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How Some Case Managers Do It!

Powell, Suzanne K., RN, MBA, CCM, CPHQ Colleagues at Mayo Clinic Hospital, Arizona

doi: 10.1097/NCM.0000000000000317
Departments: Editorial

Estimates of the health care workforce place the number with burnout symptoms as high as 60%. Case management—whichever discipline you practice in—is a stressful job, fraught with compassion fatigue and physical, mental, and spiritual signs of burnout. If not careful, those feelings can spill into one's entire life. A small convenience sample was used to determine how some case managers find their work–life balance.

The editor reports no conflicts of interest.

Estimates of the health care workforce place the number with burnout symptoms as high as 60%. Case management—whichever discipline you practice in—is a stressful job, fraught with compassion fatigue and physical, mental, and spiritual signs of burnout. If not careful, those feelings can spill into one's entire life. But these numbers also apportion that at least 40% are still engaged and healthy; this translates into better quality of care and compassion for our patients/clients.

So how do these health care workers keep their equilibrium when their colleagues are floundering? There are some important elements of resilience that relate to work–life balance: Most important may be incorporating “balance points” in one's life. Often, this is a hobby or a passion for something far removed from the typical work we do in case management ... and it seems to provide a “secret sauce” for a more symmetrical life. Within the Care Management department at Mayo Clinic Hospital, Arizona, I have witnessed incredible talent among the staff in such varied activities as opera singing, classical guitar, cello, and artistic quilting.



Seeking to understand what some colleagues do to balance various parts of their life, possibly preventing burnout and compassion fatigue, a “convenience” survey with two simple questions were sent via REDCap to 138 multidisciplinary staff members, including nurses, social workers, chaplains, and case management assistants. The two simple questions were as follows:

  1. What do you do outside work, which provides a balance to the daily triumphs and challenges of your work–life in case management?
  2. Does this activity enhance your life at work? If so, how?

This Editorial warrants two operational definitions: burnout and compassion fatigue.

  • Burnout: American psychologist Herbert Freudenberger coined the term “burnout” in the 1970s. He used it to describe the consequences of severe stress and high ideals in “helping” professions (such as case management). There is no clear definition of what burnout really is. As a result, the lack of definition makes it impossible to say how common burnout really is (Anonymous, 2017).
  • Compassion fatigue: The formal caregiver's reduced capacity or interest in being empathic, bearing the suffering of clients. It is the natural consequent behaviors and emotions resulting from knowing about a traumatizing event experienced or suffered by a person. It has been attributed to the “cost of caring” (Figley, 1995).
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The last Role and Function Study, conducted by the Commission for Case Management Certification, cited this breakdown of where health care workers practice (Tahan, Watson, & Sminkey, 2015); however, it does not reveal levels of fatigue in these settings:

  • 28.94%: Health insurance plans
  • 22.76%: Hospitals
  • 11.6%: Workers' compensation
  • 7.3%: Independent care/case management
  • 5.48%: Ambulatory/outpatient care
  • 2%: Acute rehabilitation
  • 3.64%: Veterans health or other government agencies
  • 2.28%: Home care
  • 1%: Skilled care facility

General statistics mentioning compassion fatigue and/or burnout were difficult to find, specifically on case managers. Although the incidence of burnout is at an alarming rate across all health care disciplines (including nursing, mental health, physicians, and social workers), these statistics cite general health care workforce, nurses, and social workers as the best disciplines to use vicariously:

  • 30%–45% of social workers leave their jobs within 2 years, with turnover rates 215% higher than other roles (Public Consulting Group, 2018).
  • 43% of new nurses leave their jobs within 3 years; turnover for a bedside RN resulted in the average hospital losing up to $8.1 million annually (Streamline Verify, 2016).
  • A 2013 survey of 508 employees working for 243 health care employers found that 60% reported job burnout and 34% planned to look for a different job (Bodenheimer & Sinsky, 2014).
  • Thirty-four percent of hospital nurses and 37% of nursing home nurses report burnout compared with 22% of nurses working in other settings (Bodenheimer & Sinsky, 2014).

In our little case management survey, of the 138 surveys sent out, 32 staff members replied (approximately a 24% response rate) (see Table 1):

  1. Some common themes for work–life balance includes:
    • Faith
    • Meditation/mindfulness
    • Exercise
    • Nature/animals
    • Family, friends
  2. Four of the 32 who responded deemed their out-of-work activities as “not really” or just “somewhat” helpful in balancing out their work–life.


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How Some Case Managers Find Their Balance

Other than a few editorial changes, these are the exact words of the staff. In the Preface in my first case management book (Powell, 1996), I wrote:

Case management is an important area of (healthcare), both for its contribution to humanity and because case managers play a key role in impacting the healthcare crisis ... case management is an exciting challenge ... and (case managers) are in a unique position to be recognized for their contribution to healthcare. It is my hope that this book will help develop case managers who have peak job satisfaction and who will be recognized as shining lights, pulling the fragmented pieces of healthcare together.

This stands as true today as it did more than 20 years ago. But since 1996, health care has changed dramatically and evolved at a critically fast pace, with the costs often being at the expense of the health care providers' equilibrium.

As the theme of the National Case Management Week implies (Moving Patients to Wellness), we must first move ourselves to wellness. So, I offer this convenience study as a first step, giving ideas of how some in our profession are creating a more balanced life with important self-care strategies—strategies that often culminate in having more energy to “be there” for our patients. I welcome you to take this small study and figure out the “next steps” to help the caregivers stay sound.

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A warm thanks to my colleagues at Mayo Clinic Hospital, Arizona, with a special thanks to Cathy Zehring and Braddley Waldman for their assistance in this survey. And a special thanks to Ellen Fink-Samnick, who helped with some working statistics.

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Anonymous. (2017). Depression: What is burnout? PubMed Health. Retrieved April 22, 2018, from
Bodenheimer T., Sinsky C. (2014). From triple to quadruple aim: Care of the patient requires care of the provider. Annals of Family Medicine, 12(6), 573–576. Retrieved April 22, 2018, from
Figley C. R. (1995). Compassion fatigue as secondary traumatic stress disorder: An overview. In: Figley C. R. (Ed.), Compassion fatigue: Coping with secondary traumatic stress disorder in those who treat the traumatized (pp. 1–20). New York, NY: Brunner-Routledge.
Powell S. K. (1996). Nursing case management: A practical guide to success in managed care. Philadelphia, PA: Lippincott-Raven Publishers.
Public Consulting Group, (2018). The cost of social worker turnover. Retrieved February 24, 2018, from
Streamline Verify. (2016, March 16). Nurse turnover rate infographic. Retrieved February 24, 2018, from
Tahan H. M., Watson A., Sminkey P. V. (2015). What case managers should know about their roles and functions: A national study from the Commission for Case Manager Certification Part 1. Professional Case Management, 20(6), 271–296.

case management burnout; compassion fatigue; work–life balance

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