The Controversial Move That Fights Care Manager Burnout

Reading Time: 5 minutes 

If you are a Patient Care Manager, you must eliminate unneeded stress from your life in order to be effective at your job.

“But Mari,” you’re thinking, “You don’t understand! I have people who need me!” “Things would fall apart if I wasn’t here!” 

The Two Types of Stress 

I teach my psychotherapy clients that there are two types of stress: Necessary Stress and Unnecessary Stress. 

Necessary Stress includes:

  • Legal, ethical, administrative and clinical job requirements
  • Anything you are legally required to do outside of work (e.g. caring for children or dependent adults, following traffic laws, paying taxes) 
  • Anything that would negatively impact your life in a significant way if you chose not to do it (e.g. paying your rent, mortgage, or car insurance, taking essential medications) 
  • Any stress that supports your goals and values
  • Actions that you cannot delegate to other people (e.g. finishing your CEUs) 

One example of Necessary Stress that I give my therapy clients is finals at my alma mater, UC Berkeley. During finals, hardly anyone gets adequate sleep.  Too many people drink too much caffeine. However, this level of stress happens a few weeks out of the year every six months.  This stress serves a very clear purpose–to graduate with a Berkeley degree. As a clinician, you are familiar with this type of stress and have made worthwhile sacrifices to earn your degree and license.  

Unnecessary Stress:  All of the other stressors in your life that do not fit into the category of necessary stress.  

You must manage Necessary Stress and eliminate as much Unnecessary Stress as possible. 

In order to be clear on what constitutes Necessary vs. Unnecessary Stress, you must know two things: 

  1. Your Goals (Professional and Personal) 
  2. Your Values 

Action Step: If you don’t know what your goals and values are, take ten minutes to brainstorm what you think they are. (Prompt: What are you willing to die–or go to jail–for?) 

Self-Created Stress vs. “Shit Happens” Stress 

When interacting with people outside of your job, you need to assess whether anyone close to you is creating drama due to their own actions (what I call “Self-Created Stress”) or if this person is facing stress due to circumstances beyond their control (what I call “Shit Happens” Stress).

Self-Created Stress 

Here are some signs that you may be spending time with a person who is creating stress in their own life: 

  • Most of your interactions with this person involve them complaining–particularly about other people. There’s nothing wrong with venting every once in a while, but if most of your interactions with this person involve them whining without attempts at effective action, this demonstrates that their priority is staying miserable.  

You listen to enough complaints as part of your job. It’s healthy if you don’t want to spend time with complainers when you’re not working.   

  • They keep finding themselves in the same kind of difficult situation—no matter how much you’ve tried to help them. If you’ve helped this person or suggested they get professional help, you’ve been good to them. However, you must recognize they are not interested in changing. Maybe they will be in the future, but that’s their decision (and their decision alone, no matter how much you’ve tried to persuade them).  

It’s time for you to start setting boundaries–even if listening to them is a necessary stressor. You should also reevaluate how much time you spend doing this.  Don’t be someone’s free therapist off the clock. 

“Shit Happens” Stress 

Here are some examples of “Shit Happens” Stress: 

  • Natural disasters
  • Sudden, unexpected deaths of loved ones
  • Freak accidents 
  • War 
  • Genocide 
  • The COVID-19 pandemic 

Clinicians work overtime—paid and unpaid—during “Shit Happens” stressors. I worked in Napa during the 2017 fires and helped direct fire victims to resources alongside county workers. I was also a therapist during the 2020 pandemic navigating clinical issues that I never trained or prepared for. 

If “shit happens” to someone you dearly love, you’d probably feel terrible if you didn’t do what you could to alleviate their suffering. However, it’s important to know that there are limits to how much you are able to help. Be aware of what you can best offer in times of crisis—and what’s best to delegate to someone else. 

Action Step: Write down what you are willing and able to do—and what you’re not willing and able to do—if a loved one is in a “Shit Happens” emergency.

Why Setting Boundaries is Controversial 

If you’re a woman/on the femme spectrum you’ve been pressured to hold space for both Self-Created Stress and “Shit Happens” stress. Frankly, you’ve been pressured to see them as the same. You’ve been socialized to be a caretaker—and those social pressures are multiplied in caregiving professions. Clinicians are expected to be selfless. 

“But Mari, medicine is a calling!” 

How many times have you heard that from colleagues who don’t have boundaries or self-care? How many times have you been criticized or guilt tripped for taking the PTO that you’ve rightfully earned? (You get my point.)

This social pressure is present–regardless of gender—if you grew up in a dysfunctional, addicted, or abusive household. You may be confused about the differences between Self-Created and “Shit Happens” Stress. 

I am sorry that someone convinced you that the stress they brought to your life came “out of nowhere”—or that you caused it (even though you weren’t the one putting the bottle in their hands).  

I’m sorry that you were called uncaring, selfish, or a “bad person” when you became tired of someone’s negative behavior and started to distance yourself from them. You did the right thing. (You can now recognize those guilt trips were bullshit and start setting boundaries that work for you.) 

“But…But I’m A Helper!” 

It’s a fruitless endeavor to help someone who is creating their own drama, is choosing not to take action, or is refusing to see a therapist. It doesn’t improve the situation.   

First of all, you will only become more frustrated with them. This repeated frustration will affect your capacity to do your job effectively.

Second, you will get nothing out of it. If you’re working with difficult people at your job, this experience could turn into a résumé statement, increased skills or a story for a potential interview. You don’t get CEUs for doing this shit unpaid. 

Action Steps 

Patient Care Managers—it’s time to take action.  

Action Step 1: If you don’t know what your goals and values are, take ten minutes to brainstorm what you think they are. (Prompt: What are you willing to die–or go to jail–for?) 

Action Step 2: Write down what you are willing and able to do—and what you’re not willing and able to do—if a loved one is in a “Shit Happens” emergency.
What did you learn from these exercises? What worked? What didn’t work? I welcome constructive feedback at Your feedback may be used in future blog posts to help other Patient Care Managers. 

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Disclaimer:This blog does not replace in-depth, individualized help from a health professional or provide any diagnosis or treatment. By reading, you understand this statement and commit to seeking psychotherapy or medication support if needed. You also understand that Mari Verano, LLC will not be able to intervene in a crisis or court situation. Please seek your own legal and/or crisis resources.

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