On-the-job training is good enough, right?

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Case management is a growing health care profession, with a presence in every health delivery setting. However, professionals moving to case management positions may not have access to adequate orientation and training. As a result, they often “learn on the job” and are not exposed to knowledge and skills that advance the practice of case management.

Health care professionals have faced many challenges in recent years, not the least of which was the novel coronavirus disease (COVID-19). The pandemic resulted in resignations, retirement, and an increase in dropout rates from schools of nursing and social work. As a result, the security of professional health care staffing is in jeopardy.

The shortage of registered nurses and social workers is impacting the availability of nurse and social work case managers (White, 2021). In 2021, the Bureau of Labor Statistics predicted that there would be a need for 175,00 nurses and 26,700 social workers by 2029 (White, 2021). The need for qualified case managers is growing due to initiatives in health care reimbursement reform, accountable care organizations, and value-based purchasing (White, 2021). In addition, case management services have expanded to 24-hr/365-day coverage and have extended to ambulatory settings (White, 2021).

The provision of adequate staffing is not the only concern. A 2018 review of existing qualitative studies about the challenges of implementing case management identified the barriers case managers encounter when choosing case management practice as their professional discipline. Joo and Huber (2018) identified five distinct barriers, but most concerning was that education and training were insufficient. In addition, case managers interviewed experienced demanding activities and tight deadlines, which made focusing on the client difficult (Joo & Huber, 2018).

Case management requires the ability to work independently, a high degree of self-confidence, and the ability to listen to the client and balance all of this within the framework of authorities while avoiding exhaustion or burnout (Joo & Huber, 2018). Joo and Huber reviewed 10 qualitative studies about case management, and seven of those 10 studies identified case management training, or the lack thereof, as a barrier to implementing case management. The case managers interviewed for these studies reported a lack of educational opportunities and exposure to consistent, practical training on how to be a case manager. Most reported their training focused on qualification requirements or classroom, instructor-led training (Joo & Huber, 2018). Most case managers report being “thrown” into the role and are expected to learn as they go (Joo & Huber, 2018). This type of training is inconsistent and certainly not based on evidence or best practice. The training offered to case managers was reported as not useful to their role and function. Another concerning result of inadequate training is the inability to manage conflict (Joo & Huber, 2018). Joo and Huber included a consensus recommendation from some of the contributors to the articles reviewed: the need for training for special populations such as the elderly, ethnic minorities, and prenatal women (Joo & Huber, 2018).

Some of the challenges to providing training based on evidence and best practice are the variety of case manager backgrounds from which they originate. Practice settings vary as much as the professional backgrounds of case managers, and all may interpret the practice of case management differently. Nurses, social workers, therapists, and other professionals bring a wide variety of knowledge and skills but still need training in the case management process, ethics, reimbursement models, negotiation, patient-centered communication, conflict resolution, and financial systems.

Consistency in case management practice is established with standards of practice. Health care administrators and policy makers need to recognize the need for consistent practice guided by evidence-based standards. Countries with established standards of practice for case management include Australia, Canada, the United Kingdom, and the United States (Joo & Huber, 2018). In the United States, CMSA was the first professional organization to establish the Standards of Practice for Case Management in 1995. Since then, the Standards have been updated on the basis of changes in the health care industry. Extensive literature searches have been conducted with each revision, ensuring the updated content is based on the latest evidence. The most recent revision occurred in early 2022, with the addition of a new Standard for Health Information and Technology and the inclusion of best practices for diversity, equity, and inclusion. CMSA’s Standards of Practice have been recognized by the National Committee for Quality Assurance (NCQA), Utilization Review Accreditation Commission (URAC), and all four branches of the military.

Inconsistency in case management practice is remedied by standardized education of the case management process and health care industry factors required of case management functions, such as reimbursement sources and models, federal health care programs that lay outside of typical reimbursement sources, disability, engagement and retention strategies, conflict resolution, and care coordination. CMSA, since its inception, has strived to bring meaningful education and training to the case management industry and support professional growth.

CMSA identified a need for practical education and training for novice case managers, which resulted in the development of CMSA’s Case Management Boot Camp. This 20-hr training includes the topics identified in Joo and Huber’s research and deploys multiple styles of learning activities. This program steps away from the traditional didactic form of training, using role-play, case studies, and group activities to keep the case manager engaged. The learning activities are taken from the real-life experiences of seasoned case managers.

The current and future staffing shortages will result in professionals coming to case management with little to no clinical experience except what they received during professional studies. CMSA is determined to make sure case managers, present and future, will have the skills, knowledge, and resources to succeed and for clients to regain and maintain improved health and well-being.

Designed for the case manager with less than 5 years of experience, those looking to change their area of practice, or case managers committed to advancing their professional growth, the CMSA Case Management Boot Camp solves the skill gap presented by the usual on-the-job learning tactic. Case managers ready to tackle new challenges can visit www.cmsa.org to learn more about this critical program and upcoming training dates.


Joo J. Y., Huber D. L. (2018). Barriers in case managers’ roles: A qualitative systematic review. Western Journal of Nursing Research, 40(10), 1522–1542. https://doi.org/10.1177/0193945917728689

White C. (2021, July 19). Case management workforce needs are driven by supply and demand. CMSA Blog. https://cmsa.org/case-management-workforce-needs-are-driven-by-supply-and-demand


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