2007 Salary Survey Results

Case managers facing increased caseloads, paperwork documentation with less direct patient care responsibilities

Decrease in job satisfaction, increase in caseload

Today's case managers report that they are paid more but they're working longer hours and being asked to do more documentation and paperwork.

More than half of the respondents (65%) to Hospital Case Management's 2007 salary survey were case management directors. The rest were case managers, utilization managers, social workers, or had other titles.

The majority of respondents to the survey report that they got a raise last year but 88% of them put in more than 40 hours a week with 39% working more than 50 hours a week. Many of those hours are spent doing documentation, filling out forms, and completing assessments than working with patients, says Catherine M. Mullahy, RN, BS, CRRN, CCM, president of Mullahy & Associates.

'Decrease in job satisfaction'

"I've seen a decrease in job satisfaction among case managers because of an increase in caseloads and paperwork [and] lack of mentoring and education for new case managers. A lot of nurses I talk to say they are spending a lot of time doing documentation and not so much doing the things they feel will make a difference, Mullahy says.

In this year's survey, 86% of respondents report an increase in salary during the past year, slightly more than the 84% who reported an increase in 2006 but down from 89% in 2005 and 88% in 2004. Half of the respondents reported a 1% to 3% salary increase, followed by 26% whose salary increases were between 4% to 6%. More than 10% reported receiving raises of 7% or more.

About 84% of respondents to the survey report salaries of $60,000 a year or more. The biggest percentage (27%) make between $60,000 and $69,999, with 18% reporting salaries of $100,000 or more.

Salary a 'challenge' in recruiting

Salaries make recruiting and retaining case managers a challenge, says Beverly Cunningham, RN, MS, associate administrator, clinical performance improvement at Medical City Dallas Hospital.

"Many times the premium salary is for the nurse at the bedside and not for the case manager. There is very little training for case managers so we tend to cycle the same case managers from job to job," she adds.

At South Ocean County Hospital in Manahawkin, NJ, the case management department offers a training program for in-house nurses who are interested in becoming per diem or relief case managers. The nurses attend training for two eight-hour days and work alongside a case manager. Then they fill in as case managers when a full-time case manager is on vacation or sick and some continue to work as bedside nurses as well.

As a result, when a case manager resigned recently, the department had several nurses within the hospital who applied for the full-time case management position.

"The nurses I've trained as per diem are experienced with good critical thinking skills. They've worked in the ICU or immediate care or telemetry and are right on top of what needs to be done. Our vacancy rate is not high and we're blessed with a float pool of full-time and part-time nurses," says Marilyn Butler, RN, MSN, CCM, director of case management.

At New York Hospital Queens, case managers are paid for their years of nursing experience and compensated as managers, which makes recruiting and retaining case managers easier, says Caroline Keane, director of case management.

Most of the case managers have been assistant nurse managers or nurse mangers within the building, she adds.

"Case managers need critical thinking and negotiation skills and it takes time for them to develop them," she adds.

Readers of Hospital Case Management tend to be older and more experienced nurses. Among respondents, more than 63% have 25 or more years of experience in health care, with 53% of respondents reporting that they have worked in case management for 10 years or longer.

The largest number of respondents (34%) report being in the 51-55 age bracket with nearly 78% older than 46.

That may be changing to the detriment of the profession, based on job descriptions in professional magazines, Mullahy reports.

"Case managers should have life experiences and clinical experiences that they don't get in a year or two on the job," she says.

As a case management consultant, B. K. Kizziar, RN-BC, CCM, CLP, owner of B.K. & Associates, a Southlake, TX, case management consulting firm, sees fewer younger nurses opting to go into case management; with shift differentials and overtime pay, they can make more remaining on the floor.

"Case management can still be a refuge for more experienced nurses who want a job that's not as physically demanding as working on the floor," she says.

Evening, weekend schedules now common

At one time, case management meant working Monday through Friday with no holiday or weekend work, Mullahy points out. Now, case managers are being called on to work evenings and weekends, making it a challenge to recruit case managers.

"Weekend and evening work is an issue and it will require that leaders develop the package for case managers in a different way. There will need to be some sort of perceived benefit for these new staff members. In addition, we compete in many areas where there are case managers, including insurance companies, workers' compensation organizations, and other levels of care," Cunningham says.

For instance, New York Hospital Queens has case managers and social workers on duty until 8 p.m. on weekdays and weekends.

The hospital has a staff of 23 case managers, which means they have weekend duty only 1½ weekends a year and receive compensatory time off during the week. Case managers who work until 8 p.m. on weekdays receive an evening differential.

"We have one social worker who works only weekends but when she's not available, the regular staff has to fill in," Keane says.

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