Case manager satisfaction in public health.

PURPOSE OF THE STUDY: The purpose of this study was to examine correlates of case managers' satisfaction with their work, services, and service network and to identify connections to service performance and service costs. PRIMARY PRACTICE SETTING: A decentralized public health program that exemplifies the trend toward more diverse clients and networked services. METHODOLOGY AND SAMPLE: A mixed method design with 34 case managers. RESULTS: As hypothesized, the case managers' experiences with clients and the service network, and their service effectiveness, were associated with their satisfaction with their jobs and the services they provide. Satisfaction was also positively associated with more timely service delivery. These associations were explained in part by case managers' education and training. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE: Case managers can achieve high levels of job and service satisfaction in outreach programs serving a diverse client population in a decentralized service network. Case managers' job and service satisfaction improves with reduced service problems and service delays and when case managers can devise work-arounds for persistent service problems. Using advanced practice nurses (APN) and providing more on-the-job training may increase case manager satisfaction with their jobs and the services they provide. Special efforts may be needed to prevent a decline in job satisfaction with years of experience.

The work of nurse case managers in a cancer and cardiovascular disease risk screening program.

PURPOSE OF THE STUDY: The purpose of this conceptual model of nursing and health policy-based study was to identify the frequency and correlates of activities performed by nurse case managers. PRIMARY PRACTICE SETTINGS: Massachusetts Women's Health Network (WHN) contracting organization sites for breast and cervical cancer and cardiovascular disease risk screening. METHODOLOGY AND SAMPLE: Twenty nurse case managers were interviewed. RESULTS: More time was spent performing client service activities than bureaucratic activities. Frequently performed client service activities were tracking test results, finding/connecting with clients, assessing client needs, and educating clients. The most frequently performed activity was documenting services; the least, discharging clients. Client service activity frequency was correlated with client caseload size, social barriers, overall workload, satisfaction with the way activities are carried out in the WHN, special training in WHN policies and procedures, and contracting organization service delivery arrangements. Bureaucratic activity frequency was correlated with caseload size, workload, months as a WHN case manager, system barriers, satisfaction with the way activities were carried out in the WHN, and special training. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE: Documentation requires a great deal of WHN nurse case managers' time, which perhaps could be more productively spent with clients. Thus, more efficient ways to document services need to be identified. Additional research is needed to determine similarities and differences in activities performed by WHN nurse case managers and other case managers working in cancer and cardiovascular disease screening programs. Strategies need to be identified to remove all barriers that interfere with performance of case manager practice activities. Strategies are needed to reduce client fear of bills, overcome scheduling constraints, and improve translation services to lessen language barriers to effective communication.

Evaluation of school-based health center programs and services: the whys and hows of demonstrating program effectiveness.

Evaluation and dissemination of the outcomes of school-based health center (SBHC) services is essential for the continual growth and funding of SBHCs in the United States. Since their inception, SBHCs have been practice sites for nurse practitioners and have used interdisciplinary teams to provide care for underserved school-aged children. Early research and evaluation focused on describing the types of services and the quality of care provided. Supporters of SBHCs were anxious to demonstrate that the care provided was "as good as" care delivered in traditional primary care practices. Documentation of program impacts, such as changes in population health indicators or improved academic achievement, has been more elusive. Current evaluation priorities outlined by the National Assembly on School-Based Health Care include evaluation of mental health services using a new online tool; assessing productivity of SBHC staff; measuring quality; and attempts to link SBHC care with improved academic outcomes.