Journal of Managed Care Nursing, Volume 8, Number 1 by Jeremy Williams

Vol. 8, No. 1, July 2021

Call for Articles

Journal of Managed Care Nursing Interested writers are requested to submit their editorial or research articles! The JMCN publishes topics on managed care and related subjects, like quality & utilization management, patient advocacy, current trends, changing legislature, leadership tips, and more. For more information on submitting an article, contact Jackie Beilhart at jbeilhart@aamcn.org or view the author guidelines at www.aamcn.org/jmcn.html

www.aamcn.org P (804) 747-9698 F (804)747-5316 2

www.aamcn.org | Vol. 7, No. 4 | Journal of Managed Care Nursing

JMCN JOURNAL OF MANAGED CARE NURSING 4435 Waterfront Drive, Suite 101 Glen Allen, VA 23060

Journal of Managed Care Nursing The Official Journal of the AMERICAN ASSOCIATION OF MANAGED CARE NURSES A Peer-Reviewed Publication

EDITOR-IN-CHIEF Jacqueline Cole, RN-BSN, MS, CNOR, CPHQ, CMCN, CHC, CHPC, FNAHQ, FAHM, FHIAS PUBLISHER Jeremy Williams VICE PRESIDENT OF COMMUNICATIONS Jackie Beilhart JOURNAL MANAGEMENT American Association of Managed Care Nurses 4435 Waterfront Drive, Suite 101 Glen Allen, VA 23060 phone (804) 747-9698 fax (804) 747-5316 MANAGING EDITOR Jackie Beilhart jbeilhart@aamcn.org

Vol. 8, No. 1

July 2021

TABLE OF CONTENTS Articles What Factors Impact Work Engagement Among Managed Care Nurses? Jessica Varghese. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Applying Case Management Skills to COVID-19 Home Care Rapid Response Kathy Driscoll, Laura Hatfield, Sandy Spitale. . . . . . . . . . . . . 12 Nursing Success Tips for Advancing Your Career Ashley Lipman. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16 New AAMCN Members . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18 Newly Certified Managed Care Nurses (CMCNs) . . . . . . . 21 Author Submission Guidelines . . . . . . . . . . . . . . . . . . . . . .22

GRAPHIC DESIGN Jackie Beilhart jbeilhart@aamcn.org

ISSN: 2374-359X. The Journal of Managed Care Nursing is published by AAMCN. Corporate and Circulation offices: 4435 Waterfront Drive, Suite 101, Glen Allen, VA 23060; Tel (804) 747-9698; Fax (804) 747-5316. Advertising Offices: Jackie Beilhart, 4435 Waterfront Drive, Suite 101, Glen Allen, VA 23060 jbeilhart@aamcn.org; Tel (804) 7479698. All rights reserved. Copyright 2020. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopy, recording, or any information storage or retrieval system, without written consent from the publisher. The publisher does not guarantee, either expressly or by implication, the factual accuracy of the articles and descriptions herein, nor does the publisher guarantee the accuracy of any views or opinions offered by the authors of said articles or descriptions.

www.aamcn.org | Vol. 7, No. 4 | Journal of Managed Care Nursing

What Factors Impact Work Engagement Among Managed Care Nurses? Jessica Varghese, PhD (1) 1. New York Institute of Technology, Old Westbury, New York

Summary Nurses are working outside of traditional hospital settings and moving into industries such as the managed care arena. The purpose of this study was to understand the effects of manager leadership style, structural empowerment, and job satisfaction, on nurses’ level of engagement in the managed care workplace setting. This is an observational study with a cross-sectional survey method. Primary data was collected from 299 nurses (RN’s and LPN’s) working in a managed care organization (MCO) in New York. Path analysis was used to test the theoretical model. Data analysis was performed using Mplus 7.2 statistical data analysis software.1 The independent variables in the study were manager leadership style, structural empowerment, and job satisfaction. The dependent variable was nurse engagement. The results from the study show that structural empowerment directly influences engagement. Two indirect effects were also identified. Structural empowerment indirectly affects engagement through job satisfaction. It also shows that manager leadership style influences engagement indirectly through structural empowerment and job satisfaction. Manager leadership style had the strongest total effect on engagement. Knowing that structural empowerment directly impacts engagement can help organizations tailor programs to address components of structural empowerment in their workplace settings. This in turn could influence patient outcomes. If organizations value nurses work engagement and job satisfaction they will invest in equipping their management staff with leadership training to be able to lead nurses effectively. Key Points • The work environment affects managed care nurses’ level of work engagement. • Structural empowerment and manager leadership style influence work engagement. • Creating programs to address structural empowerment and manager leadership training will foster work engagement among nurses working in the managed care environment.

www.aamcn.org | Vol. 7, No. 4 | Journal of Managed Care Nursing

INTRODUCTION Cost containment is an increasingly important focus of the health sector in the United States.2 Nurses working in managed care settings have decreased costs by effectively utilizing existing resources. Reducing the number of inappropriate emergency department and hospital admissions, focusing on preventative health care, and improving population health are key strategies for containing costs that increase the demand for nurses to manage and coordinate care.3 Engagement and empowerment are important topics to address when discussing workforce concerns and effectiveness in the United States. With the increase in the number of nurses working in non-traditional settings, research is needed to understand whether work environment concepts that fit the hospital setting also fit managed care nurses and, ultimately, if this results in positive patient and workforce outcomes. The purpose of this research study was to learn how the work environment affects managed care nurse engagement. The conceptual framework that was used for this study is Rosabeth Moss Kanter’s theory of structural empowerment. The focus of the theory is on the structures within the organization rather than the individual’s own qualities.4 This theory poses that empowerment is related to the degree of formal and informal power a person has in their organization.5 Structural empowerment is defined as the degree of access to workplace conditions that provide information, support, resources, and opportunities to learn and grow.6 The role of organizations in creating an environment that is structurally empowering is crucial. Understanding these organizational predictors and their role in nurses’ level of engagement was key in this study. The purpose of this study was to test a model that proposes a relationship between manager leadership style, structural empowerment, and job satisfaction with a nurse’s level of work engagement in managed care. This is an observational study with a cross-sectional survey method. The design purpose was to correlate manager leadership style, structural empowerment, and job satisfaction with the scores on responses to the engagement questionnaire. The research questions examined the nurses’ perceptions and perspectives. The study was conducted in a not-for-profit managed care organization serving over 1 million people and employs over 400 nurses. This managed care orga-

