The Great Exodus is Hitting Case Management

by Tiffany Ferguson, LMSW, CMAC, ACM & Marianne DiMola
Published on Jan 06, 2022

During COVID we saw that hospitals were not only full of patients but there were also empty beds, because of limited staff to handle the capacity. Now, is not the time to revert to our pre-COVID ways.

A nurse at my local hospital posted on social media, asking if anyone would be willing to house her and her four children so she could be a traveler nurse. The replies came flooding from colleagues and friends, including those in case management, which highlighted the discrepancy in pay and support for nurses that continue to work at the hospital as employees’ verse those who leave for traveler jobs. The jokes flooded about pizza parties and candy rewards as support for employee engagement.

A staff pizza party is not enough!

Although the social post was tongue and cheek, the national evidence of short-staffed departments across the country is evident. Nurses, social workers, therapists, advanced practice providers, etc. are leaving in droves for a better opportunity that offers flexibility, ability to work from home, better benefits, and higher pay. However, for the staff that are unable to leave their current employer because of personal circumstances, disengagement is at new levels with burnout associated with the ongoing pandemic and subsequently working short staffed for less pay, while you work side-side with travelers making twice as much.

A common metric for hospital departments is to decrease contract labor, however this metric has only exacerbated and highlighted a growing organizational shift. Pre-COVID, a focus on contract labor was a metric for individual departments to evaluate budgeted cost and to encourage a focus on staff retention and engagement.

Similar problems are hitting the care management department as nurses and social workers have the open opportunity to work remote, join traveler engagements, or leave for higher wages and better benefits. The market is open season and the hospitals and companies that have figured out how to invest in new and retain existing employees have an advantage for those choosing to stay in healthcare. Such as Washington-based Providence Healthcare that announced in September an investment of $220 million to retain and obtain new healthcare employees. There offerings include, higher wages, sign on bonus, greater benefits and supports for per diem and part-time staff (Muoio, 2021). It used to be that you were competing against the hospital down the street, now you are also competing with top employers around the country who are willing to adapt with better options to support and bring in talent.

Once upon a time when a company needed to hire, they simply put an ad in the paper or online and things just happened. We did not really pay attention to the how or when or the why. Someone, someday got hired. And then came COVID. Hiring is no longer something that we just do. Now there must be a strategic thought process in place to attract the best talent and retain them. The quicker we understand this, the better and faster we will hire.

So, what can we do?

There are books and lectures on the importance of the first impression and how lasting that first impression truly is. And yet sadly, the first point of contact can be frustrating, abrupt and at times antagonistic. Even as we have facilities offering $20,000 sign up bonusses, relocation and sweetening benefit packages, we have delayed or no response to resumes, antiquated online applications and less than warm first contact. Let’s review the departments goals and break down the process and ways to improve the initial contact.

Often in facilities human resources are recruiting for everything from doctors to mail clerks, CNA's, bedside nurses, anesthesiologists, and RN/SW case managers. While, so many are fighting for so few, maybe it's time to consider a Recruiting Process Outsourcing (RPO) firm for some of the more specialized positions such as nurse case managers, CDI, and appeals & denials. While working so many jobs it may be difficult for human resources to have a strong network. An RPO specializing in niche positions may be a better option. By making the right investment up front for top talent you are ensuring a successful team, patient experience, and revenue cycle.

Invest in your staff! Take the time to listen to what they need to feel supported and invested in as regards to staff support and engagement. Review your responses from your annual employee engagement survey and break down the details with your team on areas that were low scoring. This may be a great time to consider staff lead initiatives to bring address those items that they feel they are missing such as education. Consider the investment in money towards conferences, organizations, virtual in-services, and seminars, they will appreciate their employer and patients will benefit.

Internally, the case management department can also alleviate the burden of working short staffed by taking this time to reimagine department functions. Break down the jobs and think about what can be absorbed and what could be replaced with a different level of employees for support. Not every job has to be completed by an RN or a social worker. Evaluate job duties to having everyone work to top of licensure and then filling in the other needs with supportive labor to help alleviate the burden of staff overtime and high caseloads.

Care management should consider the needs of the department and staff that are looking to move up in their career. What are the opportunities for lateral and vertical movement in the organization or department? When nurses start working at the bedside, there is a career path for them. That career path often leads to charge nurse, DON or CNO. Consider how a similar path can be created in the organization for nurses looking at the business side of healthcare in revenue cycle, UR, or CM, or even informatics and CDI[T1] .

Staffing shortages can lead to desperation but please do not resort to poor hiring practices. We all know the skillset we are looking for in a nurse case manager, med-surg, critical care or telemetry bedside experience and good computer skills. Historically when there is a shortage, we have seen nurses with limited to no bedside experience thrown on an oncology unit. Not only will this individual need additional training, but the current employees will most likely feel undervalued and burdened. Any choice in hiring will still require the initial investment of proper training to ensure they are set up to succeed.

During COVID we saw that hospitals were not only full of patients but there were also empty beds, because of limited staff to handle the capacity. Now, is not the time to revert to our pre-COVID ways. We should acknowledge those who stayed in the healthcare environment through multiple COVID waves, vaccine protests, mask mandates, and political unrest. We need to be as competitive in our retention benefits as we are in hiring. We show our employees that we always value them as they continue to show up every day, on time, to care for the sick. We should consider how we can support and encourage those who are entering the field of healthcare and provide additional on the job education and guidance for success. The quality of our healthcare system is dependent on staff continuing to show up prepared and supported to offer safe care to our communities and patients.





Muoio, D. Fierce Healthcare Providence Invests $220 million to bolster, retain workforce amid nationwide labor shortage. September 2021.