
The Council on Social Work Education (CSWE) notes that “MSW programs prepare graduates for work in their chosen field of concentration or specialization and include developing skills required to perform clinical assessments, manage large caseloads, take on supervisory roles, engage in policy-level advocacy, and explore new ways of drawing on social services to meet the needs of clients and communities” (Council on Social Work Education, 2022).
There is no right or wrong answer to the question “Does an advanced degree increase the level of professionalism in case management?” From a case management perspective, the answer depends on where an individual is on their case management journey. If at the end of the career, mentor; if in the middle, decide; if in the beginning, realize the potential to impact the profession for the next 30 years!
Case management is a profession that will continue to evolve. The profession will need new leaders, nurses, ideas and policies. Education will keep us on the path, but continuous learning will provide the power to address the ever-changing world of healthcare. Obtaining an advanced degree is an individual decision; however, lifelong learning is a charge every case manager has agreed to. There will always be a choice to obtain an advanced degree. Professionalism involves the soft skills of integrity, responsibility, accountability and excellence. Are these the qualities of a case manager? Yes. The qualities mentioned above will then lead to pursuing lifelong learning. Whatever path one takes, whether an advanced degree, continuing education or attending seminars, the information retained will help us individually and collectively move the case management profession forward.
As a nurse, I often reflect on a quote by the mother of professional nursing: “Let us never consider ourselves finished nurses … we must be learning all of our lives” (Florence Nightingale); this is true of any discipline related to healthcare and should drive you as you ponder a decision.
American Association of Colleges of Nursing. (2021). AACN Fact Sheet – Impact of Education on Nursing Practice. www.aacnnursing.org. https://www.aacnnursing.org/news-information/fact-sheets/impact-of-education#.
Association of Social Work Boards. (2022). Association of Social Work Boards 2022 ASWB Exam Pass Rate Analysis. https://www.aswb.org/wp-content/uploads/2022/07/2022-ASWB-Exam-Pass-Rate-Analysis.pdf.
Barker, R. (2014). The Social Work Dictionary (6th ed.). Washington, DC: NASW Press.
Commission for Case Manager Certification (CCMC). (2018). CODE OF PROFESSIONAL CONDUCT for CASE MANAGERS With Standards, Rules, Procedures, and Penalties ADOPTED BY THE COMMISSION FOR CASE MANAGER CERTIFICATION ® (CCMC ® ). https://ccmcertification.org/sites/ccmc/files/docs/2018/ccmc-18-code-of-conduct_1.pdf.
Council on Social Work Education (2022). Advocacy and Education. https://www.cswe.org.
Faubion, D. (2022). The 9 Nursing Code of Ethics – A Must Know For Every Nurse. Www.nursingprocess.org. https://www.nursingprocess.org/nursing-code-of-ethics-and-interpretive-statements.html.
National Academies of Sciences, Engineering, and Medicine. (2021). The future of nursing 2020-2030: Charting a path to achieve health equity (M. Wakefield, D. R. Williams, S. L. Menestrel, & J. L. Flaubert, Eds.). National Academies Press. https://doi.org/10.17226/25982.
National Association of Social Workers. (2021). National Association of Social Workers (NASW). NASW – National Association of Social Workers. https://www.socialworkers.org/About/Ethics/Code-of-Ethics/Code-of-Ethics-English/Social-Workers-Ethical-Responsibilities-to-the-Social-Work-Profession.
National Council of State Boards of Nursing, Inc. (2021). Number of Candidates Taking NCLEX Examination and Percent Passing, by Type of Candidate. https://www.ncsbn.org/public-files/Table_of_Pass_Rates_2021_Q4.pdf.
Ohio State University College of Nursing. (2018). New study reveals nurses’ reported lack of competency in evidence-based practice threatens quality and safety of healthcare. New Study Reveals Nurses’ Reported Lack of Competency in Evidence-Based Practice Threatens Quality and Safety of Healthcare | the Ohio State University College of Nursing. https://nursing.osu.edu/news/2019/12/10/new-study-reveals-nurses-reported-lack-competency-evidence-based-practice-threatens.
Sibandze, B. T., & Scafide, K. N. (2017). Among nurses, how does education level impact professional values? A systematic review. International Nursing Review, 65(1), 65 – 77. https://doi.org/10.1111/inr.12390.
Smith, N., Karakashian, A., Spears, T.-L., & Pravikoff, D. (2018). Accountability in Nursing Practice. https://www.ebscohost.com/assets-sample-content/NRCP_EBCS_Accountability-in-NursingPractice.pdf.
U.S. Department of Labor. (n.d.). Skills to Pay the Bills 114 Professionalism. https://www.dol.gov/sites/dolgov/files/odep/topics/youth/softskills/professionalism.pdf.
White, K. M., Dudley-Brown, S., & Terhaar, M. F. (2016). Translation of evidence into nursing and health care. Springer Publishing Company, LLC.
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