nization has increased revenues from $2 billion to $8 billion over the last three years, while doubling the number of employees. Primary data was collected from a sample of 299 nurses, RNs (n=263), and LPNs (n=36). Inclusion criteria for the sample were all full-time and part-time registered and licensed practical nurses who have worked in the organization for a minimum of one year at the time the questionnaire was taken. This study was approved by the Social and Behavioral Sciences Institutional Review Board at the University of Buffalo, State University of New York. METHODS Instruments Data was collected using the following four tools: The Transformational Leadership Inventory Scale, the Conditions of Work Effectiveness II Questionnaire, the Global Job Satisfaction Scale, and the Utrecht Work Engagement Scale.7,8,9,10 Manager leadership style was measured using a modified version of the Transformational Leadership Inventory.7 This six item scale measured nurses’ perceptions of their managers’ leadership styles. The reliability .83 and validity of this instrument has been established.11,12 Structural empowerment was measured by the 19 item Conditions of Work Effectiveness Questionnaire II (CWEQ-II).8 The CWEQ-II has acceptable psychometric properties and demonstrates construct validity.8,13 Cronbach alpha reliabilities range from .79 to .82.14 The global job satisfaction scale, created by Quinn and Shepard in 1974 and modified by Rice, Gentile, and McFarlin (1991), uses a six item scale to assess overall job satisfaction with coefficient alpha reliability estimates ranging from .83 to .90.9,15,16 The Utrecht Work Engagement Scale (UWES) measures the dependent variable, level of engagement in the workplace.10 The UWES, also known as the Work and Well Being scale, measures vigor, dedication, and absorption, the three aspects of work engagement which are measured with three subscales. Items are scored on a seven point Likert rating scale. The mean of these three scales is calculated to obtain the overall total engagement score.

www.aamcn.org | Vol. 7, No. 4 | Journal of Managed Care Nursing

The UWES has been validated and supported with a three-factor structure corresponding to the three dimensions and found each scale to have high reliability.17 There is a very high correlation between the (latent) factors of the UWES which tells us that, although there are three dimensions in measuring engagement, it can be collapsed into one factor.10 For this study, the tool was used as one scaled score. The UWES has been validated in North America, Europe, Africa, Asia, and Australia.18 Confirmatory factor analysis has shown goodness of fit and the internal consistencies of the three subscales are sufficient.19 Schaufeli demonstrates in his research that the three engagement dimensions are moderately strong and positively related so a total score can be used as a general overall indicator of work engagement.19 The internal consistency of the UWES has been reported to be .70 or greater.20 Sample Size It is important to ensure that the sample size is large enough to have adequate power to detect the hypothesized effect.21 If the sample size is too small, it may incorrectly conclude that there is no difference between groups due to the study being under-powered. An a priori power analysis is the ideal type of power analysis because it provides users with a method to control both the type-1 error probability α and the type-2 error probability β.22,23 Statistical power analysis was conducted using G*Power software.24 Cohen’s f2 values .02 (small), .15 (medium), and .35 (large), are used as the effect size measure.22 This analysis was completed prior to conducting the study and provides information regarding the needed sample size based on the established α level, power level (1- β), and the size of the effect. Using G*Power with an effect size (f2) of .10 and a power of .85, a sample size of 140 nurses will allow a small effect size to be detected. However, larger effect sizes may be relevant because so little has been studied in this population. Data Analysis The hypothesized model in this study was tested using path analysis to examine the influence manager leadership style, structural empowerment, and job satisfaction on work engagement. The direct effect of manager 6

leadership style on work engagement was explored. The indirect effects in this path analysis were: 1. Structural empowerment, mediated by job satisfaction on engagement 2. Manager leadership style, mediated by structural empowerment and job satisfaction on engagement. Data analysis was performed using Mplus 7.2 statistical data analysis software. A model was constructed using the theoretical framework (Figure 1. Theoretical Model) and was tested for model fit. Alternative theoretical models and path analyses based on the fit statistics were also considered if this initial theoretical model was not supported by the data meaning the model fit was poor. RESULTS Demographic Findings The majority of the nurses in this study worked fulltime and had a minimum of a bachelor’s degree in Nursing. Bachelor’s-prepared nurses have the foundation of understanding the health care delivery system and are educated to use their critical thinking skills in their workplace environments. Both RN’s and LPN’s work in this managed care organization, although there are overwhelmingly more RN’s (263) than LPN’s (36). Both levels of nursing were included in this sample population. There were no significant differences between the two groups in relation to manager leadership style, structural empowerment, and work engagement. Nurses who worked in this organization range from the ages of 25 to 71 years of age. New York City’s population is racially and ethnically diverse with 43% of the population being White (U.S. Census Bureau, 2020) which is consistent with the sample used in this study as 45% of the respondents self-reported as White. One interesting descriptive characteristic was that out of the 299 nurses in the study, 102 (34%) had over 20 years of nursing experience and 79 (26%) nurses had over 10 years of nursing experience. Experienced nurses may have a depth of clinical experience that gives them confidence in the managed care environment. This may imply that newer nurses have some distinct challenges working in this type of environment, as the complex health care system is not as familiar to them.

www.aamcn.org | Vol. 7, No. 4 | Journal of Managed Care Nursing

Figure 1. Theoretical Model. * p<.05, ** p<.01, *** p<.01. Standardized estimates and standard errors are displayed. Statistically significant pathways have solid lines and statistically non-significant pathways have dotted lines. Model fit: χ2(1)=.20, p=.66, RMSEA=.00, CFI=1.00 TLI=1.02.

