3rdcareerRN

Hurrah! Occ health can vary more than many specialties, depending on what the client needs -- anything from urgent care to OSHA-regulated medical surveillance to wellness programs to safety programs, or a mix of these and more. I really like it -- slower pace, get to know your "patients"/employees very well, wide range of duties, lots of variety. I've worked as an employee of a company with the medical contract, with the same holiday/pay situation as you describe. For me, it was a small annoyance but the autonomy far made up for it.

Try systems analysis, instead of educating: Determine the highest-value person or job role, whether it is by salary or impact on the rest of the clinic. Sometimes fixing reception/check-in -- the lowest paid position -- has the highest effect on the entire clinic. Look at the big picture to identify bottlenecks between job roles. Find the worst bottleneck, then figure out why it is a bottleneck -- who is not doing what when, and why. After the top two or three system-wide bottlenecks are fixed, start on the individual job roles. Work with that job role to help them identify the most time-consuming thing they do, whether it is on the EHR or something else. Figure out why it is the most time-consuming, by breaking down the steps. Then see whether any of the steps or the entire task can be changed/eliminated. Then make that change and see if it helped. Then repeat for the next most time-consuming task. Then when that job role is performing so they can keep up, do this analysis on the next job role. I know this seems like the responsibility of the practice manager or maybe the EHR manager, but as the educator you can play a key role as the person who sees both the whole system and the details. I guarantee you if you can step outside the pure education role and fix processes, you'll have your job for life.

I agree with prior post, that COHN is a must-have and in many positions, the spiro/fit-test/audio training and certificates are a must-have/must-get-upon-hiring. Coming from the ER, I looked at CEN before going into occ health. Iin an occ health job, the vast majority of CEN will useless. It is mostly about handling emergencies in an ER, using ER equipment and ER meds.

" CCNs- certified cubicle nurses" -- that's great! I agree that doing the onsite chart reviews (such as for HEDIS QI/QA) is a good intro to seeing medical records and the patient encounter in a broader way.

A phlebotomist can successfully use a 23- or even 25-gauge needle. I myself often use a 23-gauge butterfly and have never had lab reject my specimens due to hemolysis. If there is evidence-based guidelines about hemolysis when using small-gauge needles, can you point me to it please? I'm not being snarky, I want to improve my practice.

Occupational health. Most often 1:1 or sometimes 1:2, with time to actually do teaching and focused care. Although... there was that chemical exposure incident, when it was 1:45. One then learns the true meaning of "field triage". But just try to find an occ health job...the best specialty but virtually no open positions.

Ambulatory clinic patient w/ triglycerides of >2500. Blood looked like thick milk.

A key problem I see with a new grad choosing occ health is the lack of preceptorship for learning those common hands-on skills that are needed in all clinical nursing positions. Whatever you learned in school, it is not enough to do it as the sole nurse on-site unless you get more training. If there is more than one occ health nurse at your site and/or you can have a multi-week preceptor, then you might be OK. I learned my skills mostly in the ER prior to becoming an occ health nurse. That is extremely helpful as an occ health nurse -- I'm the only one on site during my shift, and I have up to multi-hundreds of employees to care for (depending on the day of the week). Many other postings state this, and I will echo: If you decide to go into acute care later without that magic one year of acute experience, you probably won't get in. However, I like occ health so much I may never go back to acute. Good luck with whatever you decide.

Gosh, I worked in 2006 at a Midwestern US hospital where we used all these: - Gerichair with locking tray - Posey vests - Gomco suction - Kardexes (in addition to Meditech online charting -and- paper charting...!) - Taping drips for timing because there were not enough pumps for every patient to have one - M&M enemas - Red rubber straight caths Are such things actually antiquated now?

South Midwest: "Call in" / "pop" / "peaCAHn" (pecan) Fond memories of my grandfather asking "Y'all want a sodee pop?"

Let me introduce a little bit of science into the discussion, by quoting a research representative: "...The risk of musculoskeletal disorders resulting from patient handling results from the high internal forces created in the spine when a person lifts a heavy object. Musculoskeletal disorders are a high risk for patient handling because it can require lifting a patient who is far away from the worker which puts heavy loads on the spine. Repeated lifting of this type can result in scarring that causes more damage. Studies have suggested that that there can be risks of injury even when two people are lifting a 110 lb patient from a bed to a chair.[8] NIOSH {National Institute for Occupational Safety and Health} recommends that no caregiver should manually lift more than 35 lbs of a person's body weight for a vertical lifting task.[9] NIOSH further recommends that when the weight to be lifted exceeds this limit, assistive devices should be used. These recommendations have been adopted by the Veterans Health Administration (VHA) and incorporated into its current patient handling recommendations and patient handling algorithms. Moreover, other major interest groups, such as the American Nurses Association (ANA), National Association of Orthopaedic Nurses (NAON), and Association of Perioperative Registered Nurses (AORN) have all adopted similar patient handling guidelines that recommend use of technology-based solutions for patient handling and movement.[10],[11],[12] ..." Source: http://www.hhs.gov/asl/testify/2010/05/t20100511a.html {boldface added} As an occ-health nurse, I want to protect caregivers' backs!

