The Ethical Case for Case Manager Self-Care

You take the complex case because your colleague doesn’t have your experience. You stay a half hour longer to ensure the clinical team understands the client’s emotional state. Being a case manager sometimes means sacrificing personal time and expending emotional capital for the greater good. 

You also navigate rough waters when the client and family don’t agree on the next steps for care, compassionately championing the client’s wishes—even when you don’t agree with the client. 

Case managers bring their own sense of right and wrong to work daily, but often, there isn’t a single “right” way to approach a complex situation. The Code of Professional Conduct for Case Managers includes principles for addressing these tough cases: we set aside our feelings and put the interests of others above our own. We respect the rights and dignity of our clients and follow their lead.¹ 

You do all these things to live the principle to “act with integrity and fidelity with clients and others.” However, long hours and emotional conflicts can lead to physical and mental distress. 

We are all human; if we don’t rest, exercise, and manage our moral stress, it takes a toll on our health and well-being. Research demonstrates that burnout among nurses, doctors, and other professionals in health care settings is often tied to unaddressed moral suffering, defined as “the anguish that caregivers experience in response to various forms of moral adversity, such as moral harms, wrongs or failures, or unrelieved moral stress, that in some way imperil integrity.”²

There is, additionally, an ethical case for self-care. Exacerbated by long hours and heavy workloads, burnout itself carries serious risks for patient safety.³ Research shows that cultivating moral resilience builds back moral integrity, which creates a safer environment for our clients, our families, and ourselves.⁴

The Commission for Case Manager Certification recently published an ethics webinar on “taking care” of the case manager. Presenter Katherine Brown-Saltzman, a co-founder of the UCLA Ethics Center, makes the direct connection between self-care as a means to alleviate moral distress and the impact ethical concerns can have on case managers. Brown-Saltzman outlined practical ways case managers can prevent moral distress and enable moral resiliency.

Adequate rest, a healthy diet, and exercise provide the basic building blocks to support health and well-being. Identifying a friend, counselor, or mentor who can act as your sounding board or help you blow off steam is also essential. Organizational or procedural solutions may be needed if the same ethical issue arises frequently. Brown-Saltzman champions the value of building a moral community with shared advocacy, a foundation for collaboratively addressing systemic issues, and creating an ethical environment.

In addition to this webinar, the Commission’s CMLearning Network offers a number of resources to help case managers reduce stress, alleviate moral suffering, and build resiliency. A selection includes: 

• The Push Pause video series encourages case managers to take a breath and pause during challenging moments to reflect and re-energize. 

• On-demand webinar, “How can Social Connection and Community Impact the Health of our Clients?”  

• Issue brief and webinar, “Cultivating moral resilience: Balancing heart and mind for a better practice and better you” 

• Issue brief and webinar, “Burnout care: Where’s your care plan? It’s time to heal ourselves—and each other.”  

• Issue brief, “Baby steps: Enhancing your well-being—and that of your clients—is easier than you think.” 

• Issue brief, “Build Resilience Personally and Professionally: Seven Strategies for Case Managers” 

• On-demand webinar: “How to Build Your Well-Being to Thrive.” 

As case managers, we must answer the ethical call for self-care; performing at our best means recognizing the need to exercise our resilience muscles. For organizations, the ethical path is to build an environment that supports physical, mental, and emotional health needs. For every moment of moral distress, we must acknowledge its impact on our well-being. The Commission is committed to providing tools and resources for case managers to address small setbacks before they accumulate and become overwhelming.