Results There was a significant positive indirect effect of structural empowerment on engagement through job satisfaction (.19, p <.001) suggesting increased structural empowerment predicted increased job satisfaction, which then predicted increased engagement. There was a significant direct positive effect of structural empowerment to engagement without the mediating job satisfaction variable (.30, p < .01). Structural empowerment had a stronger direct effect than indirect effect to engagement. Manager leadership did not have significant positive direct effect on engagement (.04, p =.53). There is no direct effect of manager leadership style to engagement. However, manager leadership style, mediated by structural empowerment and job satisfaction, had a positive effect to nurse engagement. The results showed that the total indirect positive effect of manager leadership on nurse engagement was statistically significant (.37, p<.01). Manager leadership style did have equally significant indirect positive effect on job satisfaction (.24. p<.001) as well as a direct effect on job satisfaction (.24. p<.001). Structural empowerment also had a stronger direct positive effect on job satisfaction (.43, p<.001). Job satisfaction also has a direct effect on engagement (.44, p < .001). Manager Leadership Style Manager leadership style had three significant positive indirect effects to engagement, but no direct effect. 1. Manager leadership style through structural empowerment to engagement (0.165 or 44%)

2. Manager leadership style through job satisfaction to engagement (0.106 or 28%) 3. Manager leadership style through structural empowerment and job satisfaction to engagement (0.104 or 28%). The strength of the total indirect effects was significantly strong (0.375). This shows how important manager leadership style is in influencing work engagement. These results are consistent with the literature. Transformational leadership shows a strong positive relationship to work engagement.25,26 In addition, social support has a positive significant correlation to engagement.27,28,29 A manager’s leadership style affects the level of engagement in the workplace setting. Work engagement is positively and substantially predicted by transformational leadership.30,31A manager’s leadership training can be very important to address job satisfaction, structural empowerment, and engagement in the workplace setting. Increasing the skills and knowledge of the management team will help to motivate and engage their employees. Job Satisfaction Manager leadership style had equally strong positive direct and indirect effects to job satisfaction. Transformational leadership skills of Nurse Managers need to be improved with a focus on appreciation, respect, professional development, and caring for others, which all impact employee job.33,34 There is a direct effect of job satisfaction on engagement. Nurses who are satisfied in the jobs are more engaged. This study supports these findings in a new and very different setting.

www.aamcn.org | Vol. 7, No. 4 | Journal of Managed Care Nursing

Structural Empowerment Increased structural empowerment predicted increased job satisfaction, which then predicted increased engagement. There was also a stronger direct positive effect of structural empowerment to engagement without the mediating job satisfaction variable. “A strong relationship exists between empowerment and engagement, both essential in driving a high-performing work unit. Nurse leaders who lead a unit where nurses feel a strong sense of pride and are engaged in their work will see the benefits of quality patient care.”35 This research extends the hospital research to the managed care settings. DISCUSSION Implications for Practice Structural empowerment is important to nurses who are working in the managed care organization. Managed care organizations can benefit from this information by providing an environment that is empowering to nurses, which will affect workplace outcomes. Nurses who are satisfied in their jobs and feel empowered will have greater levels of work engagement. The structural empowerment tool has various subscales, which can be evaluated. These subscales include the amount of opportunities, information, resources, and support which exist in the organization.5 This can help organizations identify which areas the organization should focus on in greater depth. The first subscale, opportunities for learning is important to evaluate. Opportunities directly impact engagement.36 This is true whether the organization is a hospital setting or a managed care organization. Employees need to know that there are opportunities for them to grow in the roles and in their knowledge base. Creation of career ladders and succession planning are important strategic efforts in which organizational leaders need to invest. The information subscale is an important part of structural empowerment. In the managed care sector, regulations often change depending on new federal and state policies related to Medicare and Medicaid. These policy changes affect how work is conducted. Organizations need to be transparent in communicating information and its impact on workflow and practices. Communication is an important piece in 8

keeping nurses engaged. This can be done face to face, via phone or email, or through the Nurse Managers. Information sharing is key to ensuring that nurses feel that they are informed about practices. The third factor of structural empowerment is support. Nurses who have a sense of belonging and who have positive work relationships have higher levels of engagement.37 Managers need to give guidance and feedback on a consistent basis to ensure that their nurses feel supported. Acknowledging work well done at team meetings or informally letting nurses know that they are valued are two different examples of how to provide support for nurses. The last subscale of structural empowerment is resources. Nurse Managers and organizational leaders need to ensure that staff have the necessary materials they need in order to do their jobs well. For example, this can include hiring of additional personnel to help support care managers when their caseloads are high. Managers need to continue to look at productivity reports and ensure that they provide their staff with the needed resources. Manager leadership training is key to equipping Nurse Managers to provide the support needed for their direct staff nurses. This research shows the importance of manager leadership style and its impact on nurses’ level of engagement and job satisfaction. Knowing that the strength of these direct and indirect relationships emphasizes the importance of its impact. Organizations need to focus on providing the specific skillset these managers need to build effective relationships with their staff nurses. Nurse engagement has implications not only for the nurses and patients, but also to the organization as a business. Limitations and Future Research Future research should include conducting this study with a larger sample across multiple managed care settings. This would allow us to see if these findings apply to all managed care nurses, if there are changes according to the size of the organization a nurse works in, or if there are geographical differences. It would also be beneficial to incorporate a qualitative component to this study to obtain rich data about the lived experiences of managed care nurses. This qualitative information can be gathered via interviews and could

