2006 Salary Survey Results
Salaries are rising, but so are the hours case managers work
Nursing shortage, night and weekend work present challenges
Salaries for case managers are increasing, but the vast majority of case managers are working far more than the traditional 40-hour week, according to respondents to the 2006 Hospital Case Management Salary Survey.
The 2006 Salary Survey was mailed to readers of Hospital Case Management in the June issue. More than half the respondents (55%) were case management directors. Other respondents were case managers, utilization managers, social workers, or had other titles.
Recruiting challenges
Respondents to the survey report putting in long hours. In fact, almost 89% report working more than 40 hours a week, with 26% working more than 50 hours a week.
At the same time, salaries are on the increase, but raises are not as big as in the past. In this year's survey 84% of respondents reported an increase in salary during the past year, down from 89% in 2005.
The highest percentage (50%) reported getting a 1% to 3% raise, followed by 23% whose salary increases were between 4% and 6%. More than 11% reported a salary increase of 7% or more. Just more than 16% reported no change in salary over the past year compared with 2005 when only 11% of respondents reported no increase or a decrease in salary.
About 73% of respondents to the survey report salaries in the $60,000 to $99,000 range, with more than 11% reporting salaries in excess of $100,000 and 17% reporting pay of $60,000 or less.
The current nursing shortage presents two challenges to many case management directors when it comes to recruiting qualified case managers, says Beverly Cunningham, RN, MS, director of case management at Medical City Dallas Hospital.
First, there are fewer nurses available in today's job market.
At the same time, many hospitals are paying sign-on bonuses and higher hourly rates for critical positions, such as bedside staff nurses. Often, a case manager is not seen as a "critical position," Cunningham points out.
In some hospitals, due to the nursing shortage, clinical nurses also may receive incentive bonuses throughout their employment. They are paid hourly and get overtime, points out B.K. Kizziar, RNC, CCM, CLP, owner of B.K. & Associates, a Southlake, TX, case management consulting firm.
"When I'm talking with bedside nurses about changing to case management, there are also the issues of the weekend and after-hours additional pay that bedside nurses receive. That's a challenge for nurses when they can't afford a pay cut but are ready for a change," Cunningham says.
On the other hand, case managers have some flexibility to be away to take care of personal business during the workday as long as their work gets done, which makes the job desirable for many people, Kizziar says.
She expressed concern that many hospitals do not provide a sliding pay scale for case managers who have achieved certification and, in many cases, case managers are not reimbursed for all the fees involved with gaining certification.
"It's disappointing that all the work that goes into achieving certification is not rewarded by employers," Kizziar says.
In some hospitals, the nursing shortage has prompted hospitals to raise nursing pay levels overall, bringing case management salaries along with them.
That's the case at St. Vincent's Hospital in Jacksonville, FL, where case managers are paid at the save level as an assistant nurse manager, according to Jamie Zachary, LCSW, director of case management.
"The nursing shortage has affected staffing at the bedside, but I find that experienced bedside nurses want to transition to work that is not as physically demanding," she says.
At the hospitals where Kizziar consults, she has observed that the nursing shortage has had more of an effect on bedside nursing positions than case management positions.
"Case managers tend to be experienced nurses who are seeking something beyond clinical work, and that may contribute to the fact that there are less practicing nurses," Kizziar says.
In fact, nearly 71% of respondents to the Hospital Case Management survey report having been in health care for 22 years or more. Fully 55% have been in health care more than 25 years. Only 6.5% have 10 years or less experience in the health care field.
Rural case management
Case management directors in rural areas face the challenge of finding experienced case managers.
"The case managers at LGMC are all nurses, but not all bedside nurses have the skills and experience to be case managers," says Lyn Clark, RN, BSN, director of case management at Granbury (TX) Medical Center, a 59-bed facility.
The hospital pays bedside nurses higher salaries than case managers and cuts down on the case management positions when the census is low.
It used to be that case management positions were desirable because case managers worked just five days a week, but in recent years, case managers have been called on to work evenings and weekends.
At LGMC, the case management department provides seven-days-a-week coverage with two FTEs split into three positions. Two case managers work four days a week. The other works two days. Between them, they provide coverage 10 hours a day.
"Most do not want to work weekends or evenings, but we try to rotate the shifts around in a fair manner," Clark says.
The situation is different at St. Vincent's Hospital and Medical City Dallas Hospital, where weekend positions are filled by special staff.
"I hire special staff for weekends, and that makes my regular staff much more satisfied," Cunningham says.
At St. Vincent's, weekday positions are filled by full-time salaried staff, with part-time staff working in evenings and on weekends.
"We have two distinct positions, so the nurses who apply generally want those hours and days," Zachary says.
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