8.6 Resource Stewardship and Case Management
Resource Stewardship
The American Nurses Association defines Resource Stewardship as using appropriate resources to plan, provide, and sustain evidence-based nursing services that are safe, effective, financially responsible, and used judiciously. Resource Stewardship is one of ANA’s Standards of Professional Performance. The ANA Standards of Professional Practice are authoritative statements of the actions and behaviors that all registered nurses, regardless of role, population, specialty, and setting, are expected to perform competently. See the following box for competencies associated with the ANA’s Resource Stewardship Standard of Professional Performance.[1]
Competencies of ANA’s Resource Stewardship Standard of Professional Performance[2]
- Partners with the health care consumer and other stakeholders to identify care needs and necessary resources to achieve desired outcomes.
- Collaborates with the health care consumer and other stakeholders to assess costs, availability, risks, and benefits in decisions about care.
- Secures appropriate resources to address needs across the health care continuum.
- Advocates for equitable resources that support and enhance nursing practice and health outcomes.
- Integrates connected health technologies into practice to promote positive interactions between health care consumers and care providers.
- Uses organizational and community resources to implement interprofessional plans.
- Addresses discriminatory health care practices and the adverse impact on allocation of resources.
Case Management
Nurses are tasked with daily case management activities and allocating appropriate resources to their clients. Two common types of case management that staff nurses provide are educating clients about using appropriate levels of care and encouraging the use of cost-effective health care team members.
Several levels of care are available to clients for their health care services:
- Emergency department care has specialized providers and high-level diagnostics and should be reserved for immediate and potentially life-threatening needs.
- Urgent care is an elevated level of care above an outpatient visit, yet below the needs of an emergency visit. Nurses should refer patients to this setting if they have a health need that needs attention within the next 24 hours but is not life-threatening.
- Outpatient health settings provide health maintenance for chronic disease or treatment of nonurgent acute conditions. They also provide preventative services like well-baby checks and immunizations. In the outpatient setting, the nurse recognizes the patient’s time with a provider is limited, so the majority of a nurse’s time is often spent providing patient education, answering questions, and coordinating care.
- Inpatient and acute care typically occurs in a hospital setting where regular skilled nursing, diagnostic tests, and medical treatments are required. Nursing goals in these settings are to address immediate health concerns, stabilize the client, and prepare them for discharge. Most inpatient stays are 72 hours or less, so nurses must provide efficient care that includes adequate patient education regarding follow-up care after discharge.
- Telehealth is a fairly new and expanding health delivery model. Telehealth is a form of an outpatient health service where the patient and member of the health care team are able to connect remotely using technology for video conferencing. Telehealth enhances client access to multiple providers without the burden of travel. Telehealth has become an important resource in rural communities and became very popular during the COVID-19 pandemic when people were encouraged not to travel or expand their social circles.
Nurses can also address the economic pressures within the health care system by utilizing and advocating for cost-effective care by providers on the health care team. In this manner, limited health care resources are allocated wisely, and consumers receive the health care they need. For example, many Nurse Practitioners (NPs) and Physician Assistants (PAs) function as primary providers in outpatient settings and provide preventative services, treat self-limited acute medical conditions, and manage chronic disease. NPs and PAs are trained to refer clients for specialized care when indicated. Some NPs and PAs work in specialized inpatient areas and serve as the primary point of contact during a patient’s hospital stay. Nurses recognize the time of specialty physicians is limited and unnecessary referrals can be costly to the client. By using and advocating for the wise use of these health care human resources, nurses can help reduce the overall cost of health care.