www.aamcn.org | Vol. 7, No. 4 | Journal of Managed Care Nursing

help to understand this population in greater depth. Additional research can be conducted with senior leaders in the managed care industry to assess manager leadership styles, structural empowerment, and job satisfaction, and to see if it varies from what the managed care nurses expressed. Lastly, it would be interesting to see if there was a relationship between nurse’s level of engagement and patient quality outcomes (i.e. re-hospitalizations). In addition to financial implications, there are serious patient outcomes that are influenced by nurse engagement. Nurse engagement significantly affects quality measures and patient safety outcomes in hospitals, and it is important to learn if this is true in managed care settings as well. It is important from a patient care perspective to acknowledge and address nurse engagement in the workplace setting. CONCLUSION It is important to understand how the work environment affects engagement within the nursing population. Nurses who work in managed care provide a service to the American population, and it is vital to learn more about their experiences so that organizations can support them. Supporting nurses will in turn support nursing quality and better patient outcomes. Knowing what keeps nurses engaged in this type of setting can help with recruitment and retention in the future. Managed care nurses play an important role, as health care policy focuses on prevention. Leaders will have to set the pace regarding the changes, making management training even more important. As the healthcare environment continues to change it is vital for organizations to understand and improve work environments to foster nurse engagement. Nurses are a vital part of the healthcare arena and organizations need to provide the support nurses need to stay engaged in their workplace settings. This organizational support in improved work environments will improve the lives of the nurses, the organization, and most importantly, the American public. REFERENCES 1. Muthén LK., Muthén BO. Mplus User’s Guide (Sixth Edition). Los Angeles, CA:2007. 2. Enthove A, Fuchs VR, Shortell SM. To Control

Costs Expand Managed Care and Managed Competition. JAMA. 2019; 322(21), 2075. doi:10.1001/ jama.2019.17147. 3. Stiegler K, Martiniano, R, Moore, J, et al. The Health Care Workforce in New York State: Trends in the Supply of and Demand for Health Workers. Rensselaer, NY: Center for Health Workforce Studies, School of Public Health, SUNY Albany. April 2020; https://www.chwsny.org/wpcontent/ uploads/2020/04/NY_Health_Workforce_Tracking_Report_2020.pdf Accessed April 3, 2021. 4. Bradbury‐Jones C, Sambrook S, Irvine F. The meaning of empowerment for nursing students: a critical incident study. Journal of Advanced Nursing, 2007; Vol 59: 342-351. 5. Kanter RM. Men and women of the corporation. New York: Basic Books.1977. 6. Kanter RM. Men and women of the corporation 2nd Edition. New York: Basic Books.1993. 7. Podsakoff PM, MacKenzie SB, Moorman RH, Fetter R. Transformational leader behaviors and their effects on followers’ trust in leader, satisfaction, and organizational citizenship behaviors. Leadership Quarterly, 1990; 1:107–142. 8. Laschinger HKS, Finegan J, Shamian J, Wilk, P. Impact of structural and psychological empowerment on job strain in nursing work settings: Expanding Kanter’s model. Journal of Nursing Administration. 2001; 31:260–272. 9. Rice RW, Gentile DA, McFarlin DB. Facet importance and job satisfaction. Journal of Applied Psychology. 1991; 76(1): 31–39. 10. Schaufeli WB, Bakker AB. Utrecht work engagement scale: Version 1. Preliminary manual. Occupational Health Psychology Unit Utrecht University. 2003;1: 4-58. 11. Hammer A, Ommen O, Röttger J, Pfaff H. The Relationship between transformational leadership and social capital in hospitals—a survey of medical directors of all German hospitals. Journal of Public Health Management and Practice. 2012; 18(2):175-80. 12. Alban‐Metcalfe RJ, Alimo‐Metcalfe B. The transformational leadership questionnaire (TLQ‐LGV): a convergent and discriminant validation study. Leadership & Organization Development Journal. 2000. 13. Schaufeli WB, Bakker AB, Salanova M. The measurement of work engagement with a short questionnaire: A cross-national study. Educational

www.aamcn.org | Vol. 7, No. 4 | Journal of Managed Care Nursing

and Psychological Measurement. 2006 Aug; 66(4):701-16. 14. Laschinger HK, Finegan JE, Shamian J, Wilk P. A longitudinal analysis of the impact of workplace empowerment on work satisfaction. Journal of Organizational Behavior: The International Journal of Industrial, Occupational and Organizational Psychology and Behavior. 2004 Jun;25(4):527-45. 15. Quinn RP, Shepard LJ. The 1972-73 Quality of Employment Survey. Descriptive Statistics, with Comparison Data from the 1969-70 Survey of Working Conditions. 16. Pond III SB, Geyer PD. Differences in the relation between job satisfaction and perceived work alternatives among older and younger blue-collar workers. Journal of Vocational Behavior. 1991 Oct 1;39(2):251-62. 17. Bakker AB, Schaufeli WB, Leiter MP, Taris TW. Work engagement: An emerging concept in occupational health psychology. Work & Stress. 2008 Jul 1;22(3):187-200. 18. Bakker AB, Xanthopoulou D. The crossover of daily work engagement: Test of an actor–partner interdependence model. Journal of Applied Psychology. 2009 Nov;94(6):1562. 19. Schaufeli W. Work engagement: What do we know and where do we go?. Romanian Journal of Applied Psychology. 2012;14(1):3-10. 20. Mills MJ, Culbertson SS, Fullagar CJ. Conceptualizing and measuring engagement: An analysis of the Utrecht Work Engagement Scale. Journal of Happiness Studies. 2012 Jun 1;13(3):519-45. 21. Whitley E, Ball J. Statistics review 4: sample size calculations. Critical Care. 2002 Aug;6(4):1-7. 22. Cohen JE. Statistical Power Analysis for the Behavioral Sciences. 1988; Hillsdale, NJ: Lawrence Erlbaum Associates, Inc 23. Mayr S, Erdfelder E, Buchner A, Faul F. A short tutorial of GPower. Tutorials in quantitative methods for psychology. 2007 Jan 1;3(2):51-9. 24. Faul F, Erdfelder E, Lang AG, Buchner A. G* Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behavior Research Methods. 2007 May;39(2):175-91. 25. Mauno S, Ruokolainen M, Kinnunen U, De Bloom J. Emotional labour and work engagement among nurses: examining perceived compassion, leadership and work ethic as stress buffers. Journal of Advanced Nursing. 2016 May;72(5):1169-81. 10

