New Graduate Orientation & Mentorship Program for Case ...

ABSTRACT
New Graduate Orientation & Mentorship Program for Case
Managers Who Have Minimal RN Work Experience
Fusae Abbott, RN, DNSc.
Wendy DeVreugd, RN, BSN, PHN, FNP, CCDS, MBA
Janet Rowland, MSN, RN-BC, ACM
2211
CONCURRENT
Thursday, June 21, 2012
2:30 PM – 4:00 PM
Aging case managers and the potential shortage of qualified case managers are critical issues in the case management
field. The CMSA data for 24,000 certified case managers revealed that their average age was 55.1 and only 4.0% of them
were younger than 40 years of age (Park & Huber, 2009).
To address this issue, Kindred Healthcare, Inc. (KH) formed a partnership with the Samuel Merritt University MSN-CM
Program. Since 2010, KH has hired two cohorts of SMU graduates with no RN work experience for a total of 7 graduates.
KH has provided a 6-month new graduates' orientation and mentorship program for each cohort (1st cohort:
6/14/1012/31/10; 2nd cohort: 6/20/11-12/31/11).
For the first cohort, KH and SMU conducted a research study to evaluate the effectiveness of the orientation program;
and to examine issues related to improving the program. The data indicated that MSN-prepared new graduates could
perform satisfactorily at entry-level CM work. It became clear that the educational needs of the new graduates differed
from those of experienced RNs entering the CM field. They required a more intensive guided educational experience
with preceptors, so that graduate-level CM skills could be seamlessly integrated into complex CM-level, long-term acute
care hospital practice.
The SMU-KH orientation and mentorship program provides an innovative approach to bridging the gap between hospital
employment requirements and graduating case managers' levels of experience.
In this concurrent session, we will present details of the KH orientation and mentorship program, lessons learned from
the first trial, and continuous improvement strategies taking place at both KH and SMU. Some examples include the
creation of a KH Career Ladder and Succession Planning Project to promote professional development of case managers
and development of three new CM core courses at SMU: Advanced Health Assessment for Nurse Case Managers,
Advanced Pathophysiology for Nurse Case Managers, and Advanced Health Assessment for Nurse Case Managers.
OBJECTIVES
� Discuss emerging problems of the aging case management workforce.
� Critically appraise the orientation and mentorship program offered at Kindred, and the case management
curriculum offered at Samuel Merritt University.
� Discuss future strategies to educate new nurses, and foster them into the field of professional case
management.
PRESENTER PROFILES
Fusae Abbott, RN, DNSc, is the Director of the Case Management Program in the School of Nursing at Samuel Merritt
University (SMU), a health science university since 1909. Over the past 40 years, Dr. Abbott has practiced as an RN and
taught nursing in both Japan and the USA. Under her leadership, the SMU CM program has produced about 300
Masters-prepared RN graduates in the CM track.
Dr. Abbott has been involved in several research projects. The projects related to CM practice are: 1) Evaluation of the
CM Orientation and Mentorship Program for MSN-prepared New Graduates, in collaboration with Wendy DeVreugd at
Opinions expressed in conference sessions and handout materials are those of the speaker and do not reflect the opinion of CMSA, its officers or staff, or the CMSA Annual Conference

Kindred Healthcare, Inc.; 2) Improving Transition from Hospital to Home, which was a pilot evaluation of the one-year
implementation of the Sutter Transitions of Care program in collaboration with Jan Van der Mei at Sutter Health
Sacramento Sierra Region; 3) Clinical and Financial Impact of the Pharmacy Therapeutic Benefit Change (PTBC),
implemented in 2008, which was a clinical and financial analysis of the PTBC at SutterSelect Health Plan; and 4)
Effectiveness of Chronic Disease Self-Management Program in Japan: Preliminary report of a longitudinal study, in
collaboration with colleagues at Tokyo University in Japan (Nursing and Health Sciences,12, 456-463.)
Disclosure: NONE.
Wendy DeVreugd, RN, BSN, PHN, FNP, CCDS, MBA, is the Senior Director of Case Management for Kindred Healthcare
Hospital Division's West Region (six states and 26 hospitals) for case management, social work, and clinical
documentation improvement programs. Ms. DeVreugd has 41 years' clinical and advanced nursing practice, short-term
and long-term acute care hospital management and strategic planning programs, quality management, risk
management, infection control, acute and ambulatory care level case management, managed care development, shared
risk contract management, disease state management programs, business management, clinical documentation
improvement program inplementation, and legal nurse consulting.