They will not mind...in fact, they are required to provide them to affected employees free of charge by Federal regulation! (OSHA Standard: http://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=standards&p_id=10051 Personal Protective Equipment -- 1910.1030(d)(3)(i) Provision. When there is occupational exposure, the employer shall provide, at no cost to the employee, appropriate personal protective equipment such as, but not limited to, gloves, gowns, laboratory coats, face shields or masks and eye protection, and mouthpieces, resuscitation bags, pocket masks, or other ventilation devices. ...The employer shall ensure that appropriate personal protective equipment in the appropriate sizes is readily accessible at the worksite or is issued to employees. As an occ-health nurse, I want other nurses to know their occupational rights! (at least in the USA)

Kudos for thinking! What I like to see nurses here and at work do is recognize what might happen, because then they can plan a better response than whatever their immediate reaction would be. Spending an hour looking at the policy manual exposes you to lots of things that might happen, and how you should react. I had a nursing school instructor who told me to imagine the worst that could happen to my patient or family, and plan what I would do. I've found that to be useful advice. Also I find these forums hugely useful to enlarge my imagination of such things, which I hope makes me a more prepared and better nurse. (yes, I'm a former Boy Scout -- the motto was "Be prepared.") We're all in this together, so let's support each other in becoming better.

I have very similar responses to this other poster, except #8 (I have much worse benefits/security as a nurse, a worse work schedule, less than half the pay as my prior two careers, but am usually satisfied or even happy daily now.)

Whether RNs need special training appears to be an entity-specific or geography-specific policy. However, the Centers for Disease Control offers free training here: http://www.cdcnpin.org/scripts/tb/kit.asp In that training, the CDC states "There are several different methods for reading the Mantoux tuberculin skin test, and they can vary among facilities. For each facility, everyone reading the skin test should receive training in and use the same method. " Can a non-RN can perform the reading? Yes, according to that course...although the interpretation of the reading results must be performed by "a trained health care provider".

I agree, with additional thoughts: - Every consulting firm has added staff to pursue ARRA/HITECH opportunities; if you are open to being a consultant, there are opportunities now with that combo of credentials, and surely will be more over the next 3-4 years as regulatory deadlines approach. - Get into the "revenue cycle" area. Search that term, or see healthcarefinancenews.com or hfma.org or managedhealthcareexecutive.modernmedicine.com for current articles on it. Basically, how do healthcare providers obtain more due revenue faster? (It's harder than you might think.) Caveat: Both of these areas require a focus away from direct patient care, which brings up ethical problems for some nurses. If you can accept the idea of improving the system so as to improve bedside care, you'll be OK.

This person (who happens to run some completely awesome websites on healthcare informatics) gets what hospital nursing is about: "If you are a nurse, happy National Nurses Week, which started Thursday (happy birthday, Florence Nightingale!) I love nurses (literally, since I married one), so here's a shout-out to the one group of professionals (both male and female) that hospitals can't run without. I wrote this in 2003 in their honor, obviously from a community hospital perspective since I was working at one of those instead of an academic medical center at the time: The only critical people involved in patient care are nurses ... My experience is that 80% of patient care is directly influenced by nurses, often via skillfully planted recommendations that allow doctors to believe they thought of it themselves. Your patient satisfaction surveys are almost purely driven by the quality and compassion of your nurses. So is your level of patient safety. Nurses clean up the vomit, hug the babies, keep doctors from killing patients, give the drugs, do the Code Blues, and comfort the families. All the rest of us are hangers-on who look like deer in the headlights on the rare occasions when we stray into an actual patient care area where human triumph or tragedy is unfolding with a nurse at its center ... Not too long ago, a hospital was basically a clean building in a peaceful setting (!) where patients could rest and mend. That and nurses were about all anyone needed. Hospital work was charity. No MBAs, no arrogant doctors, no government red tape, no formulary of 5,000 drugs, and no cadre of specialists making large salaries to do small tasks. Oh, and by the way, no computers either. You know what? Life expectancy wasn't that much different (if you exclude the benefits of vaccinations and reduced infant mortality.) Costs were a lot lower. No one got rich in healthcare. Without all the research, the computerization, the fancy architecture, and the lack of John Wayne "I will not let this patient die" heroics, things weren't really all that much worse when it came to living and dying. If I'm sick, keep the CEO, CIO, PFS manager, and risk manager out of my room and give me the best nurses you have. When you get right down to it, a hospital is still a clean building with nurses. Everyone else is supporting cast, even if their salaries make them believe differently." from http://histalk2.com/ We appreciate it - Rock on, Mr. Histalk, whomever you are!