26. Amor AM, Vázquez JP, Faíña JA. Transformational leadership and work engagement: Exploring the mediating role of structural empowerment. European Management Journal. 2020 Feb 1;38(1):16978. 27. García‐Sierra R, Fernández‐Castro J, Martínez‐ Zaragoza F. Work engagement in nursing: an integrative review of the literature. Journal of Nursing Management. 2016 Mar;24(2):E101-11. 28. Orgambídez A, Almeida H. Supervisor support and affective organizational commitment: The mediator role of work engagement. Western Journal of Nursing Research. 2020 Mar;42(3):187-93. 29. Labrague LJ, Nwafor CE, Tsaras K. Influence of toxic and transformational leadership practices on nurses’ job satisfaction, job stress, absenteeism and turnover intention: A cross‐sectional study. Journal of Nursing Management. 2020 Jul;28(5):1104-13. 30. Lai FY, Tang HC, Lu SC, Lee YC, Lin CC. Transformational leadership and job performance: the mediating role of work engagement. SAGE Open. 2020 Jan;10(1):2158244019899085. 31. Enwereuzor IK, Ugwu LI, Eze OA. How transformational leadership influences work engagement among nurses: does person–job fit matter? Western Journal of Nursing Research. 2018 Mar;40(3):34666. 32. Knight C, Patterson M, Dawson J. Building work engagement: A systematic review and meta‐analysis investigating the effectiveness of work engagement interventions. Journal of Organizational Behavior. 2017 Jul;38(6):792-812. 33. Morsiani G, Bagnasco A, Sasso L. How staff nurses perceive the impact of nurse managers’ leadership style in terms of job satisfaction: a mixed method study. Journal of Nursing Management. 2017 Mar;25(2):119-28. 34. Jankelová N, Joniaková Z. Communication Skills and Transformational Leadership Style of First-Line Nurse Managers in Relation to Job Satisfaction of Nurses and Moderators of This Relationship. Healthcare Multidisciplinary Digital Publishing Institute. 2021 Mar; 9(3):346. 35. DiNapoli JM, O’Flaherty D, Musil C, Clavelle JT, Fitzpatrick JJ. The relationship of clinical nurses’ perceptions of structural and psychological empowerment and engagement on their unit. JONA: The Journal of Nursing Administration. 2016 Feb 1;46(2):95-100. 36. Pericak A, Hogg CW, Skalsky K, Bourdeanu L.

www.aamcn.org | Vol. 7, No. 4 | Journal of Managed Care Nursing

What Influences Work Engagement Among Registered Nurses: Implications for Evidence‐Based Action. Worldviews on Evidence‐Based Nursing. 2020 Oct;17(5):356-65. 37. Reinhardt AC, León TG, Amatya A. Why nurses stay: Analysis of the registered nurse workforce and the relationship to work environments. Applied Nursing Research. 2020 Oct 1;55:151316.

AAMCN Would Like to Recognize Our Corporate Partners Gold: TCS Healthcare Silver: Home Instead Senior Care® Humana, Inc. Mallinckrodt Pharmaceuticals Bronze: Gilead Sciences, Inc. Novocure

www.aamcn.org | Vol. 7, No. 4 | Journal of Managed Care Nursing

Applying Case Management Skills to COVID-19 Home Care Rapid Response Authors: Kathy Driscoll, RN, BSN, CCM, VP, Chief Nursing Officer (1); Laura Hatfield, RN, BSN, MPH AVP, Care Management (1); Sandy Spitale, MBA, BSN, RN, Director, Strategy Advancement (1)

1. Humana Inc.

INTRODUCTION Case managers are highly skilled at anticipating needs and are agile problem solvers. But COVID-19 put those abilities to the test. The pandemic required quick decisions and rapid implementation of changes to processes and procedures to provide effective and safe delivery of care, all while navigating an extremely ambiguous and turbulent environment. This article covers the COVID-19 response of a Humana long-term care (LTC) program delivering home care during this unprecedented healthcare crisis. The case management practices that were swiftly developed and implemented fell into three key areas: capacity assessment, member stratification, and proactive communications. ASSESSING CAPABILITIES Assessment is a critical step in the case management process and one employed daily to determine members’ immediate and future needs, as well as to identify risks. During the pandemic, that assessment process was applied not only to members, but also to providers to ascertain and address any potential gaps that could impact patients and the delivery of services. These assessments involved case managers partnering and maintaining close communications with the internal Provider Relations team. Together, they reached out to home-based care providers to evaluate their status and ability to provide services given the many challenges the pandemic posed, while keeping their clinicians safe. Similar assessments were done to determine the capacity of durable medical equipment providers, many of whom were struggling to obtain medical supplies stemming from supply chain and demand issues. 12

