Reader survey: CMs remain dedicated to field
Survey shows case managers are satisfied
Nearly 70% of hospital case managers responding to a recent survey conducted by Hospital Case Management report little or no opportunity for growth in their current facility. Despite what would be considered a bleak future in other fields, 57% of respondents intend to remain in their current position indefinitely. Only 10% say they would leave now, while 62% say they will work in case management as long as positions are available.
If those figures don’t prove case managers are committed to their careers, consider that 38% of respondents are satisfied with their jobs and 50% are somewhat satisfied. Only .7% are "very dissatisfied" with their jobs.
"In what other job would that be the case?" asks Sandra Lowery, RN, BSN, CCM, CRRN, president of the Case Management Society of America and an independent case manager with CCMI Associates in Francestown, NH. "This is one of those jobs that I can’t believe they pay me to do. It is that rewarding."
Her colleagues seem to agree, saying while there is some burnout associated with the position, their futures remain in case management.
"That’s how satisfying the job is," says Lowery. "It provides an opportunity to apply what you have learned in an academic setting and have never been able to apply in a practice setting.
"I think because our future will require that health care and business be combined in terms of a conceptual framework, case management is a golden opportunity to be able to learn and apply business skills to health care."
Case managers perceive the profession as a challenging and rewarding field that gives them the opportunity to broaden their base of contacts and level of interactivity, rather than working exclusively with a hospital team.
And while there’s a certain level of satisfaction in working with patients, families, physicians, and nursing staff, Lowery says much of the fulfillment comes from identifying a patient’s needs, matching resources, and seeing the outcome.
"You look at the big picture in terms of continuum of care and the holistic approach," she says.
Denise Kress, MS, RNC, CRNN, director of case management at Winchester (MA) Hospital, says when she began her career as a nurse many years ago, the field was very different, but oddly enough, some of the tasks can be applied to case management today.
"Patients were admitted, assigned to a nurse, and the nurse took care of the patients for their entire stay," says Kress. "You developed the plan of care and you made sure on the off-shift that others were following through. You were the person the patient, the physician, the family — everybody — knew was responsible for that patient. It was a totally different level of satisfaction."
But because of managed care, cost reductions resulting from the Balanced Budget Act, a shortage of nurses, and a variety of other reasons, there’s been a reduction in the number of licensed practitioners taking care of patients. Few facilities have been able to maintain primary care nursing, especially because more nurses’ aides are providing primary care, so nurses aren’t having contact with patients the way they used to. And caring for the patient is one element that attracts certain personalities to nursing.
"I think it is satisfying to be able to do something with the patients and their families, especially when you work with an elderly population," Kress said. "You are really able to hear what their needs, desires, and dreams are, and you try to see if you can set a safe or good plan that meets their needs and gets them what they want so they can reach their goals."
That’s not to say that all case managers are nurses who have wanted to move on. However, in hospitals, case management does require nursing skills, and nurses are more likely to make the transformation. Generally, the reasons for the change are job dissatisfaction in clinical practice, long hours, the higher intensity of care required these days, and concerns of legal liability with increased caseloads, Lowery says.
Wearing beepers, working weekends
"They think they will work normal hours in case management, but we are finding that’s not necessarily the case in hospitals," Lowery says. "Case managers are now starting to wear beepers and having to work weekends and after hours, so it isn’t quite what it was — an 8-to-5 job."
According to the survey, 58% of HCM readers work 41 to 50 hours a week, while 20% work 51 to 60 hours each week. Regarding their workload, 33% of respondents said they handle 21 to 25 cases, 25% handle 16 to 20 cases, and 24% have 26 to 30 at any given time.
The bulk of respondents — almost 58% — earn between $40,000 to $60,000 a year, with 30% earning $40,000 to $50,000, and 27% earning $50,000 to $60,000. Nineteen percent of respondents say they earn $60,000 to $70,000 annually. (Complete results from HCM’s annual salary survey will be available in the November 2000 issue.)
"It appears that there is parity in salary levels, which is what we’ve found to be the case in hospitals," Lowery says. "If those folks went outside the hospital, they wouldn’t make as much money, but salaries are going up because of supply and demand. Certified case managers in populated areas are in demand. They are definitely in a seller’s market."
Regarding education and certification, Lowery says you don’t have to be certified to practice, but you must practice to earn certification. She says it is rare for a hospital to require a master’s degree, and in many cases a bachelor’s degree is not required. According to the survey, 12.3% of respondents hold an associate’s degree, LPN, or 2-3 year degree; 40.6% hold a bachelor’s of nursing or RN; 29% have a master’s degree; 2.9% have an advanced practice nursing degree; and 15.2% hold other degrees.
In terms of data, Lowery says all indicators show case management is a growing field.
"Everything we are seeing in terms of increased education programs, both academic and continuing, the growth in publications that support the practice, and the growth in the professional society show there is a future for case management," says Lowery.
For more information, contact:
Sandra L. Lowery, RN, BSN, CCM, CRRN, president, Case Management Society of America; independent case manager, CCMI Associates, Francestown, NH. Telephone: (603) 547-2245.
Denise Kress, MS, RNC, CRNN, director of case management, Winchester (MA) Hospital. Telephone: (781) 756-4760.
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