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Departments: CMSA Highlights

Canaries in the Coal Mine

Alejandro, Jose PhD, RN, NEA-BC, CCM, CNE, FACHE, FAAN

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doi: 10.1097/NCM.0000000000000479
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My father was part of the silent majority. As a child living through the Great Depression, he understood that our world could be turned upside-down. He was taught to do more with less. Not once did he complain about how COVID-19 impacted him. “It happens, Hijo (son). Life repeats itself.” My father learned about systems-thinking from the school of hard knocks. He was a very proud man who raised 13 kids. He did not get the opportunity to attend college, but he did instill in us the importance of doing what is right.

Prior to COVID-19, there were many warning signs (canaries in the coal mine) about our lack of preparation in dealing with an infectious disease outbreak. Florence Nightingale noted that poor “living conditions” are the largest threat during the 1918 flu epidemic (Aligne, 2016). Research demonstrates how social determinants of health can dramatically spread infectious disease (Hargreaves et al., 2011).

In 2013, the Institute of Medicine (IOM) noted that “we lacked a coordinated public health system.” It noted that the U.S. public health infrastructure was fragmented and that our system lacked the ability to effectively communicate. Looking back further to 1988, the IOM's report on The Future of Public Health noted that our public health system was in a precarious position and in disarray (IOM, 1988; Oakley, 2004). We had plenty of notice that we were not prepared for a major public health event—like COVID-19.

As a case manager, you undoubtedly experience how COVID-19 continues to impact you from both personal and professional practice perspectives. The pandemic has challenged us to do more with less—to think outside of the box. We have firsthand experience of rationing in health care and dealing with shortages of common household items. At times, it feels overwhelming and enduring. It is painful and emotionally draining. Rosa et al. (2020) warn us to be prepared for “rising moral residue.” The choices and decisions we have made, amidst the pandemic, may result in ethical injuries to our psyche.

Whether a formal or informal leader, you have been charged with leading the way through chaos both as a professional and as a layperson within your personal life. Your case management and leadership competencies have been shaken up and face continuous challenge. This is truly the best time to take a moment to reflect and reconnect your passion to purpose. It is important that we recognize and tackle the early stages of burnout through professional development (National Academies of Sciences, Engineering, and Medicine, 2019).

Stepping back to reflect on what is happening around us gives an opportunity to move into a “learning mindset” (Rangachari & Woods, 2020). A learning mindset explores possibilities and considers how professional case managers can improve practice that can prepare and equip us for future change and challenge. The Case Management Society of America (CMSA) Standards of Practice for Case Management (CMSA, 2016), continuous learning, professional development, and your experience provide you with an array of tools to assist you through this transitional time.

As a case management professional, you understand the importance of building and maintaining trusting relationships. These relationships build a network that is rich in knowledge and experience. Our CMSA network can assist you in the discovery of new strategies to improve practice and your resiliency. It is important to remember that the essential components of resiliency are self-kindness, common humanity, and mindfulness (Lefebvre et al., 2020). We might equate it to “paying it forward” by taking care of ourselves and supporting the needs of others.

Throughout history, infectious disease has wreaked havoc on our global community. Before the professional role of case management was established, clinicians had to develop and implement strategies to appropriately place individuals with an infectious disease. Today, case managers have an important role of helping us navigate through this storm.


Aligne C. A. (2016). Overcrowding and mortality during the influenza pandemic of 1918. American Journal of Public Health, 106(4), 642–644.
Case Management Society of America (CMSA). (2016). CMSA Standards of practice for case management. CMSA.
Hargreaves J. R., Boccia D., Evans C. A., Adato M., Petticrew M., Porter J. D. (2011). The social determinants of tuberculosis: From evidence to action. American Journal of Public Health, 101(4), 654–662.
Institute of Medicine (IOM). (1988). The future of public health. The National Academies Press.
Institute of Medicine of the National Academies. (2013). The future of the public's health in the 21st century.
Lefebvre J. I., Montani F., Courcy F. (2020). Self-compassion and resilience at work: A practice-oriented review. Advances in Developing Human Resources.
National Academies of Sciences, Engineering, and Medicine. (2019). Taking action against clinician burnout: A systems approach to professional well-being. The National Academies Press.
Oakley C. K. (2004). Going it alone: Public health improvement without comprehensive health care reform. American Behavioral Scientist, 47(11), 1462–1466.
Rangachari P., Woods J. L. (2020). Preserving organizational resilience, patient safety, and staff retention during COVID-19 requires a holistic consideration of the psychological safety of healthcare workers. International Journal of Environmental Research and Public Health, 17(12), 4267.
Rosa W. E., Schlak A. E., Rushton C. H. (2020). A blueprint for leadership during COVID-19. Nursing Management (Springhouse), 51(8), 28–34.
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