At the same time, the clinical team explored available resources in their own communities that could serve as viable alternatives when necessary. For example, Humana’s care managers worked with partners to provide over 1 million meals to those most in need of access to healthy food. Understanding the strengths and vulnerabilities of the provider workforce and community-based options was critical to ensuring members received uninterrupted services and the care they needed. MEMBER STRATIFICATION AND OUTREACH Given increased demand for services and the constraints and shortages caused by the pandemic, it was necessary to triage members to ensure case managers could focus on those most at risk and address any gaps in care. This process involved case managers identifying home-based members’ essential and non-essential needs and categorizing them accordingly. With COVID-19 affecting many existing support systems, it was essential to determine if there had been changes to the assistance provided by friends and family members, as well as other needs, since the onset of the pandemic. Employing practices used for disaster planning for such events as hurricanes, but with a longer time horizon, outreach to members helped assess their immediate needs, including whether they had a 30-day supply of their medications, sufficient medical supplies and ample food on hand. A prioritization database tool was developed enabling case managers to input member stratification data and update as needed. The database made important information readily available as well as facilitating a quick

www.aamcn.org | Vol. 7, No. 4 | Journal of Managed Care Nursing

response to changing needs and circumstances. The flexibility in understanding and addressing members’ changing needs also helped build a bridge between members and case managers during the crisis. INCREASED PROACTIVE COMMUNICATIONS Being proactive is a key strategy and skillset of case managers. During the pandemic, staying proactive required constant reassessment of the impacts of COVID-19 based on continually evolving guidance and protocols. It also meant addressing the panic and fear experienced by both members and those providing care. Frequent communications was a key contributor to building trust and mitigating misinformation. With the pandemic severely reducing social interaction, a pilot program was instituted to help address

members’ isolation and loneliness. The Virtual Pal/ Companion Program provided a weekly, friendly check-in call that allowed members the opportunity for informal conversation and to share stories with one of the team members. As the world opens up and members are vaccinated, plans are in place to connect them with community-based organizations that can help support their social and emotional needs going forward. For home-based COVID positive members, case managers increased outreach to daily check-in calls to coordinate any additional resources and services needed and answer any questions as they coped with the virus. A recent partnership with a virtual platform company is enabling remote “face-to-face” visits with members in place of phone calls, allowing more personal interactions and better visibility into a member’s wellbeing and their home environment.

www.aamcn.org | Vol. 7, No. 4 | Journal of Managed Care Nursing

During the crisis, additional support was provided to the entire Humana team through email briefings to keep everyone well informed as information, policies and procedures evolved. In addition, an enterprisewide home business task force was created to keep all aligned, as well as communicate challenges and best practices as the pandemic playbook was being developed.

Laura Hatfield, RN, BSN, MPH Associate Vice President, Care Management, Humana Laura is AVP, Care Management in her role with the ECOM Clinical Strategy Team at Humana. She formerly led care management operations for In-Home services. She is a member of the Case Management Society of America, the American Association of Managed Care Nurses, and the American Society of Aging.

APPLYING PRACTICES TO POSTPANDEMIC HOME CARE The pandemic truly challenged the agility and resilience of case managers. At the same time, it has led to innovations and approaches that could provide an improved home care model post-pandemic. Reliance on remote and digital health capabilities during the pandemic has altered practices that could help better serve vulnerable and high-need populations into the future. It strengthened relationships and communications with provider partners and community-based resources. This crisis has made apparent the critical skills embodied in case management and brought new meaning to the benefits of working together as a team. About the Authors Kathy Driscoll, MSN, RN, CCM Vice President, Chief Nursing Officer, Humana Kathy oversees Humana’s strategy of improving the experience of Humana’s nearly ten thousand nurses, care managers, and social workers. She’s on the Board of Trustees for the American Nurses Foundation and is a member of numerous professional organizations including The American Nurses Association and The Case Management Society of America. Sandy Brett Spitale, MBA, BSN, RN Director, Strategy Advancement Home Solutions, Humana In her role at Humana, Sandy establishes opportunities for innovation and advancement in care delivery at home. Sandy also serves as one of the founding nurse leaders of the Nursing Advisory Council. She is a member of The American Nurses Association and The American Association of Managed Care Nurses.

www.aamcn.org | Vol. 7, No. 4 | Journal of Managed Care Nursing

Partners in care when you need it most. Because aging is a team effort.

Partners in care.

Home Instead® is your partner in care. From personal care, to Alzheimer’s and Dementia care, we can work with you and follow CDC guidelines to safely support the health and well-being of individuals while providing care. We are here and ready to complement your care and services.

Personal Care

Hospice Support

Memory Care

Coordination of Care

Medication Management

Meals and Nutrition

Transitional Care

Transportation

Learn more at HomeInstead.com/CMSAToday or call (888) 995-9817 www.aamcn.org | Vol. No. 4 | Journal of Managed Care Nursing Each Home Instead® franchise is independently owned and7,operated. © 2020 Home Instead, Inc.

Nursing Success Tips for Advancing Your Career Ashley Lipman (1)

Career planning in nursing is a skill that frequently gets overlooked. Yet, it's an essential aspect of finding one's passion and drive while maintaining a sense of control over the road ahead. Engaging in career planning can help you determine what specialty you wish to strive toward and where you'll find yourself one, five, and ten years from now. While time and experience will naturally advance your career over time, taking control and honing in on your goals will help drive the process. Consider these key success tips and strategies for advancing your nursing career in a sustainable, self-nourishing manner. Find the Path that Impassions You Your career goals and desires you possess while becoming a registered nurse could change once you get into the field. Many new nurses entering their practice are quick to discover that their job isn't what they envisioned. Others find new passions and values through experience. Success is a term that varies from person to person, regardless of their career path. The first step in driving your nursing career forward is understanding what success means to you. This discovery stems from periods of self-reflection and value exploration. Give yourself time to build self-awareness and identify your core values as a nurse and a human being. Then consider how those values translate into career opportunities. If you're someone who values a challenge and variation, you might find that working in an ER is the right path for your career. Your personal experience in navigating the death of a close loved one may drive you to work in oncology or palliative care. Nursing is a challenging career, and it's natural to have different feelings about your choice to become a nurse from one day to the next. However, if you find a 16

