CMagill

Actually, yes. If I clocked out in the ED and a patient started coding, I would help my peers and take care of the patient. There were many nights when I would be stopped by a coworker or a patient on my way out who had questions or needed help with something. Part of being a caregiver is putting the needs of others before your own. It isn't always about boundaries, it is about recognizing that I have been that person who needed help, and I appreciated those who stopped what they were doing or stayed late to make sure I had what I needed, and I want to pay it forward.

I very much appreciate your comment of "there is not prize for 'most worked hours'." I may need to put that on a sticky note and put it on my monitor! I do have a bad habit of eating at my desk, so I will have to work on that! Thank you for taking the time to comment!

First, let me explain how karma worked its unfriendly magic. While working one day, my peers and I discussed how much time we had accrued in our "sick bank" and the limited ways in which we're allowed to access it. I commented, "the only way I will ever use mine is to have surgery.” And boom, a few weeks later, I was in the hospital with multiple fractures. As I was waiting to go to the OR, I really wished I had kept my mouth shut! An Inpatient Experience After the procedure, I spent almost a week in the hospital. The ED nurse inside did not make it easy. I was non-weight-bearing but could not bring myself to push the call button to ask for assistance to the bathroom. I did not want to disturb the nurse or the tech. The pain was miserable, but I could not ask for the medication I knew was available on the MAR. (They would surely think I was drug-seeking, right?) I profusely apologized to the physical therapist when it took longer than I felt it should have to get dressed, the whole time thinking, "I know she has other patients to see.” When I should have been resting, I found myself wondering how many of my patients had needs that went unmet because they didn't want to bother me, were afraid of what I might think of them, or felt I had more important patients to care for. Then I finally heard the words I had waited for all week: "You can go home today.” Unfortunately, my joy was short-lived when the surgeon followed up with, "You'll be non-weight-bearing for 12 weeks." I thought I had hallucinated; did he say twelve weeks?! Can a person cook dinner and fold laundry on one leg for twelve weeks? How was my boss going to take the news? At that moment, I realized the road to recovery was going to be a bit longer than I had wanted to admit. Feeling Like A Burden At Home The confidence and attitude of encouragement I knew as a nurse deserted me as soon as I took my position on the couch, propped up with pillows and my negative thoughts. I felt fearful and helpless and worried that my husband would become resentful of having to do every little thing for me and that my daughter was being forced to grow up too fast doing things I should be responsible for. Fretting became my full-time job. Three Months Later Three months finally passed (much more slowly than I would have preferred), and on my way to my final follow-up visit, I thought, "Yes, things will finally go back to normal!” Wrong! The surgeon gifted me with sixteen weeks of physical therapy. Oh good, something new to worry about. How was my husband going to manage his work schedule and drive me to PT three days every week? How am I going to get to my appointments and make sure someone is home when the kids get off the bus? Am I destined to be a burden to my family for the rest of my life? (Dramatic, I know.) The PT Process I had gone from kicking tail and taking names to being frustrated because I couldn't pick up a marble with my toes. My type A personality struggled to accept that I wasn't going to walk normally after one PT session. At least the resistance band exercises gave me something else to do on the couch besides sulk and feel sorry for myself. What I Learned Nurses don't make "terrible patients" because we're judging IV sticks, waiting too long to seek care, or because we're too demanding with our care needs. Nurses are lousy patients because we feel like we can't ask questions someone might think we should already know the answer to. We feel like we can't admit we need help, so we don't ask. We are used to being strong, and the feelings of powerlessness and weakness are almost more debilitating than the injury or illness itself. This experience was humbling, and it opened my eyes to aspects of patient care I had not given much thought to before. I came out a better nurse and a better person in the end, but I can assure you I will not be discussing the hours in my "sick bank" anytime soon!

