The Great Exodus Hitting Case Management

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 who continue to work at the hospital as employees versus those who leave for traveler jobs. The jokes flooded about pizza parties and candy rewards as support for employee engagement.


Although the social post was tongue-in-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, the ability to work from home, better benefits and higher pay. However, for staff who 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 they work side-by-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 remotely, 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 employees, while retaining their existing employees, have an advantage for those choosing to stay in healthcare. For example, in September, Washington-based Providence Healthcare announced an investment of $220 million to retain and obtain new healthcare employees. Their offerings include higher wages, sign-on bonuses, greater benefits and supports for per diem and part-time staff (Muoio, 2021). It used to be that they were competing against the hospital down the street; now they 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, it simply put an ad in the paper or online and things just happened. We did not really pay attention to the how, the 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.


There are books and lectures on the importance of the first impression and how lasting that first impression truly is. 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 bonuses, relocation and sweetening benefit packages, we have delayed or received no responses to resumes, antiquated online applications and less-than-warm first contact. Let’s review the department’s 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, CNAs, 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 with regard 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 are low scoring. This may be a great time to consider staff-led initiatives to address those items that they feel they are missing, such as education. Consider the investment in money toward 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 have everyone working at the top of their 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 who 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 being a 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.

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 placed in an oncology unit. Not only will these individuals 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 need to show our employees that we will 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 depends 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.

tiffany ferguson

Tiffany Ferguson, LMSW, CMAC, ACM, is CEO of Phoenix Medical Management, Inc., a care management company. Tiffany serves on the board for Northern Arizona Gerontology Association and the American College of Physician Advisors (ACPA) Observation Subcommittee. Tiffany is a regular contributor to RACmonitor, Case Management Monthly, and commentator for Finally Friday. After practicing as a hospital social worker, she went on to serve as director of community case management and quickly assumed responsibilities in system-level leadership roles for health and care management and c-level responsibility for a large employed medical group, which included value-based arrangements, PCMH and outpatient care management. Tiffany is a graduate of Northern Arizona University and received her MSW at UCLA. She is a licensed social worker, ACM and CMAC certified.
marianne dimola

Marianne DiMola has more than 25 years of experience in healthcare human resources management and career development.

Marianne is the president and founder of Global Care Management, specialist in care management staffing and consulting.




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