Ethical dilemmas may create an occupational hazard for the case management workforce
The day-in-day-out dealing with ethical dilemmas creates an occupational hazard for the workforce. Case managers spend their days juggling unlimited balls of clinical and organizational ethics, professional ethics, and personal values. Our heads spin with feeling forced to factor in so many potentially competing priorities. We usually know the right action to take but feel constrained in taking it. This dynamic is known as moral distress. Ultimately, the high levels of stress from these efforts can take their toll on even the most experienced case manager. Burnout can set in, as well as workforce trauma in some instances.
Reality
Case managers often feel pressured to prioritize their ethical responsibilities to each client, each family, and the employer. Factoring in our own perspective is also critical but may feel unimportant. What may present as the best decision for the client or their family members may be costly for an organization. For example, you are case managing a client with a Managed Medicare plan admitted to the hospital for pneumonia. While implementing the discharge plan, there’s a glitch: The client’s respiratory company is no longer contracted to be in network for the insurance company. However, neither the client nor his family will allow you to contact any other provider. You call the managed care organization (MCO) case manager to obtain out-of-network approval, which she agrees to do. However, the process takes an extra day, longer than anyone expects. The physician is pushing to write the discharge order because the client finally has a white count within normal limits and a temperature of 98.9°F. You strive to balance client and family autonomy, as well as organizational pressures, to effect a timely discharge without incurring variances or extra costs. It can feel impossible to keep each ethical ball in the air without worrying one will drop at any moment.
Management
The ability to take charge of moral distress is critical to case manager wellness and long-term sustainability in the workforce. Obtaining support and validation from colleagues and mentors will empower your efforts.
For more information, see The Essential Guide to Interprofessional Ethics in Healthcare Case Management.