Professional affiliations: Ms. DeVreugd is an Editorial Advisor for HCPRO's Case Management Monthly: Best Practices
and Practical Solutions, and a regular contributing columnist for CMSA Today ("Mentorship Matters"). She is a past
Advisory Board member of the Association for Clinical Documentation Improvement (2007-2010), and is a member of
several ACDIS workgroups. Ms. DeVreugd actively works with CMSA through Kindred Healthcare's Silver Company
Partnership to support new case manager career development, and will participate in the CMSA Career and Knowledge
Pathways project in 2012. Ms. DeVreugd has developed several University Educational Partnerships to benefit the
ongoing growth and development of Kindred's case managers, and developed and implemented a MSN in Case
Management Mentorship Program in partnership with Samuel Merritt University in Oakland, CA, for graduate-level
degree nurses with a specialty in case management, which is in its third year of supporting new nurses into the field of
case management for career development.
Disclosure: Speaker discloses that she is on the HCPRO Editorial Advisory Board for Case Management Monthly: Best
Practices and Practical Solutions (periodical).
Janet Rowland received her RN and AA degree from Contra Costa College; BSN from the University of the State of NY;
MSN from Samuel Merritt College in Nursing Case Management; and is currently a doctoral candidate at St Mary's
College of CA. She is certified by the ANCC as a Nurse Case Manager, and is a member of the ANCC Content Expert Panel
in Case Management. She has over 15 years' experience in case management; and is currently an Assistant Professor at
Samuel Merritt College School of Nursing, in the MSN Case Management Program.
Disclosure: Speaker discloses that she has involvement with the NAPGCM Journal Editorial Board, but is not
compensated.
Opinions expressed in conference sessions and handout materials are those of the speaker and do not reflect the opinion of CMSA, its officers or staff, or the CMSA Annual Conference

New Graduate Orientation and
Mentorship Program
for Case Managers Who Have
Minimal RN Work Experience
Fusae Kondo Abbott, RN, DNSc.
Wendy M. DeVreugd, RN, BSN, PHN,
FNP, CCDS, MBA
Janet W Rowland, MSN, RN‐BC, ACM
Session Outline
• Background
– Challenges
• Partnership between Kindred and SMU
• MSN New Graduate Orientation and Mentorship
Program
– Educational preparation at SMU
– Orientation and mentorship at Kindred
• Results of the program
• Lessons learned from the first cohort
• Future plans
Recruiting and Retaining
Case Managers
• Outside, aggressive
talent acquisition
efforts
• High entry and exit
rates among various
healthcare settings
• Existing company
turnover and
retention rates
…AFFECTS…
• Quality of case
management services
• High turnover costs of
recruitment and
training
• Revenue capture
• Patient and family
satisfaction
1
3
5
Objectives
1. Discuss emerging problems of the aging case
management workforce
2. Critically appraise the orientation and
mentorship program offered at Kindred and
the CM curriculum offered at Samuel
Merritt University
3. Discuss future strategies to educate new
nurses and foster them into the field of
professional case management
Challenges in the Case Management Field
• Aging case managers
• Potential shortage of qualified case managers
– Average age of certified CMs: 55.1
– Only 4.0% of 24,000 certified CMs: < 40
50
45
40
35
30
25
20
15
10
5
0
Age
=60
(Park & Huber, 2009)
35
30
25
20
15
10
5
0
Years of Experience & Age
2‐5 6‐10 11‐15 16=<
50.2 53.0 55.9 59.0
Kindred Challenges
• 2008‐2009 nationwide case manager
turnover rates up to 38%
• 2010 Survey
� 89% of West Region case managers over age 40
� 65% over age 50
� 22% over age 60
60
55
50
2
4
6
1

We Need a
Case Manager
NOW
We Want a Nurse Who Has:
• Years of RN work experience
• A good understanding about CM practice
(complexity and system's approach)
– Finance, regulations
– DC, UM, CM in general
• Mature (professional demeanor)
• Passionate about case management
• Willing to learn
• Flexible in adapting to changes
Educational Partnership Vision
• Infuse and foster a larger access for the
professional case management community
through networking, publishing, and
professional educational alliances to provide
meaningful mentorship opportunities, while
mutually benefiting graduate registered
nurses
7
9
11
• Who is qualified!
