Nursing a Need to Teach Managed Care

Review of the current status of managed care education for nurses

In 1999, Ellen Brzytwa, R.N., M.S.N., M.P.H., reviewed the availability and content of managed care education for nurses.

Although nearly half of the U.S. population receives its health care under some form of managed care contract, neither health care providers nor students have access to education to help them practice in a managed care environment. In particular, very little is known about the state of managed care education for the nursing profession nationally.

The investigators adapted a survey on managed care competencies, originally designed to evaluate physician training for managed care, and mailed it to 1,050 employers and educators of nurses, receiving 292 usable responses. They also requested written comments, and received 43 responses. The principal investigator conducted 39 interviews with experts in both provider education and managed care.

Key Findings

The principal investigator reported the following findings to the Robert Wood Johnson Foundation (RWJF):

  • Managed care education is not generally available to nursing students and practicing nurses.
  • Faculty of schools of nursing are not trained to teach managed care and have little opportunity to learn about managed care or practice in managed care settings.
  • Health care institutions are attempting to provide some managed care education to their nursing workforce, but do so in-house.
  • Employers and educators of nurses agree that the managed care competencies that address the practice side of nursing are most important; however, by combining ratings of importance and deficiencies in a composite score, the authors found that enhanced education is needed for six managed care competencies:
    • Understanding the need to select cost-effective diagnostic tests and treatment modalities.
    • Operating under capitation payment arrangements.
    • Understanding the principles of managed care business practices.
    • Engaging in quality measurement and improvement.
    • Distinguishing among different reimbursement mechanisms.
    • Integrating practice guidelines into nursing practice.
  • Using the composite score calculations, the authors found, from both employers of nurses with BSN (Bachelor of Science in Nursing) and APRN (Advanced Practice Registered Nurse) degrees and managed care organizations (MCOs) employing physicians, four key managed care competencies as the highest needs for future education:
    • Understanding the need to select cost-effective diagnostic tests and treatment modalities.
    • Operating under capitation payment arrangements.
    • Engaging in quality measurement and improvement.
    • Coordinating care efficiently.
  • Partnerships among schools of nursing, MCOs, and education and telecommunications enterprises hold promise to assist schools of nursing in delivering managed care education to nursing students and practicing nurses.

Key Recommendations

  • The report recommended that RWJF "fund a national program with five strategic initiatives to improve the availability and accessibility of managed care education for nurses:
    • Increase the number of faculty prepared to teach managed care.
    • Accelerate the development of managed care curricula for nursing.
    • Improve the knowledge and attitudes of national nursing leadership regarding the challenges/opportunities of managed care.
    • Accelerate the involvement of nursing leadership with advanced telecommunication enterprises to more effectively distribute managed care education and other continuing and degreed education.
    • Convene a high-level work group of health professions educators and telecommunication experts to analyze opportunities for professional and continuing health care workforce education.

In addition to the report, an article on the study was published in the Journal of Nursing Education. The principal investigator also presented findings to an annual meeting of Colleagues in Caring, an RWJF national program, and at Colleagues in Caring project meetings in South Dakota and South Carolina. See the Bibliography for details.


The Robert Wood Johnson Foundation (RWJF) supported this project through a grant of $35,818.