8.6 Resource Stewardship and Case Management

Resource Stewardship

Resource Stewardship is one of the Standards of Professional Performance established by the American Nursing Association (ANA). Resource stewardship is defined as using appropriate resources to plan, provide, and sustain evidence-based nursing services that are safe, effective, financially responsible, and used judiciously. See the following box for competencies associated with the ANA’s Resource Stewardship Standard of Professional Performance.^[1]

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 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.
• Assisted living refers to licensed facilities that provide safe living accommodations and three meals daily. Residents receive assistance with medications and ADLs and may receive general nursing care.^[3]
• Skilled nursing facilities, commonly referred to as “nursing homes” or “long-term care facilities,” are licensed facilities that provide 24-hour licensed nursing services. Residents may require total assistance with ADLs.^[4]
• Home health refers to services provided in a client’s home that may include nursing, home health aide, physical therapy (PT), occupational therapy (OT), and speech therapy.^[5]
• Hospice offers palliative and supportive services providing physical, psychological, social, and spiritual care for dying clients and their families. Services may be provided in the client’s home or an inpatient setting. Hospice may include nursing, home health aide, social worker, chaplain, PT, OT, ST, nutritional therapy, and volunteer services.^[6]
• 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 telephone calls or video conferencing on a computer with an Internet connection. Devices may be provided to monitor vital signs and other health indicators. Telehealth enhances client access to multiple providers without the burden of travel. Telehealth has become an important resource in rural communities, especially due to social distancing required by the COVID-19 pandemic.^[7]

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.