1. Zawalski, Sandra BSN, RN, CRRN, CCM, ABDA, MSCC
  2. Mann, Chikita MSN, RN, CCM

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Increased caseload, greater complexity, more responsibility. This is the reality for professional case managers across the health and human services spectrum as they experience greater demands for their knowledge and expertise on behalf of individuals (i.e., "clients") who benefit most from case management services. In addition, as part of interdisciplinary teams, professional case managers are responsible for tracking outcomes, not only for case management but also for the interventions of the entire team (Tahan, Watson, & Sminkey, 2016).


Case managers, particularly those who have distinguished themselves by attaining board certification, are increasingly recognized for the value they bring across health and human services, especially for providing care coordination, the heart of the case management process. As demands on case managers escalate, there is a potential downside: Case managers are doing more, often to the point of feeling stressed and, at times, overwhelmed. It is not uncommon for case managers to become ensnared in a cycle of trying to catch up by working during "downtime" (e.g., lunch breaks, after hours, and time off), which undermines their attempts to de-stress. Work-life balance may seem to be an impossible goal.


Studies indicate that overwork and burnout are common among medical professionals. Among U.S. physicians, for example, the prevalence of burnout is at an alarming level, with physicians in emergency medicine, general medicine, and family medicine at greatest risk (Shanafelt et al., 2012). Nursing, the discipline most common among case managers, is shown to be one of the most stressful professions due to factors such as workload, disorganized work environments, and the stress of making difficult care decisions (Stempniak, 2016). These same stress factors are encountered by case managers across multiple practice settings.


The experience of work stress and burnout varies among organizations, due, in part, to workplace culture. Disorganization, a polarized environment, and workplace conflict quickly escalate stress. Even within healthy environments individuals can experience work-related stress and feelings of being overwhelmed because of the volume and nature of the work. Severe cases, clients who are difficult or unmotivated, and conflicts between clients and their family members/support system can challenge even experienced case managers.


Although dealing with a growing caseload may be an unchanging reality, there are steps professional case managers can take to help combat burnout. Following are some "straight talk" practical suggestions for dealing with workplace stress and preventing burnout among case managers.


"No" Is Not a Bad Word

A common problem for many case managers is setting and maintaining healthy boundaries, particularly when it comes to prioritizing demands on their time. The inside joke that "if you don't know who to give it to, give it to the case manager" may make us smile, but it's no laughing matter. As the "go-to people" and the "hub" of communication and information for the interdisciplinary team, case managers often are asked to take on tasks that fall outside of case management practice (e.g., being asked to compile a report on patient readmission statistics for the past 3 months). If individual case managers have difficulty saying "no" to such requests made within their organizations, their supervisors need to step in, especially when what is being asked is not a cost-effective use of their time.


Being busy is not the same as being productive, and doing more does not automatically translate to doing well. For example, a workers' compensation case manager named "Jill" rushed from one appointment to the next, catching up with phone calls using hands-free cellular technology while she drove, and working on reports and updates instead of taking lunch. The more Jill accomplished, however, the more overwhelmed she felt, because she had conditioned herself to believe she could get it all done if she just worked enough hours. Jill became her own worst enemy by taking on extra tasks beyond her already full caseload.


Jill also had lost perspective of what was urgent and needed her immediate attention and what was less important and could be attended to the next day or in a different manner (such as telephonically). The extent of her problem came to light when Jill reported her hours for the month; she was averaging more than 10 hours a day. Her supervisor stepped in, and together they reviewed Jill's schedule to see how she could better manage the demands on her time. As Jill learned to prioritize and say "no" to tasks that were outside the scope of her duties as a case manager (and with her supervisor's support), she became more effective and experienced less stress.


Addressing Communication Difficulties

Poor communication also can amplify case managers' frustration, adding to job stress and feelings of being overwhelmed. A disconnect in communication can happen within the interdisciplinary team; for example, a physician waits until late on Friday to issue discharge orders, creating an end-of-the-day scramble. (If this becomes a pattern, it can be addressed at the next interdisciplinary team meeting.)


Communication can break down between case managers and their clients. As a newly hired case manager providing telephonic case management, John would occasionally become bogged down in long conversations with clients. His supervisor observed the change in John's body posture during these difficult calls, from sitting upright to slumping further in his chair. In these conversations, the client did all the talking as the discussion went around in circles with no resolution. As a solution, John's supervisor offered training and coaching in motivational interviewing techniques. Rather than allowing clients to spin off into unproductive "what-if" scenarios, John learned to use motivational interviewing to identify the client's goals and set priorities. Conversations became more productive when they focused on the priorities, whereas secondary issues were "tabled" for later discussion.


A Healthy Culture Begins With the Supervisor Relationship

Case managers who feel overwhelmed and pulled in multiple directions must be comfortable approaching their supervisors for help, without fear of judgment or criticism. Relationship building goes both ways, but much of the responsibility rests with the supervisor to show genuine compassion and advocacy for the staff. This also means being a role model around work-life balance. If the supervisor never takes lunch, sends e-mails at midnight, and skips days off, then he or she is sending a message about what is expected of others.


Supervisors who "walk the talk" ensure that staff members take time off; otherwise, people are at risk of becoming burned out. For example, one case manager was asked by her supervisor when she had last taken a day off, the answer was shocking. It was already October and the case manager had not taken a day off that calendar year. As the case manager scheduled time off, she was told gently but firmly by her supervisor that she needed to "unplug" during those days-no work e-mail, no reports.


Encouragement: The Secret Weapon

The reality of health care today-greater volume of complex cases and an aging population requiring care from multiple providers-sets the stage for continued demands on professional case managers. Add to that the maturing of professionals in the field, which will make it difficult to increase the ranks of qualified case managers, even to keep pace with pending retirements.


These sobering factors raise questions about what can be done to combat burnout among case managers who are being asked to do more in less time. One seemingly small, but highly effective, technique is encouragement. It makes a difference in morale when case managers feel recognized and appreciated for their efforts; when supervisors acknowledge their team, individually and collectively; and when case managers are empowered to speak up about their needs, including help in setting priorities and maintaining boundaries. Encouragement also lifts people out of the spiral of feeling overwhelmed without any relief in sight.


Encouragement comes in many forms-a few words, a handwritten note, or an e-mail that makes someone smile. Helping with priorities and boundaries, one-on-one coaching from supervisors, and demonstrable encouragement do make a difference. People feel noticed and valued; they know they are seen and recognized for what they do on behalf of clients for whom they advocate. They become self-motivated to focus on ways to work better and work smarter.




Shanafelt T., Boone S., Tan L., Dyrbye L., Sotile W., Satele D., Oreskovich M. (2012). Burnout and satisfaction with work-life balance among U.S. physicians relative to the general U.S. population. Archives of Internal Medicine, 172(18), 1377-1385. Retrieved from[Context Link]


Stempniak M. (2016, April 19). Nurse burnout is a "public health crisis," and here are innovative ways hospitals are addressing it. Hospitals & Health Networks. [Context Link]


Tahan H. A., Watson A. C., Sminkey P. V. (2016). Informing the content and composition of the CCM Certification examination: A national study from the Commission for Case Manager Certification: Part 2. Professional Case Management, 21(1), 3-21. [Context Link]