Freedom keeps CMs happy in job

More autonomy means less stress

Case management directors wanting accurate evaluations of overall job satisfaction among case management staff should look at control over practice, job stress, and work satisfaction, say nurse researchers who measured satisfaction among acute care and community-based case management models.

Results from the comparison can enlighten case management professionals on ways to make their jobs more satisfactory and less stressful, says Rose Gerber, PhD, RN, associate professor of nursing at the University of Arizona in Tucson and co-author of the study.1

"Having some control over the way your practice is directed helps for better coordination and for increased satisfaction of all those involved," adds Ann Lancero, MS, RN, nurse case manager at Carondelet Health Care in Tucson, one of the facilities participating in the study.

Consider simple strategies

Gerber and Lancero say case managers and directors should take proactive steps to reduce stress and improve satisfaction by considering, for example, such simple strategies as the following:

* Consider flextime to allow more autonomy.

Many facilities' administrators are realizing the benefits of allowing their case managers to set their own schedules as their caseloads dictate. Flextime is one way to give case managers the autonomy they need.

In fact, Gerber says job satisfaction may be greater for beyond-the-walls model managers simply due to the work environment, which typically includes flextime. "These case managers practice very independently, whereas those in the hospital are still really functioning as part of a team, even though I don't think all case management jobs necessarily allow that much more autonomy " she says. The two models studied allow for a "fair amount" of autonomy, Gerber adds.

Create an open environment

* Include case managers in committees, group meetings, and research teams.

Although autonomy is important to increasing job satisfaction, it is also important that case managers continue to feel that they are an important part of the organization and that their feedback is meaningful. Create an environment where "everyone is able to be open and share with one another in visions and goals," Lancero says. "For instance, in working on a vision and a goal for our group practice here at Carondelet, we are all asked to give feedback and ideas."

The case managers are free to form and join committees within the organization to give their perspectives and feedback on various projects. "We are not mandated what we should do, but rather are asked how we feel about [various issues]. That really helps," says Lancero, co-author of the study.

* Ensure documentation reflects case managers' impact on the care process.

Although many case managers may feel as though documentation comprises a large part of their daily jobs, much of a case manager's direct influence on a patient's care is not documented, Gerber says.

"It is difficult to document some of the less tangible pieces of the job," observes Gerber. "Really looking for the hard figures to document what it is that we as case managers do becomes very difficult. You can establish a long-term caring relationship with a client that may very well keep him out of the hospital, but it's hard to document that that patient would have been in the hospital if you hadn't been in there working with him."

* Encourage further education.

The more education case managers have, the better equipped the case managers are to handle stress, Gerber says. Continuing education efforts can ensure case managers stay on top of their jobs.

"The other area that we really couldn't get a handle on was the educational differences [among case managers]," Gerber says about her research efforts. "This is an area that needs to be looked at more carefully because there were statistically significant differences between the two groups. The within-the-walls group had less education than the beyond-the-walls group. We cannot, with this particular study, relate [the findings] to education, but that was the one big difference between the two groups."


1. Gerber RM, Lancero AW. Comparing work satisfaction in two case management models. Nursing Management 1995; 26(11):45-48. *