My work-from-home journey began in February 2020. It didn't take long for me to start logging in earlier than required, and I began skipping lunches and staying on past the time I would have left the office. In the evenings, I would do a "quick" email check just to be sure I wasn't missing something important, which often led to logging back in and working on something that could have easily waited until the next day. While going to the office allowed me to have dedicated work hours, transitioning to working at home left me feeling like I wasn't allowed to turn it off. I realized this was not a healthy (or sustainable) way to manage my days, and over time I have learned to separate my work and personal time (ahem...for the most part). Set A Structured Work Schedule The main thing I have done to counteract this self-created imbalance is, adhere to a more structured work schedule. I log in when my day is scheduled to start, and I log out when the workday is scheduled to end. Of course, there are always exceptions, but I generally try to limit myself to working only during the hours designated on my time sheet. As a nurse, it isn't in my nature to leave work unfinished, and adjusting has not been easy. I am three years into the work-from-home routine, and I still struggle with this every day. After committing to a more structured schedule, I will admit I enjoy the "extra" time it seems I have in the mornings! I spend more time with the kids before they go to school, do some household chores, and even manage to get a little reading in every now and then! I feel more prepared for the workday because I have a better mindset, and I don't feel so sluggish when it's time to "clock in.” I'm able to have dinner on the table at a reasonable time, and I don't feel so mentally drained in the evenings. I still give 100% of myself to my work during those set hours, but I am finally appreciating the true value of putting my family first and enjoying quality time with them. (Why does this still make me feel guilty sometimes?!) Get Up and Move! In the office, it was easy to pause and take a trip to the breakroom or stop by a co-worker's cubicle to say "hi" and catch up for a few minutes. At home, I found myself working for hours (and by that, I mean all day) without leaving my seat. I am reminded of my days in the Emergency Department when people would ask, "How can you forget you need to use the restroom?” Well, I just want to finish one thing, and that turns into five things, and before you know it, the time is 3 pm, and your stomach is wondering why you haven't eaten all day. "Get up and move" sounds simple, but I tend to be so focused on my work I truly don't notice the time passing me by. I've been known to set alarms throughout the day as a reminder to separate myself from my chair. I know the work isn't going anywhere, but for some reason, I still have difficulty putting it on hold, even for just a few minutes. It makes me sad to think of how many sunrises I've missed because I chose to start burying myself in work several hours before the sun came up. Mobile Apps ... Friend, or Foe? The ability to access work-related information on my phone is a bit too convenient for me. Just like texting while driving should not be happening, neither should I be reading work emails while making dinner or in the middle of the night when I should be sleeping. I have not removed the apps from my phone, but I have chosen not to look at my phone for anything work-related outside of my scheduled hours. (I did turn off the notifications; my willpower is not strong enough to just let that "ping" go unnoticed.) One step at a time! Something To Prove? Not everyone gets to experience the benefit of working from home (and not everyone sees the opportunity as a positive thing.) On some level, I felt I had to work harder and put in longer hours to show my boss I wasn't taking advantage or abusing the privilege. Guess what? She doesn't think any less of me for sticking to my scheduled hours, and she encourages me to enjoy my personal time. I had burdened myself with expectations that actually caused her to worry I would burn myself out. It was eye-opening to realize my work-life imbalance had the opposite effect on how she viewed my work performance. She knew before I did that longer hours don't make someone a better coworker. In The End I still think it's perfectly okay to have a strong desire to perform well and go above and beyond what is required, but I also know my work should not be the primary thing defining me as a person. I believe the best way to bring value to my team is by setting boundaries for myself that contribute to my overall well-being. Having a work-life balance allows me to be more productive both at work and at home, and by lifting the burden of impossible expectations, my sanity has a greater chance of remaining intact!

