Being a case manager is very rewarding, but the pressures and responsibilities of the job contribute heavily to stress. This runs contrary to some perceptions, particularly among novices in the field, who expect that as case managers they will have less pressure than when they were working at the bedside or in other direct caregiver roles.
The complexity and number of the cases handled, the responsibilities of coordinating care, the need to communicate with multiple parties including patients, families, physicians, and insurers, all add up to job stress. Consider a survey by the Case Management Society of America (CMSA) to gauge stress among case managers. Of a total sample of 942 case managers surveyed, 52% had a "stress quotient" in the "requires attention zone," compared to 45% in the general population. Furthermore, 75% of the overall group scored in the "requires attention" zone for stress-related burnout. These statistics point to the need for case managers to assess ways in which they can reduce their job-related stress and improve their self-care (CMSA, 2006).
Reducing Job Stress
The very nature of case management as a process, rather than as a finite set of tasks, can trigger stress. The case manager is never "done"; there is always something else to do. Case managers also handle multiple cases simultaneously, all with unique circumstances and complexities, such as multiple traumas or comorbidities or challenging socioeconomic issues.
Handling these stresses requires time management, prioritization, organization, and flexibility. Case managers cannot plan their days down to the last minute because dealing with the unexpected is inevitable. Patients can take a turn, for the better or worse, which requires the case manager to respond and adjust the care plan accordingly. The goal is to prioritize for each day what items need to be accomplished, knowing that there will always be more to do the next day.
Another way to reduce job stress is to tap into supervisor and peer support. Having access to skilled senior case managers who have an in-depth body of knowledge offers tremendous support. Developing a circle of mentors and colleagues to turn to for advice and feedback is essential for all case managers-and crucial for those who are new to the responsibilities of the field. Membership and participation in professional associations, such as CMSA, can be very beneficial.
Stress can also stem from having too much emotional investment in a particular case. A good case manager is compassionate and has empathy, but at the same time must maintain a level of objectivity to avoid "compassion fatigue" or burnout. See Box 1 for tips for stress reduction.
Focus on Self-Care
The irony for many case managers is that, although we oversee the care of individuals and address the needs of patients and their families, we do a poor job of taking care of ourselves. As the CMSA survey revealed, 69% of the respondents said they do not take care of their own health by eating well or exercising. The first step in improving self-care is to look at how you handle stress-both positively and negatively.
* Do you work a reasonable number of hours? What do you do during the day to take a break and remove yourself from the situation (even a 5-min walk around the block can help) so you can come back with a fresh perspective?
* Do you take time off, including your vacation? How often are you ill; if frequently, what signal is your immune system sending you?
* Do you follow the basics of health and wellness, such a good diet, regular exercise, 8 hr of sleep, and drinking enough water during the day?
* Do you actively create balance between personal and professional activities, and plan for "me time?"
* Are you aware of negative patterns that indicate stress, such as overeating, overdrinking, and the use of illicit drugs?
To be effective case managers, we must first take care of ourselves. In a demanding occupation-dealing with complex medical cases, families in crisis, and the responsibilities of developing a care plan involving many other parties-case managers can easily become overwhelmed. Even when we feel good about what we do and rewarded intrinsically as well as professionally, cumulative job stress takes a toll. The answers lie in what we do for ourselves, seeking out support in our work environment and promoting our own self-care.
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