• Who can work from
tomorrow!
One Solution
• Educational partnership between:
–Samuel Merritt University
–Kindred Healthcare, Inc.
• Providing a 6‐month, new‐graduate
orientation and mentorship
program for new MSN graduates
with no RN work experience
Who is Kindred Healthcare?
“Dedicated to Hope, Healing, and Recovery”
• Leading Provider of Post Acute Care Services specializing in
critically‐ill and complex patients
• Publically traded healthcare organization with corporate
headquarters in Louisville, Ky.
• 121 Acute Care Hospitals throughout the U.S. in 40 states
• Also has Skilled Nursing, Rehab‐based contracts, and Home
Hospice divisions
• Ranked one of Fortune magazine’s Most Admired Healthcare
Companies 2009, 2010, and 2011
8
10
12
2

Market Specific Integrated and Coordinated Care
Delivery Models
LTACHs (121)
Inpatient Rehab Hospitals (5)
Nursing and Rehabilitation Centers (224)
Acute Rehabilitation Units (113)
RehabCare External Customers (1,563)
Home Care and Hospice (19)
Existing Cluster Market
Potential New Cluster Market
(as of June 1, 2011)
With Focus On Developing Cluster Market Service Offerings
Kindred Complex Case Management:
Roles and Functions
Complex skills promoted in:
• Resource management
• Complex discharge planning
• Interdisciplinary care
facilitation and coordination
• Clinical Documentation
Improvement (CDI)
• Patient and family advocacy
History
1909–
Diploma
Nursing
Program
Department of…
1981–
BSN in conjunction
with St. Mary’s
College
1990-MPT
•Kindred has 3 Regions:
• West
• Central
• Southeast
• Over 500 RN and SW case
managers
• Typical caseload:
• 1:15 ‐1:18
MSN programs:
1993-FNP
1994-CRNA
1996-ELMSN
1997-CM
1994-MOT
1999-MPA
1999–
A Sutter
Affiliate
2005–
ABSN
13
15
2011–
DNP
2002-DPT(1994)
2002-DPM
17
Patient Service Intensity
Uniquely Positioned to Take Advantage of
Changing Healthcare Landscape
HOME
OUTPATIENT
REHAB
ADULT
DAY CARE
HOME
HEALTH
CARE
“Continue The Care”
ASSISTED
LIVING
TCC
SKILLED &
NURSING TCU
FACILITIES
Patient Illness Severity
LTACs
FREESTANDING/ HIH
IN‐PATIENT SAU
REHAB
HOSPICE
ACUTE CARE
HOSPITALS
TRANS
CARE
Samuel Merritt University:
A Health Science University
– In 1909, enrolled first class of 18 in
a diploma nursing program
– In 1981, transitioned to a BSN‐
granting institution
– Now offers 13 specialty health
science programs
– Prepares the most NCLEX‐eligible
graduates in California
– about 500/year
ELMSN‐CM Curriculum
Semester 1 – Semester 4
Pre‐Licensure Total: 61 units
Semester 5
Research Methods
History and Theories of Nursing
Analysis of Health Policy Issues
Semester 6
Epidemiology and Bio‐Statistics
Program Evaluation and QI
Healthcare Finance
Semester 7
Synthesis Requirement
Case Management
3 units
3 units
3 units
3 units
3 units
3 units
3 units
8 units
(3 units theory + 5 units clinical)
Total 90 units
ICU
14
16
18
3

Case Management Theory: Topics
•Case management models
•Acute hospital case management
• Discharge planning / Utilization management
• MS‐DRGs, LOS, Medicare regulations, compliance, cost
benefit analysis, etc.
