Mommy TeleRN

I got into my hospital's quality department doing chart abstraction and eventually started working from home. Love it! Find out who your PI/quality manager is and put out feelers!

New to quality. Im having a hard time understanding all the different quality measures and how things get reporting to the governing bodies. For instance...AHRQ IQI 11 - Aneurysm deaths. It states this is reported via claims. I assume this means they review claims and compare to deaths. So does this mean this is only tracked for MEDICARE patients? because we have a committee to review our aneurysm deaths and I'm trying to understand the inclusion criteria. How does a hospital know how they did? Does CMS send them a report? ANY HELP understanding very much appreciated! I'm LOST.

As a new CM abstractor I can tell you we have to report that to all kinds of people lol. Is it possible the MD charted earlier in the stay why no ace/arb? It doesn't HAVE to be written at discharge if it's written anywhere in the chart. He can also update his discharge summary and put it in there. I believe they have 30 days they can update the discharge information.

I would go with Children's..I've heard good things. I believe UT now does all their peds through Childrens if I recall correctly. Perhaps you could contact a nurse recruiter for more of the details re pay and benefits.

Oh and to answer your actual question: My job will be in performance improvement (doing data management for instance core measures compliance, but that is just part of it) Other things: informatics (does your hospital have a computer charting committee you can join?), case management; educators (for instance doing new hire orientations to hospital, others may need a MSN); You may have a hard time with just one year experience, but use this time to do that networking and get to know people who can help you advance.

Totally agree with HouTX. NETWORK! Join committees, get to know people in other departments. Perhaps a procedural area would be a good next step for you? Not office, but something different anyway. I just landed my first job away from bedside. I will be working in an office 8 hr days, salary, desk, computer. I have to beef up my non-scrubs wardrobe lol and will be doing some serious shoe shopping this weekend for cute heels! AND I didn't even have to take a paycut..something I was for sure would come with leaving bedside. How did I land the job? I made myself a resource. My manager knew it. I have been on committees, applying for certification in my specialty. She has handpicked me for dealing with difficult patients/families, for specialized ICU core float staff, etc over the past few years. When HER boss asked for recommendations for this new position, my name came up and she told me about the position and encouraged me to apply. All the things I've accomplished in the past few years be doing my "extras" were great topics on my resume and in my interview. I was able to show I went above and beyond my basic staff nurse duties. And as a member of the float pool, I don't get raises for these things (all float get the same pay) so it would have been easy for me to just "do my job" because there was no financial incentive for my review. But it has paid off for me in brownie points :)

As far as specialization, depends on the hiring practices of your local hospitals. When I graduated, everyone pretty much was on a level playing field. When you got hired after passing NCLEX, you could go into ER, ICU, OR, Med-Surg, Tele, etc and you completed orientation for that specific area. There were internships basically that were 6-9 months long (most hospitals are only 3 months however). Some hospitals, especially now, can be more picky. For instance my current facility is applying for magnet and are only hiring BSN prepared new grads. I think they are being more selective in the specialty areas especially and do not hire new grads into some of them, like CVICU. You must have med-surg experience first. Bottom line, depends on the hospital. As far as vomit, feces - I am the gag QUEEN. But overtime it isn't as bad. I can handle incontinent patients better than dumping a bedside commode for some reason lol. For vomit, try and hold it as far from you as you can and flush quickly. Technically you should measure it though, sometimes I just can't though! Yes you can wear a mask as it's part of personal protection equipment and if someone is vomiting that is a potential exposure. But as was mentioned above, they don't do much for smell. I have been known to tear an alcohol swab to take a whiff of...also baby powder squirted over smelly things helps mask the smell until you can get it dumped. There are areas of nursing with less exposure to these things. If you work more with ambulatory patients who can do their own toileting for instance. Procedural areas have to deal with it less than say med-surg. Med-surg would have to deal with it less than ICU because they have CNAs who do most of the toileting. It was funny a few weeks ago I was working ICU and had a pt that had diarrhea like 6x during my shift. His son was helping me and I noticed him gagging and turning his head away so after that I got another staff member to help me. But for me, I didn't even notice the smell at all! I thought WOW I have finally gotten used to this! lol

Do you know exactly what you'd be auditing in the charts? I just got a position away from bedside and will start in a couple weeks. My position will be pulling data from charts for core measures and various database registries. I was really worried if the pay would be comparable. I was pleasantly surprised. I have been a nurse 4 years and work float. I would have had to take a big paycut to leave float and work one department. With my new job I will make comparable to what I'd making work day float and I get a little better benefits (mainly paid time off which I don't currently get) If you think you are ready for a change go for it!

I think some of it depends on the hospital and how they staff various units. I float and there are some floors that tend to be better staffed and have a 5:1 ratio instead of 6:1 and they are a little easier. Stepdown can be easier depending on how it's set up.. they aren't as sick as ICU usually and you have 3-4 patients. I find ICU a little slower pace than the floor. I have so much more time to spend with each patient and can learn more about them. You have so many nurses around it's easier to get help like pulling up the patient, bathing, toileting and you usually have plenty of RT's and often docs around (esp in a teaching hospital) at night than on the floor. The docs to me seem like they listen better and are generally more helpful in the unit, they tend to know about the patient and what is going on, monitoring their labs and things themselves a little more frequently as the ICU pt requires more frequent changes in the plan of care. My hospital used to have a chest pain center and I really liked that.... you are doing the same type of thing all the time and it's easy to have a routine. Although you'd occ have someone unstable it was pretty easy to get a doc on the scene.

I would try to focus on your patients. I think it would look bad to go to your 3rd job in less than one year. It doesn't sound likes it's an unsafe working environment, just not your "fit". Keep doing your best and set the example in professionalism. Part of that is staying with a job for more than a few months :)

I don't know anything about school nursing, but you will have to spend a lot of time in the hospital setting for your clinical time in nursing school.

Those back surgery patients usually have a ton of pain! I've only ever seen one that wasn't in bad pain. She was the exception! Often you will have to help them turn because they won't do it independantly, so you have potential for impaired skin integrity (in addition to their incision), potential for infection, and altered elimination due to narcotic usage and decreased mobility. As far as labs, a CBC for sure as others mentioned to assess for bleeding but also to monitor white count. Although in my personal experience, neurosurgeons tend not to order very many labs or diagnostic testing.

I would just leave it as is for the ones already sent out. Chances are they may not even notice it. If you send corrections you are bringing it to their attention.

Thanks llg. I was offered the position today. I'm still a little nervous about the whole exempt thing and them running me into the ground lol..but since I already work at the facility I know it's a good place and I think they will do right by me. The time off is extremely generous and the pay is about the same as a full time day float position. Less than what I could make working full time night float but better than if I left float and took say a procedural area job...so all in all I think it's a good move for me.

After a total of 4 weeks of interviewing..I got the job offer this morning. Have to discuss with hubby but I can't see why I wouldn't accept! I hope you hear back soon..keep us posted!