We know that being a case manager comes with a lot of different stressors. It's just part of the job. But we want to help ease some of that stress. This is another post in our ongoing series of blogs on case manager stress relief.
Team management helps CMs share the load
One of the major reasons for the growing critical shortage of nurses is the stress that goes along with the profession. Case managers, many of whom are trained nurses responsible for nursing services, face a high rate of turnover and "burnout" as well.
"The problem is that case managers are in a job that can be called a fire station,’" says Linda Arnold, RN, a motivational expert based in Brunswick, ME.
"If there are a number of calls that come in, you have to handle them." What case managers can do is look at how they organize themselves and keep the level of stress to a minimum, says Arnold, who also is a trained psychiatric nurse.
Kathleen Lambert, JD, RN, who has been a practicing nurse for 31 years and a health care lawyer for 10, says that one of the biggest challenges facing case managers is the number of tasks they are required to perform.
Using the team concept
"Case managers are in a continuous multitasking situation," says Lambert, who spoke on legal issues affecting case managers at the 7th Annual Hospital Case Management Conference, held recently in Atlanta. One technique that she found very helpful when her patient care load got very heavy was to "team manage" with another nurse whose skills and temperament were similar to her own.
"Rather than try to carry the whole load by myself, there would be certain cases that I would team-manage with another nurse," she explains. In many instances, these were the more complex cases that required more insight in terms of what was needed for the patient.
"This gives the patients the advantage of having more than one person looking at their needs in that particular situation."
This technique also helps to protect the patient, Lambert adds. "If you get tied up with another issue for another patient, the other case did not get away from you to where you could barely catch up to it or put the patient at risk. It is an effective way of managing it, and it is very collegial."
Once a team approach is established with one patient, it’s easy to use the same approach with another patient, she adds. "The rhythm is already there."
Anne Llewellyn, RNC, BHSA, CCM, CRRN, CEAC, co-founder of Professional Resources In Management Education in Miramar, FL, says that working in a team with another case manager is especially effective if it is focused on mentoring and the value and resources that each case manager brings to the process.
"We cannot do this job in silos," she explains. "Working together with other case managers streamlines the process and decreases the fragmentation that occurs so often."
Another technique Lambert recommends is "calendaring," which she learned as an attorney. Attorneys often work a case backward by starting with an end date and then "calendaring" what must be accomplished at certain points along the way. "You work backward to the date where you are today," she says. "That gives structure as to what needs to be done on what case."
Ellen Mitchell, MA, RNC, a case manager at Saint Vincent's Hospital and Medical Center in New York City, says that she uses a similar technique involving multidisciplinary action plans (MAPs) based on diagnoses. Mitchell says when she begins her day, she looks at the census for her unit and writes lists about what those patients require that day.
"I look at it going forward on a day-to-day basis," she says. "It is almost like having your own list of things to accomplish. I call that my to-do’ list. That is how I organize my day."
Llewellyn stresses that an important part of the case management stress relief process is organization. "If case managers are not organized, they will not be able to handle their caseloads effectively and they will burn out," she warns. "Calendaring or some type of a diary system is very effective."
While there are many tools that make this task possible, case managers often have their plans interrupted by unexpected events, Llewellyn says. "Being flexible allows us to adjust our day to meet these unexpected events."
Knowing when to say no and when to ask for help is also important, she says. "If you work in an organization where there are other case managers, make sure that sharing resources and offering help is part of the culture of your case management department," Llewellyn adds.
Two important principles are to accomplish a little bit all the time, and never to let anything overwhelm you, Lambert adds. "If you just bite off a little bit at a time, it is doable. That is basically what calendaring is. It says, Here is your case; here is the endpoint. Do these little pieces along the way, and you will reach your goal.’"
According to Arnold, common-sense techniques that apply to many other professions also apply to case managers.
Case managers should understand how they react to certain situations — what she calls their "existing points of view" — and learn how to let go of the ones that are not helpful. By prioritizing and doing what is in front of them, nurses will preserve their resources, she explains.
"Nurses have a tendency to get caught up in shoulds. Sometimes, [nurses] are right that things should not be the way they are, but if that is the way they are, you use a lot of energy and cause a lot of stress by saying they should not be," Arnold says.
These are just a few ways some experts in the field have found to create case manager stress relief. We hope you find them helpful and invite you to share your own stress relief techniques.