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  1. LIFTING THE FOG OF Ethics Kathleen Fraser MSN,MHA,RN-BC,CCM,CRRN CMSA Executive Director

  2. ETHICS • Moral principles that guide a person’s behavior. All decisions have an ethical or moral dimension for a simple reason --- they have an effect on others.

  3. Ethical Development • Ethical behavior exists to foster and preserve our clients welfare. • Unethical behavior, by definition, fails to do so because it is self-serving.

  4. “Courage is being scared to death and saddling up anyway.” John Wayne

  5. Case Managers are routinely confronted by gray areas due to having to deal with multiple stakeholders or points-of-view.

  6. Case management is neither linear nor a one-way exercise. The assessment responsibilities will occur at all points in the process. Facilitation, coordination and collaboration will occur throughout the client’s health care encounter.

  7. Regardless of title or area of expertise, the case manager is dealing with complex cases in which there may not be a clear right and wrong.

  8. If we want to preserve the ethical ethos of case management, case managers must know the ethical standards/scope of practice, which they are held and comply with them.

  9. Case Management Codes of Ethics • CMSA Standards of Practice • ANCC Code of Ethics • NASW Standards for Social Work Case Management • Professional Conduct for Case Managers (CCMC)

  10. Standards of Practice • Empowering the client to problem-solve by exploring options of care, when available, and alternative plans, when necessary, to achieve desired outcomes. • Encouraging the appropriate use of health care services and strives to improve quality of care and maintain cost effectiveness on a case-by-case basis. • Assisting the client in the safe transitioning of care to the next most appropriate level. • Striving to promote client self-advocacy and self-determination. • Advocating for both the client, employer and the payer to facilitate positive outcomes for the client, the health care team, and the payer.

  11. However, if a conflict arises, the needs of the client must be the priority. A case manager’s primary obligation is to his/her clients.

  12. Stewards Stewardship: Responsible and fiscally thoughtful management of resources.

  13. Case Management Process The case management process is carried out within the ethical and legal realm of a case manager’s scope of practice, using critical thinking and evidence-based knowledge.

  14. “The ethics of excellence are grounded in action-what you actually do, rather than what you say you believe. Talk, as the saying goes, is cheap.” Price Pritchett

  15. Awareness of the 5 basic ethical principles • Beneficence • Non-malfeasance • Autonomy • Justice • Fidelity

  16. ANCC Code of ethics for Nurse Case Managers • It not only applies to the individual patient but also their family and/or care givers. • The nurse case manager in all professional relationships, practice with compassion and inherent dignity, worth and uniqueness of every individual, unrestricted by consideration of social or economic status, personal attributes or the nature of health problems. • When delegating, the NCM is responsible for the task delegated therefore the outcome is still your ethical responsibility. • Interdisciplinary collaboration imperative.

  17. NASW Standards for Social work case management • “Standard 1. Ethics and Values • The social work case manager shall adhere to • and promote the ethics and values of the • social work profession, using the NASW • Code of Ethics as a guide to ethical decision • making in case management practice.”

  18. CCMC Commission’s Code of Professional Conduct • “The Commission for Case Manager Certification is committed to the assurance of ethical case management practice as outlined in their Code. A code of conduct agreement is signed upon becoming a CCM.” • Patrice Sminkey, CEO of CCMC

  19. Client-centric Individualized and Goal Directed care. A collaborative partnership approach. Whenever possible, facilitate self-determination and self-care through the tenets of advocacy, shared decision making, and education. Turn the passenger into a driver! Use a comprehensive, holistic approach. Practice cultural competence, with awareness and respect for diversity.

  20. Communicating with non-english speaking patients • Use a professional medical translator if at all possible. Less likely to be affected by “false fluency” with medical phrases. • Even with a translator, when possible use words or phrases that are more easily understood by people outside of medical care. • Inform translator you want translation as literal as possible and tell you if there is not literal translation. • Ensure in advance the translator understands the need for confidentiality. Also make sure the patient understands the conversation will be confidential. • Watch the patient while the translator speaks and when the patient replies paying attention to the body language. • Speak directly to the patient as if the translator was not present, allowing your words to be translated exactly as spoken.

  21. Age of the internet! • Trust yourself, you know more than you think you do. • Dr. Benjamin Spock


  23. Nurse Licensure Compact • All 50 states require current nurse licensure within their state. • 25 of the 50 states are Compact states. • Legislation pending: Oklahoma, New York, New Jersey, Georgia, Illinois, Massachusetts, Nevada and West Virginia.

  24. When RNs practice (onsite or telephonically) across state lines, they are required by law to be licensed in each state in which their patients treat, not the state the nurse resides.

  25. Individual Liability The individual RN who is not licensed currently does not meet the Nursing Licensure Standards of Care and in fact is engaged in criminal behavior as seen by the law, rules & regulations.

  26. Penalties Penalties for providing nursing services without a license range from $1000 fine to 1 year in jail to lifetime prohibition from practice

  27. This leaves the case manager In an ethical conflict In a legal conflict With his/her own professional license on the line With his/her personal and family assets at risk in case of an incident causing harm to a patient

  28. You are never wrong • to do the right thing! • Mark Twain

  29. Trust your ethical intuition! • Emphasize communication and collaboration across multiple points of interface over our health care continuum • Expect to maneuver grey areas • Review ethical dilemmas as a positive

  30. Red Flag • If you feel uncomfortable being asked to do something you think is unethical, it probably is.

  31. Create an ethical decision making tree

  32. Ethical Summary • Go back to the basics • Use Critical Thinking Steps • Suspend Judgment • Deconstruct • Reflect • Synthesize

  33. “Be the thermostat, not just the thermometer” Dr. Martin Luther King

  34. Website Resources

  35. Case Manager Survival Skills

  36. How do you keep your passion for Case Management when our patients, their families, bosses, physicians, employers, adjusters, etc, etc, etc…. can drain the passion completely out of you?

  37. “The pessimist may be right in the long run, but the optimist has a better time during the trip.” Anonymous

  38. Questions