•Disease management/health education
•Cultural dimensions of health care
•Outcomes evaluation
•Legal and ethical issues in CM practice
•Future directions for case management
Case Management Clinical
• Preceptorship
• 225 hours at various settings, including clinical
seminar –1 hr/week at school
• Learning activities
• A plan of clinical practicum
• Clinical logs
• Case study & life care plan
• Seminar attendance & participation
•CM certifications / CM professional organizations 19
20
• Community hospitals
• Sutter
• John Muir
• Marin General
• Dignity Health
• Kaiser –17 facilities
• University hospitals
• UCSF
• Stanford
• VA
Clinical Sites
•County hospitals
•Alameda County Public
Health
•Sutter VNA & Hospice
•Community‐based
programs
•Westside Community
Mental Health Center
•Brighter Beginnings
•RNS Healthcare
Synthesis Projects
1 Disease Management of Community‐dwelling Patients with Heart Failure
2 Case Management Approach to Reduce Global Burden of Neglected Tropical Disease
3 Case Management in the NICU: Improving Safe Discharge
4 Telephonic Case Management for End Stage Congestive Heart Failure
5 Case Management of Obesity in Adults
6 Osteoarthritis in the Older Population: A Program to Improve Outcomes
7 Case Management Program for Mothers with Gestational Diabetes Mellitus
8 Transition to Rehabilitation: A Case Management Process for Traumatic Spinal Cord
Injury
9 A Case Management Program for the Reduction in Rates of Heart Disease in Women
Veterans with a History of MST and/or Diagnosis of PTSD
10 PEMS‐MED: Preventing Elderly Male Suicide by Managing Elderly Depression
11 A Case Management Program for Pregnant and Parenting Teens
12 A Case Management Proposal for Women with Ovarian Cancer to Improve Outcomes
13 A Case Management Program of Medication Management for Community‐dwelling
Filipinos
Synthesis Projects
• Development of a case management program
• Development of an interdisciplinary CM tool
• Development of a research proposal in
relation to CM practice
• Development of a cost-effective and efficient
CM process within an acute care setting and
in the transition from acute care to the next
level of care
Consultants 21
22
23
Kindred’s Goals
for Case Management
•Differentiation of company ‐ LTAC
•Branding for excellent case/care management
•Social responsibility
•Give back to community and CM field
•Grow competencies in case management
•Reduce case manager turnover to < 10%
annually, increase retention > 1 year to > 85%
Excellent Patient Care Management
24
4

Kindred/Samuel Merritt Partnership:
2010 MSN in Case Management
Mentorship Program
March
June
July-
Dec
• Kindred hired 3 MSNs
• Intensive “onboarding”
4-week orientation
• 5-month mentorship at
hired local sites
Mentorship Program Approval
1. Identification of need:
• Case manager shortage
• Existing turnover rates
• Aging case manager workforce
• Need for higher CM competencies for complex
patient care management
2. Relating advantages of educational
partnership
3. Proforma: Projected costs vs. Return
on investment
25
27
Kindred/Samuel Merritt Partnership:
2010 MSN in Case Management
Mentorship Program
March
June
July-
Dec
• Kindred hired 3 MSNs
• Intensive “onboarding”
4-week orientation
• 5-month mentorship at
hired local sites
Pre‐Hire
•Notification to Samuel Merritt students
•Develop selection process structure
•Selection committee participants
•Arrange job interviews with respondents
•Predictive Index testing prior to interview
•Through interviews, identify strong MSN
commitment to change and growth
•Match with Kindred mission, vision, values
Good to Great –Jim Collins
"Those who build great companies understand
that the ultimate throttle on growth for any
great company is not markets, or technology, or
competition, or products. It is one thing above
all others: the ability to get and keep
enough of the right people. “
What does Collins mean by the “right people’?
29 30
26
28
5

Predictive Index Helps Answer
Questions Like:
What motivates people to action?
For what kinds of work are they best suited?
What meets their needs, and therefore
unleashes their energy and best efforts?
How do they reach their judgments around
people and things? What is their basis for
judgment?
4-Week “Onboarding” - What Is It?
Onboarding, also known as organizational socialization, refers to the mechanism through which new
employees acquire the necessary knowledge, skills, and behaviors to become effective organizational
members and insiders. Bauer, T. N., & Erdogan., B. (2011).
Factor A -measures the
drive to exert one’s
influence on people and
events.
Predictive Index Testing
Reference: The Oliver Group, www.olivergroup.com
Performance = Competence X Motivation
A
LOW Relative to Norm
NORM
AVERAGE
Relative to Norm HIGH
Unassuming, Unselfish Dominant, Assertive
D O M I N A N C E
Factor B – measures the
drive for social interaction
Reserved, Introspective Extroverted, Sociable
with other people.
Factor C - measures the
B EXTROVERSION
intensity of a person’s
tension and pace.
Driving, Intense Patient, Relaxed
Factor D - measures the
drive to conform to
formal rules and
structure.