What Is Clinical Documentation? Simply stated, "clinical documentation" refers to the information entered into a patient's medical record by the healthcare professional. While the data captured is specific to each patient, the components of the medical record are mostly universal. Below are some examples of documentation you will find in a medical chart: Care Plans and Progress Notes Diagnostic Studies and Treatment Plans Height, Weight, and Allergy Information Immunization Status Past Medical History and Current Symptoms Prescription Information and Medications Administered (during the inpatient stay) Vital Signs Multiple members of the healthcare team access and contribute to a patient's medical data, and it is important to ensure the documentation portrays a true illustration of the patient's state of health. This is where the Clinical Documentation Improvement (CDI) specialist comes in! The CDI specialist acts as a liaison between the healthcare provider and the coding team to promote precise documentation, which supports improved patient care and better billing practices. Clinical Documentation Improvement (CDI) The American Academy of Professional Coders (AAPC) describes CDI as "the process of reviewing medical record documentation for completeness and accuracy.” A CDI specialist, also known as a Clinical Documentation Specialist (CDS), often has both clinical and coding experience. The role of the CDS is to thoroughly review progress notes, imaging interpretations and lab values, historical and current diagnoses, consult and procedure notes, etc. – they look at all documentation which may be used to determine the condition of the patient as the hospital stay progresses. If a discrepancy is found, the CDS will work with the provider (who is ultimately responsible for the information contained in the patient's chart) to improve areas in the medical record where documentation may be lacking or to resolve any conflicting information. What Is a DRG? DRG stands for "diagnostic-related group,” a method used by Medicare and other insurance companies to pay the health system a specific rate for a patient's hospitalization. The DRG assigned to the encounter is influenced by several factors, such as the seriousness of the patient's current illness, previous or unresolved health complications that may be hindering the healing process, the amount of resources required to treat the patient, any procedures that are performed, the likelihood of the patient returning to his/her baseline status, and many others. The CDS performs a concurrent review of the medical record, meaning the chart is reviewed while the patient is in the hospital, to establish a "working" DRG. Once the patient has been discharged, the coder will also perform a thorough review of the chart, resulting in the "final" DRG. In the end, the goal is for the DRGs identified by both the CDS and the coder to be in agreement. A matching DRG helps to validate several things: The documentation in the medical record accurately represents the patient's condition. The bill that will be sent to the patient will not include unnecessary charges. The hospital will be reimbursed appropriately for the care provided to the patient. A Non-Bedside Nursing Opportunity Nurses who are looking to leave the bedside but do not wish to leave healthcare altogether may want to consider a position as a CDI specialist. Their clinical background provides several benefits, such as: Knowing where to look for pertinent information Identifying conflicting, incomplete, or missing documentation An established rapport with other healthcare professionals Familiarity with provider communication preferences Certification Opportunities Nurses love to continue learning, and they can become proficient in coding processes over time if this is not something they are currently familiar with. Organizations like The American Health Information Management Association (AHIMA) offer a wide range of certification opportunities. A few examples are: Certified Coding Associate (CCA) Certified Coding Specialist (CCS) Certified Documentation Improvement Practitioner (CDIP) The Association of Clinical Documentation Integrity Specialists (ACDIS) is another organization that offers certification opportunities for those who have achieved success in the CDS role. These organizations promote learning and growth in this field by bringing people together and sharing knowledge through conferences, forums, and podcasts. Choosing to leave the bedside can be a difficult decision, and sometimes nurses are required to consider other options before they feel like they are ready. As a CDI specialist, nurses have a particularly important role, both as a patient advocate and as a valued member of the care team. Promoting accurate documentation is essential because we all know, References AAPC - Coding and CDI: It Takes Two AAPC: What Is Clinical Documentation ACDIS AHIMA - Certifications & Careers Medicare Advantage - What is a Medicare Diagnosis Related Group (DRG), and Why Does It Matter for Beneficiaries? MedMG - What Is The Purpose Of Medical Records?

