2003 Salary Survey Results

Creativity helps with CM recruitment, retention

Nursing shortage has intensified staffing problems

Each year, Covenant Health System in Knoxville, TN, has a "Case Management University" for nurses in the system who are interested in becoming case managers.

"The nurses who participate get basic education about case management and our model. When there is an opening, they have that certification," says Sandra Marshall, RN, MSN, senior vice president of organizational effectiveness/clinical outcomes for Covenant Health.

At Sarasota (FL) Memorial Hospital, the case management department has done such a good job of proving its value to hospital administration that a hospitalwide budget cut had minimal impact on case management.

"This is our biggest retention and recruitment strategy. We have been resourced well because we have performed well. Case managers who apply to the hospital are usually very excited about our staffing ratios," says Judy Milne, director of integrated case management and quality improvement at Sarasota Memorial.

Those are two examples of how case management departments are rising to meet the challenge of recruiting and retaining staff as the nursing shortage grows more acute.

Case management departments across the country face difficulties in finding experienced staff, reports Teresa Fugate, RN, BBA, CPHQ, CCM, manager at Pershing Yoakley & Associates, a Knoxville, TN-based health care consulting firm.

The problem is compounded by the fact that hospitals are offering nurses who work the floor incentives such as shorter shifts, sign-on bonuses, and higher pay but don’t offer the same benefits to case managers. Case managers put in long hours and now have to work weekends and possibly evenings to meet insurance company mandates, she adds.

Part of the reason for the differential is that hospital administrations on the whole have not understood the value that case management brings to the organization, Fugate adds.

That’s why case managers need to start collecting the data they need to show the value of the program.

"Hospital administrators are financially focused, and case managers should be showing how they can affect the bottom line. Until case managers start collecting the data they can use to show the value of their services, the nursing shortage can hurt their programs," she says.

According to Marshall, when she started working at her position at Covenant two years ago, she immediately tackled retention and recruitment of case managers.

"At the time, salaries for case managers weren’t what I expected them to be, nor did their responsibilities meet what needed to be met for that level of nursing practice," Marshall says.

She has required that her case managers be at an advanced practice level and become certified. When they meet those requirements, they get a significant pay increase, she adds.

Marshall got approval from the administration for increased pay for the case managers by showing the value that case management brings to the organization.

"We looked at length of stay and cost per case and were able to show that we got a low denial rate because of the case managers working closely with the utilization review staff," she says.

Because of the respect that case managers receive in the Covenant organization, staff nurses have been stepping forward and aspiring to be case managers, Marshall says.

The challenge is recruiting RN case managers who have experience in clinical case management and utilization review, Milne reports.

"We get a lot of applicants who have insurance case management experience but not hospital experience, and that is a different skill set," she adds.

Her hospital has created special pay incentives for bedside nurses since they are considered a critical need, a move that sometimes causes resentment among the case management staff.

"Nurse case managers don’t have to deal with infectious diseases. We don’t have to transport patients; we aren’t as likely to have to work on weekends and nights; and we don’t typically get tapped for overtime," she adds.

The case management department does have support from the hospital administration who realize the value the case managers bring to the hospital, she adds. For instance, the hospital has been ranked No. 1 in the country for Medicare efficiency, a rating largely due to the efforts of case management, she adds.