My limited insight: - There is definitely a need for health education in the public clinic, but I don't have experience in doing mass presentations there. I got to do 1:1 teaching as a volunteer nurse. -In my occ health job, I'm responsible for all the bulletin boards and brochures (monthly) we publish. Topics include all the usual ones for preventative health and then a few specific to our 1000-worker population. I really like researching, writing, laying-out, and even sometimes illustrating this material. - There is an occupation called medical/science writer, and some of them do the same type of research/write/publish on contract to health foundations and special-interest groups. - You might -- with some journalism or English lit. credentials -- get a job or contract directly at a health organization which wants to publish a patient/family guide on some disease. With a technical background, you might be able to create new health-product information or usage guides. With deep science background you can write materials for pharm firms -- there is a strong cohort of pharm writers I ran across a few years ago. In my (years of) experience, having some credentials (degree, credits on printed/audiovisual materials, listed as a presenter in a conference, etc.) opens other doors. Start off volunteering, then start asking for an honorarium, then start asking for fees. I don't know anyone making a living as a health educator, but it certainly can be a part-time gig. Good luck!

I have a question for those of you in community health clinics, esp. if hospital-affiliated. Do you have a doctor or NP or PA in the clinic all the time? Do they see patients Q15 min. like in a private practice? As a former ER nurse, I had a doctor present in the unit all the time, which was great. As a student nurse in a volunteer community clinic, we had one doc and a handful of 2nd-year med students present in the clinic. As an occ-health nurse, I don't even have one even on call (but then I seldom need one). I continue to think about what I want to do when I grow up :) and fondly remember those two doc-nearby settings, even though I like the 100% autonomy of occ health. Please tell me about your clinic situation, so I have more info about what I might do next. Thanks!

Sent you some answers in a PM.

I can't answer to various hospitals' policies, but in the U.S.A. there is quite clear Federal policy about who can access charts and when, and updating them. (45 C.F.R. 164.508, 164.524 and 164.526 and the easy-to-read http://www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/consumer_rights.pdf extracted here:) "Providers and health insurers who are required to follow this law must comply with your right to... Ask to see and get a copy of your health records You can ask to see and get a copy of your medical record and other health information. You may not be able to get all of your information in a few special cases. For example, if your doctor decides something in your file might endanger you or someone else, the doctor may not have to give this information to you. In most cases, your copies must be given to you within 30 days, but this can be extended for another 30 days if you are given a reason. You may have to pay for the cost of copying and mailing if you request copies and mailing. Have corrections added to your health information You can ask to change any wrong information in your file or add information to your file if it is incomplete. For example, if you and your hospital agree that your file has the wrong result for a test, the hospital must change it. Even if the hospital believes the test result is correct, you still have the right to have your disagreement noted in your file. In most cases the file should be changed within 60 days, but the hospital can take an extra 30 days if you are given a reason."

Medicare reimburses based on diagnosis-related group, rather than on individual charge items for a patient (such an IV catheter). ( see http://www.cms.hhs.gov/AcuteInpatientPPS/01_overview.asp ) So I am not sure you are pursuing a question that has a direct answer. You might clarify with the hospital's revenue-cycle / billing department, specifically the coding supervisor. That person should be able to answer any medication-specific reimbursement question and what documentation is required. After all, the coder must ensure the item is documented in the medical record before it can be coded for reimbursement. However, as an informatics person, I applaud your efforts to standardize how the EMR is used.

I forgot to mention it earlier: You really need to spend time on auntminnie.com if you have not been around imaging/ PACS.

As with any new infosystem, find out: - Who wants it, and who is sponsoring it at an executive level - What problem are they trying to solve - What they absolutely require (versus what they want) - Who is funding it - What the sponsor's vision is for this solution Key strategy questions: - Strategy for getting existing images into the PACS (whether; which ones; how; when) - Strategy for getting images back out of PACS (to whom; where; how fast) --(Are the radiologists wanting to see images at home on a computer, in their pocket on an iPhone, in their clinic off hospital property; are images to be sent to offshore doctors, etc.) - Strategy for long-term storage (does image ever go from electronic form to offline form; when; how does it get recovered for viewing) This is a short list of key implementation concerns, but it should be enough to start. :)

Thank you for acting as a community health advocate! This link has over 5000 results: http://www.cdc.gov/search.do?queryText=brochure&action=search Entering "brochure" in this site's search box gives over 9000 results: http://www.nih.gov/ I've used both sites to order brochures for a free clinic a few years ago.