Media reaches the general public in a variety of ways. Market Business News describes media as “the communication channels through which we disseminate news, music, movies, education, promotional messages, and other data. It includes physical and online newspapers and magazines, television, radio, telephone, the Internet, fax, and billboards.” Healthcare-related matters are often the topic of choice among different media outlets, and good or bad, this inevitably contributes to public opinion, which then influences healthcare-related decisions. New stories tend to highlight errors or mistakes. Pink’s musical track “Just Like A Pill” implies the nurse is not available or is unwilling to meet the patient’s need. The negativity found in these forms of media promotes distrust between the public and healthcare professionals. When interviewing candidates for an ED position, several nurses stated they applied because they “watch Grey’s Anatomy.” Movies and television shows with a health-centered theme that do not depict real-world medical processes lead to confusion and frustration when the public struggles to separate reality from entertainment. Whether intentional or not, the underlying tone of various news stories, music, and TV shows is derogatory and full of mockery, broadcasting a message to society that healthcare professionals are not professionals at all. Advantages and Disadvantages of Social Media in Healthcare Social media adds another layer of complexity. It is becoming more customary for organizations and individuals to use digital methods to recruit experienced coworkers, share information and market their services, and bring attention to health-related conditions that could potentially be life-threatening if left undiagnosed or untreated. While evidence does exist to show that social media can add value to healthcare practices, this approach to communication is not without significant shortcomings. A major concern is the amount of misinformation that is easily accessible and widely disseminated. There are few to no restrictions when it comes to posting health-related material on social media platforms, and there is no review process to corroborate the qualifications of the author or the truthfulness of the published content. Additionally, the use of social media changes the professional nature of the provider-to-patient relationship and introduces opportunities for confidential information to be made public. I have seen both positive and negative effects of mixing media and health-centered content. For example, patients who are unsure of which level of care they need can easily find this information. Chest pain? Go to the emergency department. Sore throat? Go to urgent care. On the other hand, online searching can turn minor symptoms into perceived emergencies when the information is not processed appropriately. A Cultural Shift Over the years, I have seen the influential role in healthcare shift from the provider to the patient. With so much information readily available, patients feel empowered to direct their care, and the media has played a large part in leading patients to assume the prominent role when it comes to making healthcare decisions. An unfortunate side effect is that medical expertise is often taking a backseat to internet searches. Patients used to present to the ED and describe the symptoms they were experiencing and then allow the physician to formulate a plan of care. Now they state the diagnosis they think is a good fit based on information they find online and then make demands regarding testing and treatment. Patients today are more reluctant to consider the educated opinion of the provider at their bedside. Nurses Are Not Immune to Google Searches I recently participated in my own online search. My son got a piece of food lodged in his esophagus. A biopsy was collected during the endoscopy procedure while in the emergency department. When the result became available, the surgeon expressed concern for possible Eosinophilic Esophagitis (EoE). I have over twenty years of clinical experience, but I was not familiar with EoE. So, I consulted “Dr. Google.” A quick internet search was the easiest and fastest way to get the information I needed. Upon hitting the Enter key, I had eight million results instantly at my fingertips! I explored every bit of information I could find on sites such as MedlinePlus.gov and MayoClinic.org. I was confident the information found there would be authentic. However, mixed in with the dependable sites were also a multitude of “.com” pages that claimed to produce “official” patient content. When reading further, I concluded that the intention of those articles was to promote a product and entice me to open my wallet, not to deliver information to a mom (who forgot for a moment she’s a nurse) who was trying to decide if her son really might have this rare disease and what to do about it. How Do We Keep Common Sense Alive? Sites like The National Institutes of Health (NIH) are trying to help turn confusion into clarity. They have published tips to help consumers maintain a degree of common sense when navigating the online world to find health-related material. Some suggestions include only viewing sites from “trusted sources,” such as those that end in .gov, .org, and .edu, and avoiding sites that offer a quick and/or easy treatment option for a complicated medical problem. So, to what extent should we allow the media to influence our healthcare decisions? This is not a “one size fits all” answer. As nurses, we want to educate with certainty and refrain from contributing to any misconceptions, so we must be diligent when using media to grow our own knowledge and cautious when determining if the information is worthy of passing along. References/Resources Market Business News: What is media? Definition and meaning NIH News In Health: Finding Reliable Health Information Online Online Master of Public Health: The Role of Social Media in Healthcare – A Public Health Perspective Pink – Just Like A Pill University of California San Francisco: Should You Go To Urgent Care Or The Emergency Room?