C P A T I E N C E
Informal, Independent Formal, Conforming
D F O R M A L I T Y
31 32
33
35
35
Kindred/Samuel Merritt Partnership:
2010 MSN in Case Management
Mentorship Program
March
June
July-
Dec
• Kindred hired 3 MSNs
• Intensive “onboarding”
4-week orientation
• 5-month mentorship at
hired local sites
4‐Week Classroom Teaching
•Patient Assessment
•Discharge Planning
•Utilization Management
•Quality –PDCA Model
•MS‐LTC DRGs
•Clinical Documentation
Improvement (CDI)
•Coding Facesheets Review
–Basic Concepts
•Attend DCM Leadership
Monthly Call
•Clinical
•Floor Orientation
•Respiratory Therapy
•Wound Care
•Infection Control
•EMR Training
•InterQual LTACH &
Software Training
•Allscripts Training
•Practicum(s)
34
36
6

Kindred/Samuel Merritt Partnership:
2010 MSN in Case Management
Mentorship Program
March
June
July-
Dec
• Kindred hired 3 MSNs
• Intensive “onboarding”
4-week orientation
• 5-month mentorship at
hired local sites
Considering Cultural Diversity…
•Individual Needs of Mentorees:
CEO/Leadership Review for Support
•Patients and Families: Worksite Cultural
Diversity Review
•Match Needs of Both Facility and MSN CM
•Other Opportunities
What Comes Next after Mentorship?
• “Mentorship Should Never End”
• Identify MSN’s goals for career development
as a CM
• “Career Ladder” choice for next phase at
Kindred
•Clinical expert: Certification
•Administration
•1, 3, 5 year plans
37
39
Mentorship 5‐Month Structure
2‐Week Break for Relocation to Hired Sites
•Meeting facility CEO &
preceptor to discuss
individual support needs
•Regular meetings with
preceptors to monitor
progress
•CM competency progress
documented
•Follow‐up on assigned areas
needing to be strengthened
•Weekly MSN SWOTS
for “reflective practice”
and self‐identified
growth opportunities
•Weekly calls for
support and resources
•Publishing of one
complex patient case
Kindred/Samuel Merritt Partnership:
2010 MSN in Case Management
Mentorship Program
March
June
July-
Dec
• Kindred hired 3 MSNs
• Intensive “onboarding” 4week
orientation
• 5-month mentorship at hired
local sites
What’s Next?
Beyond Orientation & Mentorship
Evaluation of the MSN-Prepared CM New Graduates’ 2010 Orientation and Mentorship Program
Fusae Abbott, RN, DNSc., Wendy De Vreugd, RN, BSN, FNP, CCDS, MBA, Janet Rowland, RN, MSN
Samuel Merritt University & Kindred Healthcare, Inc.
Background
Aging case managers and the potential
shortage of qualified case managers are
critical issues in the case management field.
The CMSA data for 24,000 certified case
managers (CCMs) revealed that the average
age of the CCMs was 55.1 and only 4.0% of
them were younger than 40 years of age
(Park & Huber, 2009).
Purpose
The purpose of the study was to evaluate the
effectiveness of the CM orientation and mentorship
program for MSN-prepared new graduates with no RN
work experience.
Research Questions
• Can an MSN-prepared new CM graduate from
SMU, with no RN work experience, perform
competently as a case manager after completing a 6month
new graduate orientation and mentorship
program?
• What parts of the orientation and mentorship
program helped the graduate to function as a case
manager? To what degree? What didn’t work?
Methods
• A case study method
• Subjects: Three SMU new graduates and their four
trainers.
Case Management Program
Although the healthcare industry recognizes the
shortage issue, SMU ELMSN-CM graduates still
face difficulties in obtaining CM positions.
Hospitals traditionally require 1 to 3 years of RN
work experience for CM entry positions, but
ELMSN-CM students can have no more than one
year of RN work experience by the time they
graduate.
Findings
“Subjects”
Subjects SMU New KH Trainers
Number
Graduates
3 4
Age 25 to 34 51 to 60
Work experience 1 to 10 years N/A
before SMU
Work as an RN 0 more than 30 years
Work as a CM 0 6 to 30 years
Work as a manager 0 11 to 30 years
“Can new CM graduates perform
competently as case managers after
orientation/mentorship?”
�All three SMU new graduates met all the standards
for the 90-day evaluations, as assessed by their
supervisors at KH.
