title: The work of nurse case managers in a cancer and cardiovascular disease risk screening program.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  Massachusetts Women's Health Network (WHN) contracting organization sites for breast and cervical cancer and cardiovascular disease risk screening.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: College of Nursing and Health Sciences, University of Massachusetts, Boston, USA. jacqueline.fawcett@umb.edu
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Fawcett
authors.forename: Russell K
authors.initials: RK
authors.lastname: Schutt
authors.forename: Gail B
authors.initials: GB
authors.lastname: Gall
authors.forename: Elizabeth Riley
authors.initials: ER
authors.lastname: Cruz
authors.forename: Mary Lou
authors.initials: ML
authors.lastname: Woodford
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000517:prevention & control; D019090:Case Management / Q000458:organization & administration*; D003159:Community-Institutional Relations; D003266:Continuity of Patient Care; D004282:Documentation; D006801:Humans; D008403:Mass Screening / Q000451:nursing / Q000458:organization & administration; D008404:Massachusetts; D008875:Middle Aged; D016294:Models, Nursing; D020380:Needs Assessment; D009369:Neoplasms / Q000175:diagnosis* / Q000517:prevention & control; D024802:Nurse's Role / Q000523:psychology; D015401:Nursing Administration Research; D009730:Nursing Assessment; D015403:Nursing Evaluation Research; D009740:Nursing Staff / Q000193:education / Q000458:organization & administration / Q000523:psychology; D010353:Patient Education as Topic; D018570:Risk Assessment / Q000458:organization & administration*; D011795:Surveys and Questionnaires; D013996:Time and Motion Studies; D014932:Women's Health Services / Q000458:organization & administration