In any practice setting, continuous learning is vitally important for case managers, particularly to support evidence-based practice. The COVID-19 pandemic, however, has further raised the stakes on ongoing education. As the health care system confronted a previously unknown pathogen, clinicians from all disciplines and who practice across the health and human services spectrum found themselves scrambling to respond.
Unpredictability was soon recognized as the hallmark of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the coronavirus disease 2019 (COVID-19) it caused. For example, early on in the pandemic, the variation in the virus's incubation period, ranging between 2 and 14 days, made it difficult for clinicians to make an early diagnosis and initiate treatment; at the same time, its high level of contagion soon made it a global health crisis (Jean et al., 2020). With no widely accepted intervention and no vaccine, managing the disease became challenging, as the severity of symptoms varied widely from patient to patient.
Amid such unpredictability and urgency, case managers responded with individualized care plans for patients with the disease, both on inpatient and outpatient bases. In addition, for severely ill and injured individuals who were already in the health system, the major focus was on reducing contagion risk. (A full discussion of the implications of COVID-19 on case management can be found in the accompanying article in this issue, "Case Management on the Front Lines of COVID-19: The Importance of the Individualized Care Plan Across Care Settings.")
In every care setting, COVID-19 has pulled the rug out from under us, often changing how case managers normally interact with clinicians, colleagues, and the clients (or patients) we serve. In my specialization of catastrophic case management, case managers needed to reengineer how they advocate for severely ill and injured people who often spend several weeks to months in acute care and subacute care facilities. For example, field case managers often could not go on-site to observe clients who were severely ill or injured and act as the "connector" among all parties. Instead, almost overnight, these case managers shifted to telemedicine, making virtual visits and communicating by teleconference. Even as case managers learned telehealth tools themselves, often they also had to teach others how to use them. They were learning by doing-in the moment, in very fluid conditions.
Learning on the Job
Professional case managers have a history of learning on the job; indeed, for them it is the primary mode of learning (Tahan et al., 2020). The pandemic, however, has required case managers not only to be flexible and adaptable in the way they practice but also to self-educate by reading research and other articles from reputable sources. In addition, case managers need to remain current with the protocols and procedures within their own practice settings.
As a professional case manager, I have learned three important lessons during the pandemic. I share them here to encourage other case managers to record their own lessons learned and to share them with others to increase our knowledge and understanding.
1. Knowledge continues to evolve. Since the coronavirus outbreak was first reported in China in late 2019, voluminous research has been published, with frequent updates made available from sources such as the World Health Organization and the Centers for Disease Control and Prevention (CDC). As more became known about the disease, protocols sometimes changed, such as the wearing of masks. Initially, individuals were discouraged from wearing face masks so as not to create shortages for health care professionals and other essential workers. Later, the CDC urged people to use cloth face masks to slow the spread of COVID-19, saying it could be a critical tool in the fight against contagion by reducing the spread of the disease (CDC, 2020). In a rapidly changing situation such as the pandemic, we should expect knowledge will continue to evolve. Therefore, case managers need to take responsibility for remaining up to date.
2. Know yourself. Case managers need to be self-aware of their level of comfort in being exposed to patients with COVID-19. I have spoken with health care professionals who expressed fear of close contact with these patients and with others who were more comfortable, provided they had access to personal protection equipment (PPE). Safety protocols and risk mitigation are paramount, such as frequent handwashing, wearing PPE, and maintaining social distance whenever possible. At the same time, case managers who have elevated levels of anxiety and stress must address them, such as by talking to supervisors and colleagues.
3. Understand the sense of loss. The pandemic has changed so much. Some people have lost loved ones; others have suffered economic losses. There is also upset because of the disruption of normal life. We need to give each other and ourselves time to grieve our losses so that we can find a way forward. A phrase heard frequently in the pandemic is "we are all in this together." We need to embrace that truth by supporting each other. When tempers flare or people get upset, give each other some grace; we never know what people are going through.
As of this writing, states in the United States are at various stages of reopening, with some setbacks amid a second wave of contagion in late 2020. Even as daily life begins to return to a sense of normalcy (albeit while wearing face masks), we cannot lose sight of the fact that we are still in the throes of the pandemic. At the end of 2020, it appeared that there were many more months to go before we can consider widespread vaccination. Life was still not yet "normal." The same held true for case managers, even as we moved forward in practice. In acute care, primary care, and similar settings, case managers have begun seeing patients in person again; workers' compensation and catastrophic case managers have been able to attend more doctor's appointments with clients. Yet, for many people, disruptions continued in how they worked and interacted with colleagues and with clients (or patients) receiving case management services. Often, there was also a sense of loss.
Amid these ongoing disruptions, and the emotions they trigger, we need compassion for others and for ourselves as we continue to get through this. All these experiences are part of our learning. This knowledge will shape us as advocates, colleagues, and members of interdisciplinary teams for whatever comes next.
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