�At the end of the 6-month program the three
graduates were rated on a 5-point scale as functioning
at “independent” or higher levels for all the CM
functions, as assessed by their trainers.
In 2010, Kindred Healthcare, Inc. formed a
partnership with the SMU CM Program and
hired three SMU-CM graduates who had no
RN work experience. KH Hospital Division,
West Region provided a 6-month new
graduates’ orientation and mentorship
program (6/14/10 – 12/31/10).
“What worked and what didn’t”
�Factors related to the success of the program
� Work environment
� Support provided from senior administrators
to staff CMs
� Having some experienced CMs to whom the
graduates could go for advice and suggestions
� Stable staffing
� Welcoming atmosphere
�Graduates’ characters and skills
� Positive and “Can Do” attitudes
� “Self-starters” and flexibility
� People skills
� Organizational skills
� Time management
� Ability to ask for help Conclusion
Learning process:
Challenges and what helped
38
40
Recommendations
To the SMU-CM program:
1.Five-minute case presentation exercises in clinical
seminars.
2.Reviewing standard treatment options for five
common disease conditions seen during a student’s
preceptorship.
3.Communication simulation exercises involving
difficult patients, family members, and physicians.
4.Speaking up in inter-disciplinary meetings during the
clinical practicum.
To KH:
1.Strengthen the 4-week orientation to bring new
graduates onboard to KH.
2.Provide opportunities for new graduates to work at
least a week with bedside RNs and priority LTAC
ancillary services.
3.Teach LTAC-specific equipment and treatments.
4.Develop critical pathways for five common disease
conditions at LTAC.
5.Teach about site-specific issues, such as resources in
the community, insurance companies and kinds of
insurance that patients may carry, physician practice
patterns, and types of patients.
�The data indicated that MSN-prepared new graduates
could perform satisfactorily at entry-level CM work.
�It became clear that the educational needs of the new
graduates differed from experienced RNs entering the
CM field.
�It is necessary to define what RN work experience is
critical to CM practice.
�The challenge to MSN education is to find how
academia can prepare graduates on those critical tasks,
and so prepare the next generation of case managers.
Implications
CM Functions and Skills
Time Frame Challenges What Helped Progress
First 4 weeks
‐ Fear, uncertainty, ‐ Talked about these ‐ By the end of the 3
– Classroom teaching anxiety
feelings with a trainer
‐ Lack of clinical
‐ Supportive environment
�The SMU-Kindred orientation and mentorship program
Discharge Assessment (identifying a patient’s clinical trajectory and anticipated
experience
‐ Learned about CM tools
and applied them right
process treatments, critical thinking)
provides an innovative approach to bridging the gap
after the lectures
Planning (multi‐disciplinary collaboration)
between hospital employment requirements and
Implementation (coordination, education, referrals, resource linkage)
Evaluation (documentation and reporting)
graduating case managers’ levels of experience.
Utilization Authorization, concurrent review, use of criteria, documentation for
�Based on the successful outcome of this trial in 2010,
management compliance, appeal process, managing inappropriate utilization
the partnership between SMU and KH continues and KH
Communication Patients and their families, physicians, payers, staff, etc.
Advocacy Collaboration, negotiation
has hired four SMU graduates in 2011.
Information Identifying best practice, quality improvement
�KH has created a Career Ladder to promote
search
Performance Organization, problem‐solving, ability to ask questions and to ask for
professional development of case managers.
skills
help
42
Professionalism
• Discuss the plan with the MSNs 41
42
rd Data Collected:
week the new
graduates felt confident in
applying the CM tools, knowledge,
and skills that they learned.
• Demographics and characteristics of the
subjects
1 to 3 months
‐ Communication with ‐ Learned about how to
– By the end of 90 family members deal with difficult
• Thoughts and feelings of the new graduates and
days
‐ Dealing with end‐of‐ patients’ cases
life care issues
their trainers in regard to the program
3 to 4 months
‐ Communication with ‐ Learned about how to ‐ Helping others, teaching others
– Caseloads increased physicians
negotiate with
‐ Felt comfortable in dealing with
• Confidence and competency levels of the
‐ Building relationships physicians
families – thanked by family
with physicians
‐ Learned to work on time members for listening to and
graduates
management and
answering their concerns
• Various on-going assessments at KH as part of
prioritization
4 to 6 months
‐ Common challenges ‐ Learned to negotiate with ‐ Began negotiating with insurance
their standard practice for new hires
– Dealing with difficult faced by CMs at LTAC insurance companies and companies, SNFs, and physicians to
cases
‐ Recognized that they SNFs
facilitate discharge decisions
• Weekly SWOTT reports by the new graduates
were staying late at ‐ Needed to find the ‐ Each published an article about
work
balance between work dealing with a difficult case
and their personal lives
7

Research Study on the First Cohort
Research Questions
• Can an MSN‐prepared new CM graduate from
SMU, with no RN work experience, perform
competently as a case manager after
completing a 6‐month new graduate
orientation and mentorship program?