path that impassions you, you'll find a reason to push through and keep showing up. Invest in Continuing Education The world of medicine is always changing. Centuries of research and the rapid evolution of technology mean that nurses entering the field today will experience a very different reality ten years from now. Consider the work done on Puerperal Fever and maternity death rates in the 1800s. Years of research and study led to a revolutionary medical discovery that's second nature today: the importance of medical providers washing their hands. When you become a nurse, you graduate with the knowledge that you'll never stop learning. To drive your career forward, you must commit to engaging in continuing education. Whether it's acquiring new skills or specializing in a particular field, look for ways to build your resume and experience with each passing year. Make Network Connections As medical practices are run as a business, they aren't above the nuances of networking and politics. In some cases, career advancement comes from having the right recommendation or connections. Dedicate some time in your schedule to networking and creating a name for yourself in your field. Consider engaging in a mentorship relationship to learn from nurses and healthcare professionals you admire. Outline Actionable Goals In a recent study review outlining the struggles of time management for physicians, one of the key strategies for success was identified as setting short and longterm goals. Similar studies have been conducted on

www.aamcn.org | Vol. 7, No. 4 | Journal of Managed Care Nursing

REFERENCES

clinician-educators and faculty members.

1. Lane HJ, Blum N, Fee E. Oliver Wendell Holmes (1809-1894) and Ignaz Philipp Semmelweis (1818-1865): preventing the transmission of puerperal fever. Am J Public Health. 2010;100(6):1008-1009. doi:10.2105/AJPH.2009.185363 2. Gordon CE, Borkan SC. Recapturing time: a practical approach to time management for physicians. Postgrad Med J. 2014 May;90(1063):267-72. doi: Prioritize Self-Care and Balance 10.1136/postgradmedj-2013-132012. Epub 2014 Mar 5. PMID: 24599633 Nursing puts you in a perpetual caregiver role. Those 3. Sadowski E, Schrager S. Achieving Career with familial responsibilities often experience this even more so. One of the most effective things you can Satisfaction: Personal Goal Setting and Prioritizdo for your career as a nurse is to take a step away and ing for the Clinician Educator. J Grad Med Educ. 2016;8(4):494-497. doi:10.4300/JGME-D-15-00304.1 prioritize self-care. Setting actionable goals will help you identify the steps to take to get from where you are now, to where you want to be in your career. Your career goals won't be set in stone; they may change over time. However, having those key steps forward will give you the drive and direction you need to succeed.

Self-care and finding your version of a healthy worklife balance are imperative for preventing burnout. Finding your passion and balance and setting clear, productive steps forward will help you find success as a nurse. Use these strategies to craft your career and achieve your goals.

www.AAMCN.org Fall Managed Care Forum 2021 • Visit the AAMCN website at www.aamcn.org to register for the Fall Managed Care Forum in Las Vegas, NV November 3-5th. Nurse's Pre-Conference on Wednesday, November 3rd. We'll also be proctoring the CMCN exam the morning of the 3rd. Social Media • Members of AAMCN can join our Facebook discussion group at www.facebook.com/groups/ AAMCN • LinkedIn

www.aamcn.org | Vol. 7, No. 4 | Journal of Managed Care Nursing

Welcome New AAMCN Members! Kara Adams Abby Addleman Adriana Agnew Gretchen Ales Christina Andreoli Dante Andres Shellee Andrews Ashleigh Arcaro Maria Argo Felecia Bacote Debra Bagwell Holly Bailey Rosemary Elaine Balubar Donna Banks Janette Begay Raquel Benavides Therese Georgette Benipayo Gwendolyn Blue Rhoda Borbajo Jennifer Boudreaux Tailor Broussard Michelle Brusio Arverta Buchanan Bobbie Buckner Wilsa Dela Cruz Cabrera Kara Campbell Benita Carpenter-Smith Jenifer Carter Jennifer Carter Yajaira Carvajal Shalva del Castillo Erica Cevallos Melanie Chandler Noida Clarke Sandra Cleaver Karen Cobb Renee Coleman Tisha Conrady Shanika Cooper Carol Corbie Sherrie Corbin Leah Cote Maria Coutee Carla Couture Vikki Crabill Sheryl Creekpaum Patricia Crillo 18

Sonia Dareus Elizabeth De Leon-Gamboa Amira Dent Rachel Dibble Lisa Rochelle Dixon Dana Dobson Belinda Doherty Cathy Duggan Kristie Dyer Carol Dziekan Virginia Emme Sherry Everett Leslie Forsythe Maria Fratangelo Linda Fuller Kimberly Fulton Leah Gabrielson Nicole Gama Erica Gardner Jenifer George Yvette Geyen Shelly Giglio Jessica Gilmore Jonelle Goode-Smith Kathy Goodman Courtney Gordon Heather Gore Kaitlin Goss Raeleen Grabeau Brandon Green Mary Gregory Timothy Grenn Stephanie Griffin Kim Guest Ghea Guzman Annette Hall Sabrina Hameed Mariam Hannon Karen Harper Tonya S. Harris Cynthia Hasty Taylor Hernandez-Velasquez Lynda Irvin Gandimathi Jeyabalan Moritha Johnson Chelsie Johnson Lisa Johnson

www.aamcn.org | Vol. 7, No. 4 | Journal of Managed Care Nursing

Karen Johnston Marie Joseph Jessica Kayrouz Maureen Kenner Jill Kercell Tonya King Laura Kocur Lydia LaBelle Erin Lane Macey Leonard Mandy Lindsey Beth Long John Marcus Lozica Carrie Lucas Kelly MacKillop Ruth Madawick Nicole Malbrough Margie Malek Lucy Mancini Jennifer Markulec Natashia Mathers Laura McCarthy Michelle McComb Yolawnda McKinney Mary McQueen Salle Mcfield Lucy Meitin Frankie Meriman Megan Miller Kathy Molson Julie Monnig Connie Montgomery Glenda Moon Robert Moore Bobbi Mullins Tammy Murer Destinee Myres Kaci Netto Melissa Neuman Michelle Niccum Marcie Nytes Heather Ochsner Krystal Osborne Cindi Owens Kalina Patel Bethany Patterson Aletha Perry Kimberly Philipp Valerie Pierry

