Case managers and other professionals who experience stress might suffer job dissatisfaction, depression, sleep problems, headaches, upset stomachs, and other health issues, according to the CDC.

Burnout and moral distress can affect how case managers perform their jobs, as well as how they confront ethical dilemmas.1 (More information is available at:

Among the most common stress factors for case managers are redundant paperwork, competing deadlines, staffing shortages, and lack of resources, says Dennis Fisher, MM, who retired at the end of 2018 as the program director for the Behavioral Health Training & Education Network in Philadelphia.

“I’ve done stress management training for 10 to 15 years, and I’ve compiled a list of stressors for case managers and case management supervisors,” Fisher says. (Find more information at:

Another stressor is working with populations experiencing serious physical or behavioral issues, he adds.

“There is the stress of not knowing what you’re walking into,” Fisher says. “This affects you physically, mentally, behaviorally — all the ways it plays out in life.”

Hospital leaders can be alert to this type of stress and encourage case managers to ask for help whenever they feel overwhelmed.

“Have case managers negotiate a deadline or maybe give them the authority to do a report in a different way that might save time,” Fisher suggests. “There’s not a magic bullet to reduce stress, but there are some common things that, if you put them into practice and get permission to put them into practice, can be key.”

There also are a number of proven stress reduction strategies that individual case managers can employ. Fisher suggests that overwhelmed case managers try these tactics:

• Self-care. “Get enough sleep — around seven hours a night. Get enough exercise, whether it’s walking or something more strenuous,” he says. “Try exercise that you can do three or four times a week for 20 to 30 minutes.”

Also, case managers should take time to relax every day and watch what they eat, Fisher says.

“Early in my career, when I was doing case management and case management supervision, I ate a lot of doughnuts because it was something portable,” Fisher says. “After I went to the doctor, who asked what I did for a living, I realized fruit was just as portable and better for me.”

Music therapy also is a way to relieve stress, says Fisher, who started his career as a music therapist.

Another self-care strategy is to find activities that balance one’s life. These might include a social network, religious faith, meditation, yoga, guided imagery, art, and listening to music.

“It helps to have a close friend or family member who you can vent to,” he says. “Somewhere down the line, you could return the favor when you’re less burned out than they are.”

Everyone also benefits from giving and receiving love and affection. “That might be unconditional love of a pet.”

• Exercise. People need exercise. It helps with stress, but it is a discipline that needs to be developed. By establishing a routine, someone could break through their desire to skip it and take that walk or run or bike ride.

“Schedule it. Block out times you can do it. Let other people be responsible for what they can be responsible for, so you can exercise,” Fisher says.

“You can always justify taking time to exercise by telling [loved ones], ‘I can give you better quality time if I’m less stressed out.’”

Exercise is part of that balance. A case manager who spends a portion of the day at a desk can balance out that time with 20 to 30 minutes of rigorous activity, he says. “If I’m sitting at a desk all day, I make sure I get physical activity.”

• Positive self-talk. “Have a mantra you can say to yourself. It should be something you can remember and chant,” Fisher says. “It should be something that brings you back when you are in the middle of a conflict situation.”

Someone might choose to say or think, “Love, joy, peace, patients, kindness, goodness, faithfulness, gentleness, self-control,” he says.

Positive self-talk is possible when someone is calm, so take deep breaths and make sure there’s time for progressive relaxation, Fisher advises.

“Tense your muscles. Then do deep breathing, releasing the tension. Flex muscles and let go,” he says. “Time breathing with it.”

Most important, take five minutes at the beginning of the day to walk around the building while engaging in positive self-talk.

“Don’t look at your phone while you do this,” Fisher says.


  1. Sortedahl C, Mottern N, Campagna V. Case managers on the front lines of ethical dilemmas: advocacy, autonomy, and preventing case manager burnout. Prof Case Manag. 2018;23(1):4-9.