• What parts of the orientation and mentorship
program helped the graduate to function as a
case manager? To what degree? What didn’t
work?
What is a “SWOT”?
Evaluation Tools
• Kindred
– Competency assessments developed by the
Center for Case Management
– 90‐day evaluation
• SMU
– CM functions and skills, a 5‐point scale
“Needs a lot of help,” “Needs minimal help,”
“Independent,” “Comfortable,” “Excellent”
– At the end of Mentorship Program
43
45
47
Data Collected:
• Demographics and characteristics of the
subjects
• Thoughts and feelings of the new graduates
and their trainers in regard to the program
• Confidence and competency levels of the
graduates
• Various on‐going assessments at KH as part of
their standard practice for new hires
• Weekly SWOT reports by the new graduates
Findings: “Subjects”
Subjects SMU New
Graduates
KH Trainers
Number 3 4
Age 25 to 34 51 to 60
Work experience
before SMU
1 to 10 years N/A
Work as an RN 0 more than 30 years
Work as a CM 0 6 to 30 years
Work as a manager 0 11 to 30 years
CM Functions and Skills
Discharge process Assessment (identifying a patient’s clinical trajectory and
anticipated treatments, critical thinking)
Planning (multi‐disciplinary collaboration)
Implementation (coordination, education, referrals,
resource linkage)
Utilization
management
Evaluation (documentation and reporting)
Authorization, concurrent review, use of criteria,
documentation for compliance, appeal process, managing
inappropriate utilization
Communication Patients and their families, physicians, payers, staff, etc.
Advocacy Collaboration, negotiation
Information
search
Identifying best practice, quality improvement
Performance skills Organization, problem‐solving, ability to ask questions and
to ask for help
Professionalism
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“Can the Subjects Perform
Competently as Case Managers?”
• All three SMU new graduates met all the
standards for the 90‐day evaluations, as
assessed by their supervisors at KH
• At the end of the 6‐month program the
three graduates were rated on a 5‐point
scale as functioning at “independent” or
higher levels for all the CM functions, as
assessed by their trainers
Learning Process:
Challenges and What Helped
Time Frame Challenges What Helped Progress
1 ‐ 3 months
•By the end of
90 days
• Communication
with family
members
• Dealing with end‐
of‐life care issues
• Learned about
how to deal
with difficult
patients’ cases
Learning Process:
Challenges and What Helped
Time Frame Challenges What Helped Progress
4 to 6 months
•Dealing with
difficult cases
• Common
challenges
faced by
CMs at LTAC
• Recognized
that they
were staying
late at work
• Learned to
negotiate with
insurance
companies and
SNFs
• Needed to find
the balance
between work
and their
personal lives
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51
• Began negotiating
with insurance
companies, SNFs,
and physicians to
facilitate discharge
decisions
• Each published an
article about dealing
with a difficult case
53
Learning Process:
Challenges and What Helped
Time Frame Challenges What Helped Progress
First 4 weeks
•Classroom
teaching
• Fear,
uncertainty,
anxiety
• Lack of
clinical
experience
• Talked about
these feelings
with a trainer
• Supportive
environment
• Learned about
CM tools and
applied them
right after the
lectures
• By the end of the
3 rd week the new
graduates felt
confident in
applying the CM
tools, knowledge,
and skills that they
learned
Learning Process:
Challenges and What Helped
Time Frame Challenges What Helped Progress
3 to 4 months
•Caseloads
increased
• Communication
with physicians
• Building
relationships
with physicians
• Learned about
how to
negotiate with
physicians
• Learned to
work on time
management
and
prioritization
• Helping others,
teaching others
• Felt comfortable
in dealing with
families – thanked
by family
members for
listening to and
answering their
concerns
“What Worked and What Didn’t”
Factors related to the
success of the program
� Work environment
� Support provided from
senior administrators to
staff CMs
� Having some experienced
CMs to whom the graduates
could go for advice and
suggestions
� Stable staffing
� Welcoming atmosphere
Graduates’ characters
and skills
� Positive and “Can Do”
attitudes
� “Self‐starters” and
flexibility
� People skills
� Organizational skills
� Time management
� Ability to ask for help
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54
