By Christina Sanchez, LCSW

Imagine a case manager wrapping up their day, feeling inundated with paperwork, pending calls, and the looming responsibilities of their evening routine with family. Does this scenario sound familiar? Research indicates that healthcare workers frequently experience feelings of being overworked and burned out (The 2024 NAMI Workplace Mental Health Poll, www.nami.org). While many know that self-care is the solution, the ideas often center around activities such as exercise, meditation, nutrition, or doctor appointments. Amidst the multitude of personal and professional demands, our focus should be on returning to the basics of setting boundaries. 

What are boundaries?  

As healthcare clinicians, we must establish boundaries across various settings and roles. Take a moment to do a quick internet search with "boundaries," "case manager" and "healthcare worker."  Like I did, are you finding an abundance of articles, references, and resources for setting personal boundaries in a professional setting?  Many of the articles emphasize the importance of setting boundaries, especially encompassing physical, behavioral, and professional aspects: 

• Physical boundaries: protecting your personal space and safety may include limiting contact or touch. 
• Behavioral boundaries: determining how time is spent, information is shared, emotions expressed, and connections made with others. 
• Professional boundaries: showing professional conduct, self-disclosure practices, integrity modeling, time management, and role-related tasks.  

Boundaries are limitations that can evoke different feelings depending on the individual and the situation. As a social worker and social scientist, Brené Brown asserts in her book Dare to Lead, "Clear is Kind. Unclear is unkind." Boundaries establish expectations and provide a sense of control, particularly in unpredictable circumstances. 

Why is it hard to set boundaries? 

Take a moment to reflect on your classroom learning and discussions on setting boundaries. What themes stand out to you? For me, these include themes such as maintaining work and life balance, exercising caution and awareness with self-disclosure when building rapport and supporting the client, and learning to say no. Do these sound familiar? My guess is that these themes may resonate with your experience. 

In today's work environment, when boundaries are needed, a few new considerations make it hard to set those boundaries.  In my current role, I listen to numerous nurse and social work case managers across the country in various roles.  Some of the themes that I've heard and observed that challenge our boundary setting include: 

• Connecting with others: The COVID-19 pandemic has heightened awareness of the importance of connections, whether virtual or in person, and the prevalence of issues like isolation and loneliness. 
• Speaking up and using your voice: With a broadened focus on diversity, equity, and inclusion, there is a societal and professional shift towards authenticity and vulnerability, along with a desire for transparency in decision-making.  
• Changing work dynamics: Many organizations have adopted new work styles, such as remote or blended work, and increased reliance on technology, leading to higher productivity expectations and workloads. The need to be more efficient with resources and day-to-day work is prevalent. 
• Addressing mental health needs: There's a growing recognition of the importance of addressing mental health care needs, whether for oneself, family members, teammates, or those served. According to the 2024 NAMI Workplace Mental Health Poll, "Employees who are less comfortable talking about their mental health at work are more likely to report feeling burnout and their mental health suffering because of work." 

What are three easy steps for setting up boundaries? 

Despite the challenges healthcare professionals face, it's crucial to prioritize solutions within our control, such as setting boundaries. It's up to us to find the right solutions to be able to "focus on the things that you can control."   

There are many resources to support us with setting boundaries. As case managers, we already have the tools needed! Here are three simple steps to get started with setting boundaries: 

1. Permission: Permit yourself to establish boundaries. Before planning to address the areas of opportunities for boundaries, acknowledge that it's acceptable to say no and commit to setting boundaries, understanding that you can't control others' reactions. This may be a challenge, but you can commit to it. 

1. Self-Assessment. Identify the boundaries by considering your physical, behavioral, and professional needs. Determine where you can best protect your time, energy, and resources. Ask yourself, "Where is my biggest area of opportunity?" 

Make a Plan:

1. Utilize your skills as a case manager to create an action plan.
2. Set SMART goals—Specific, Measurable, Achievable, Relevant, and Time-Bound—to ensure you follow your plan.
3. Consider having an accountability buddy to support you through this plan. 

While the cliché statement about self-care: "If you don't take care of yourself, you can't take care of others," may be true, finding an effective and successful self-care path can be challenging. If you are stuck with figuring out your self-care path or have tried self-care techniques but still feel burnout and overwhelmed, consider permitting yourself to have personal and professional boundaries, digging into your toolkit as a case manager, and getting back to the basics to set a commitment to build and uphold those boundaries. 

Secure your spot today for #CMSA2024, the case management event of the year! https://cmsa.societyconference.com/ Don't miss out on unparalleled education and networking opportunities. With 75+ CEs offered covering diverse topics and practice settings, this is your chance to elevate your skills and connect with industry leaders. Take your career to new heights, June 4-7, in Providence, RI!

References :

• Mental Health of America, Setting Boundaries as a Health Care Worker (2020): https://mhanational.org/setting-boundaries-health-care-worker 
• National Council of State Boards of Nursing, Nurses Guide to Setting Boundaries (2018): https://www.ncsbn.org/public-files/ProfessionalBoundaries_Complete.pdf 
• National Association of Social Workers, Standards for Social Work Case Management (2013): https://www.socialworkers.org/Practice/NASW-Practice-Standards-Guidelines/NASW-Standards-for-Social-Work-Case-Management  
• National Alliance on Mental Illness, The 2024 NAMI Workplace Mental Health Poll (2024): The 2024 NAMI Workplace Mental Health Poll | NAMI: National Alliance on Mental Illness 
• Brown, B. (2018, October 15), Clear Is Kind. Unclear Is Unkind. https://brenebrown.com/articles/2018/10/15/clear-is-kind-unclear-is-unkind/  

Bio: Christina Sanchez, LCSW is a healthcare professional with 20 years of experience. As a Clinical Strategy and Practice Lead within the Chief Nursing Organization at Humana, she has practiced within a variety of roles to include clinical, management and strategy.