Maha Poladian Monica Pongracz Brandy Porter Tricia Posey Mindy Preszler Mary Quinn Allyson Reese Rebecca Rigsby Melissa Roberts Natalie Roche Vanessa Rodriguez Nicole Rogan Wendy Rogers Jeannette Rojas Eric Rubio Kara Ruffin Rikki Sanders Rebecca Savion Jael Schessler Christina Schiller Amanda Schneider Abby Scott Jennifer Seymour Sharon Sheridan Candida Smedley Mona Smith Johanna Smith Brandi Smith Kimberly Smith Sabrina Smith Paula Snide Kristi Soehnge Ivana Soldo Donna Spriggins Brenda Stamper Ebony Steed Jennifer Stephens Deanna Stotts Ema Sugay Melissa Thacher Jordyn Thibodeaux Marissa Thomas Ethel Tiu April Tucker Lisa Turley Erin Tyler Jessica Utecht-Whillcok Veronica Valdivia Anna Marie Villa www.aamcn.org | Vol. 7, No. 4 | Journal of Managed Care Nursing

Jennifer Wade Sabrina Waldon Sean Walker Yolanda Walker Lisa Walson Svetlana Ward Tracy Weatherby Marsha Weatherholtz Elizabeth Werts Rebecca West Susan L. White Steffani Wilkinson Stacy Williamson Tori Wingate Kim Wood Morgan Yarber Leigh Ann Yokomizo Johnson Yonka

www.aamcn.org | Vol. 7, No. 4 | Journal of Managed Care Nursing

Congratulations to the Newly Certified Managed Care Nurses (CMCNs)! Donna Alfred, RN, CMCN Carol L. Allen, RN, CMCN Ashleigh Andre, RN, CMCN Ashleigh Arcaro, RN, CMCN Sylvia Asante, RN, CMCN Sheila Ann Certeza Asare, RN, CMCN Melinda Bagot, RN, CMCN Amy Bailey, RN, CMCN Christina M. Bailey, RN, CMCN Rolando M. Benavidez, RN, BSN, CMCN Gelasia Bernier, LPN, CMCN Rachel L. Blankenship, RN, CMCN Theresa Brocato, RN, BSN, CMCN Michelle Brown-Graham, RN, CMCN Leslie Butterbaugh, RN, BSN, CMCN Anitra Bynum, LPN, CMCN Erica L. Cevallos, RN, CMCN Hannah Cheesbro, RN, CMCN Theresa Christophersen, RN, CMCN Qiana Coffey, RN, MSN, CCHP, CMCN Denise Crandall, RN, CMCN Michelle P. Cuenca, RN, CMCN Sharon Dabney, LPN, CMCN Jodi Decoteau, RN, CMCN Jessica Dickinson, RN, CMCN Natosha Q. Dokes-O’Connor, LPN, CMCN Lisa Dwyer, RN, CMCN Olukemi Esan, RN, CMCN Kayla Fazi, RN, CMCN Regina M Fenner, RN, CCM, CMCN Karen M. Fitzpatrick, RN, MSN, CMCN David Gardner, RN, CMCN Michelle Gill, RN, CMCN Kathy Goodman, RN, MSN, BSN, BBA, CMCN Courtney Gordon, LPN, CMCN Elaine Grimmett, LPN, CMCN Sabrina Hameed, RN, CMCN Amy Hoagland, RN, CMCN Fred Inman, IV, RN, CMCN Patrica Isom, RN, MSN, CMCN Susan D. Jacob, LPN, CMCN Charlene Johnasen, RN, CMCN Ann Johnson, RN, CMCN Ellen Johnston, RN, CMCN

Crystal Keeseman, RN, CMCN Catherine Kennedy, RN, CRRN, CMCN Laura Kocur, LPN, CMCN Gia Lawrence, RN, CMCN Rosemary Martinez, LPN, CMCN Tina Meeks, APRN, CMCN Kristen M. Mendel, RN, CMCN Ashley Miffitt, RN, CMCN Patricia M. Mitchell, LPN, CMCN Koby Mitchell, RN, CMCN Mollie Morris, RN, CMCN Sandra L. Munson, RN, CMCN Katherine Murphy, LMSW, CMCP Nicola Olsen, LPN, CMCN Vanessa Portillo, LVN, CMCN Melissa Rackard, RN, CMCN Laura Ann Ramon, RN, CMCN Jacqueline Ramos, LPN, CMCN Gloria A. Rios, RN, CMCN Wendy D. Rogers, RN, CMCN Melissa Romano, LPN, CMCN Brandi Ross, RN, CMCN Henrietta Rudy, RN, CMCN Sally Ruppert, LPN, CMCN Cindy Schmidt, RN, CMCN Kathryn E. Sharkey, RN, BSN, CMCN Cassandra Shatley, RN, CMCN Rebecca Sichau, RN, CMCN Donna H. Spriggins, MSN, RN, CMCN Linda Stanton, RN, CMCN Sarah Stephenson, RN, CMCN Currie Stewart, LPN, CMCN Joann Louise Storey, RN, CMCN Kara Thompson, RN, CMCN Michelle Vann, RN, CMCN Julie Wenzel, LPN, CMCN Elizabeth Werts, RN, CMCN Lisa Young, RN, MSN, CMCN Marie Michelle Zang, RN, CCM, CMCN

www.aamcn.org | Vol. 7, No. 4 | Journal of Managed Care Nursing