9

Recommendations
to the SMU‐CM program:
• Five‐minute case presentation exercises in
clinical seminars
• Reviewing standard treatment options for five
common disease conditions seen during a
student’s preceptorship
• Communication simulation exercises involving
difficult patients, family members, and
physicians
• Speaking up in inter‐disciplinary meetings
Recommendations
to Kindred Healthcare:
• The orientation and mentorship program
needs to address issues unique to LTAC:
– Difficulties in dealing with catastrophic and
complex patients ‐patients having 20+
comorbidities on average
– Difficulties in dealing with dysfunctional
family members (Family Systems Theory)
– Difficulties in assertively communicating
with physicians
during the clinical practicum 55
56
Recommendations to Kindred Healthcare:
• Continue to strengthen the 4‐week orientation, with
MSN feedback, to bring new graduates onboard to KH
• Provide opportunities for new graduates to work at
least a week with bedside RNs and priority LTAC
ancillary services
• Teach LTAC‐specific equipment and treatment
modules
• Review case management planning for five top
complex disease conditions at LTAC
• Build up site‐specific resources, such as resources in
the community, insurance companies and kinds of
insurance that patients may carry, physician practice
patterns, and types of patients
Conclusion
• The data indicated that MSN‐prepared new
graduates could perform satisfactorily at
entry‐level CM work
• It became clear that the educational needs
of the new graduates differed from
experienced RNs entering the CM field
• It is necessary to define what RN work
experience is critical to CM practice
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59
Recommendations to Kindred Healthcare:
• Continue to individualize educational experience
as much as possible
• Addressing and matching the variability of differing
experiences with MSN strengths
• Supporting the different and ongoing “growth curves”
of MSNs and cultures
• Balancing “matrix” collaboration and time
management skills at a complex level of care
• Standardizing preceptor strengths
• Expanding the mentorship support period
Implications
• The SMU‐Kindred orientation and mentorship
program provides an innovative approach to
bridging the gap between hospital employment
requirements and graduating case managers’
levels of experience
• Based on the successful outcome of this trial in
2010, KH has hired more SMU‐MSN graduates:
– 4 MSNs in 2011
– 3 MSNs in 2012
• Promoting ongoing development of a “pipeline”
for new case managers is critical
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60
10

Implications
• Kindred has created a Career Ladder to
promote the professional development of
case managers
• The Kindred Foundation developed
scholarship programs
– For Samuel Merritt University CM students
– For Kindred employees –Case managers
• Kindred assists MSN and other case
managers (RN and SW) to publish
Taking It to the Next Level Together!
Future Plan –SMU
• Lack of clinical experience
– Development of 3 new courses
• Advanced Health Assessment for NCMs
• Advanced Pathophysiology for NCMs
• Advanced Pharmacology for NCMs
– Meeting the new “Essentials of Master’s
Education in Nursing” requirement of the
American Association of Colleges of
Nursing
• For roles with a direct care practice
component
Taking It to the Next Level Together!
Future Plan – KH
• Expand case manager employment
opportunities in a large company in 40 states
• More standardization of the educational
experience across a larger field
• Continue to refine both SMU and Kindred CM
curricula to continually improve CM skills
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63
65
Presentation of
Our “New Blood”
in the CM Field
A Message from
the First Cohort
Taking It to the Next Level Together!
Future Plan –SMU
• Models of training
– Intensive CM training
• i.e., partnership with Kindred Healthcare
– Post‐graduation CM residency program
– RN new graduate orientation to CM track
– Mentorship for MSN students by
mature and experienced case managers
Q&A Session
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Contact Information
Fusae Abbott & Janet Rowland
fabbott@samuelmerritt.edu
jrowland@samuelmerritt.edu
www.samuelmerritt.edu
Wendy DeVreugd
Wendy.DeVreugd@kindredhealthcare.com
www.kindredhealthcare.com
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