Case managers are combatting stress, compassion fatigue, and burnout on several fronts as the COVID-19 pandemic surges across many parts of the United States.

They are fighting to help patients and families at a time when hospital resources are strained and care transitions are challenging. They are fighting their own grief as more patients die. They are combatting misinformation online and in person as anti-vaccine and anti-mask patients make their views loud and clear.

“It’s frustrating the healthcare system that good people, who did not take the vaccine, got sick. Doctors realize they would have taken the vaccine if the information got to them in the right way,” says Hariharan Regunath, MD, FACP, FIDSA, assistant professor of clinical medicine and medical director of the progressive care unit at University of Missouri Health Care (MUHC). “I [treated] a farmer, who was admitted and on oxygen. I asked him if we had the opportunity to rewind time a few weeks and he had known he would get COVID-19 if he would have taken the vaccine.”

The farmer said he would have taken the vaccine. “I asked him why he didn’t take the vaccine, and he said that he doesn’t even give his animals a vaccine that is not approved by the FDA, so why would he take one,” Regunath recalls. “We did not offer him the opportunity for clarifying that millions have had the vaccine, and the data are here; the message has been muted.”

Empathy for patients — even those who made a mistake and ended up in a hospital bed — can help case managers survive the frustrating pandemic weeks and months.

“I just rely on empathy — putting myself in their shoes and trying to look at things from their perspective,” says Nada Fadul, MD, assistant dean for diversity, equity, and inclusion education programs and associate professor of infectious diseases at the University of Nebraska Medical Center. “I ask more questions before coming to judgment. When I see a patient, for example, who is absolutely resistant to getting vaccinated, I ask them why that’s the case.”

Then, Fadul says, “I hear your decision, and just want to understand.”

Her view is that it is not their fault because they are influenced by the media and others. “It’s important to embrace empathy for patients because that’s why we came into this job in the first place,” she says. “Expressing that empathy is very important because it builds that trust.”

Healthcare professionals miss opportunities to connect with people and help them change their perspective if they do not show empathy for their patients. “If we say, ‘He’s just an anti-vaxxer’ and move on, we’ve lost an opportunity to make a difference in someone’s life,” Fadul says.

Case managers and others can cope with the continuing pandemic and its uncertainty with these tactics:

Find a safe space. Healthcare workers need a safe space where they can express their feelings without feeling judged.

“You can have a huddle or brief meeting after a difficult situation,” Fadul suggests. “What’s happening right now is people are running from one thing to another and not having that time [to process]. They’re harboring feelings inside.”

Huddles and safe spaces are critical for healthcare staff so they can express frustration before they burn out, Fadul adds.

Accept unreasonable conditions. The pandemic’s effect on hospitals and employees is not fair or reasonable. Hospitals that could celebrate their quick actions and tactics for getting though the pre-vaccine period now find themselves in a worse situation through no fault of their own.

Researchers recently found frontline healthcare workers reported feeling more anxious, overwhelmed, that they were not sleeping, and that they feared death in 2020. At the same time, they mostly believed their administration was supportive.1

It helps when employees trust their employer is doing its best, even when the work environment is unreasonably overwhelming and stressful.

“We have seen waves when healthcare systems have been overwhelmed, and hospital census goes up,” Regunath says. “When the census increases by 50%, it stresses our hospital system, doctors, and nurses.”

Hospital employees are used to surges in patient populations in the winter during flu season, but those usually end by spring. With COVID-19, there is no way to predict how long a surge will last. They know how to cope with intermittent stress, but are finding it burdensome to accept the pandemic stress, which is lasting for months.

It is hard to accept unreasonable conditions. “It took me a while to come to this point. I was constantly in a fight mode,” Fadul says. “But that approach did not work at all, so I said, ‘Let me see what else might be done.’”

Fadul’s acceptance of the pandemic’s resurgence and patients who have not been vaccinated has made it easier for her to cope with the situation. “I’m not here to plug the ocean, just here to take care of my patients and do what’s best for them,” she explains. “Expressing empathy for the patient is very rewarding to do, and it helps us cope with the situation.”

Offer/accept support. MUHC offers a program called the For You Team that supports physicians, nurses, and other providers who believe they cannot move past lingering stress related to patient care or issues.

“For example, we had a young adult patient who was working [in an industrial building] and didn’t know there was carbon monoxide in the closed room. He had very young kids. He came into our ICU,” Regunath recalls. “The man died, and the nurse caring for that patient and my entire team were all very emotionally affected by that situation; it stuck on our hearts for a while.” The For You Team met with the providers and offered them counseling and support.

During COVID-19 surges, the For You Team helps staff find positive moments in their experience. Anyone can ask the support team for help for themselves or for a colleague. “I can say, ‘I think he needs help, so can you reach out to see if he’s doing OK?’” Regunath says.


  1. Maduke T, Dorroh J, Bhat A, et al. Are we coping well with COVID-19?: A study on its psycho-social impact on front-line healthcare workers. Mo Med 2021;118:55-62.