Effects of Case Management on the Nursing Context-Perceived Quality of Care, Work Satisfaction, and Control Over Practice


Dr. Lynn, CB# 7460 Carrington Hall, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7460.


Purpose: To examine in 1995 the effects of case management on the context of nursing practice-perceived quality of care delivered, work satisfaction, and control over nursing practice-rather than the commonly studied effect on fiscal outcomes.

Design: Prospective quasi-experimental. Sampled were nurses on four units at one community hospital where patients with DRG 107 (Coronary Artery Bypass Graft, with no cardiac catheterization) were traditionally hospitalized.

Methods: Registered nurses on these units completed quality of care, satisfaction, and practice-control scales before and 1 year after implementation.

Findings: Significant positive differences were found in several aspects of perceived quality of care for both staff nurses and case managers, with specific increases found in nurses' perceived ability to develop relationships with patients, ability to be therapeutic, and support for good care from the institutional structure and administration. A significant decrease in nurses' satisfaction with their pay and other rewards as well as respect from colleagues was found. Case managers were found to have significantly increased perceptions of control over their practice.

Conclusions: Case management was found to have a primarily positive effect on nurses-staff and case managers alike. There were significant increases in several aspects of the nurses' perceptions of the quality of care delivered. Additionally, case managers were more satisfied with the administration, the respect they received, and their pay and rewards in the institution. Most strikingly, case managers perceived themselves to have more control over their practice. Some negative effects of the program were a decrease in satisfaction with the pay and rewards by the staff who were not case managers.