Bunnybop

I I have been doing this job a little over a year and I do prefer it over bedside nursing. However, it is not exactly what I was expecting. I think my situation might be different compared to other facilities with an established CDI department. I also work in Maryland and we use APR-DRG vs MS-DRG and we work on MHACS (Maryland Hospital Acquired Conditions). There is not a lot of training/information I can find for APR-DRG which has been challenging. I originally started out making more then I did as a floor nurse, but my hospital gave all the nurses a pay increase and I now make less then I would if I were still on the floor. My day consists of reviewing a minimum of 25 charts a day (12 new reviews and 13 follow ups) and sending out approx 5 queries a day or more if possible. We also write all the Coder queries and try to look for ways to eliminate MHAC’s by researching the chart to determine if a condition was present on admission, or if we sequence a code in a certain order it will eliminate it. We use 3M 360 software and Meditech to do our chart reviews. My department consists of my Manager, 2 other CDI RN’s and one part time employee who tracks down the doctors to sign their queries (she is a godsend)! Our coding department is outsourced and we are not allowed to communicate directly with them, everything has to go through my manager. Before COVID hit I was working in the hospital. Even though we had our own office, we were required to go to our 2 units each day and spend half a day on each of them. I believe my boss’ goal was for us to have some face time with the doctors. I found it to be challenging because we would have to pack/unpack our lap top 6x a day. Fight for a spot to sit in and it can be distracting with all the noise/distractions. It would be freezing and I would have to wear my jacket and lap blanket on one of the floors. You have to pack up your stuff or pee like your butt was on fire so no one steals your stuff or your chair. I found the doctors either avoided me like the plague, or when I did have a doctor to chat with, I did not have anything I needed to speak to that Dr about specifically. Most of the doctors I speak to would rather an e-mail/text because they are so busy. Some hospitals do weekly/monthly teaching to the whole departments (Surgery/Medicine/Hospitalist/Residents). My facility has yet to embrace that (and I am a little thankful because I think I would be terrible at it :P ) Some facilities are working totally remote. Some are in the hospital still and some do a hybrid. Now that I am working from home, my boss has increased my chart review from 18 to 25. I find I am working 10-12-hour days 5 days a week on salary pay (no overtime). While I really do enjoy working from home, I do find it challenging to stay on task some days with the distractions at home (getting my niece to stay in her on line class, the cats jumping all over my keyboard… the internet..). Or I get exhausted from just sitting and reading with no one to speak to (I know I need to make up my mind)! Moving from the floor to CDI I am still not in control of my surroundings or my day. Even though I know I must do 25 charts a day, many things happen that mess up my workflow. My boss will ask a question about chart that I must review and its back and forth with e-mails while I try to work on the remainder of charts. Instead of giving me just 12 new charts to review a day sometimes she will give me 20! (which can be very time consuming). I will almost be done my new reviews and she throws 6 more in there and it just gets you down because you thought you might finish on time and now you won't. We are supposed to have autonomy but, my boss micro-manages us. I must educate myself and usually on my own time and at my own expense $$. I was never given a formal training. I sat with the Manager for one day to learn 3M and how to write a query. I sat in the office for 3 weeks attempting to code charts and was able to ask questions but was never taught how to do a chart review. My work was never reviewed so I never even knew if I was doing things right/wrong. I was only allowed to sit with one experienced CDI RN for one day and I learned so much. My boss has tried to keep us CDI’s separated from each other because we were cutting into each other’s productivity with questions, but I feel like if we were allowed to sit with each other in our own space it wouldn’t take so long to answer a question, and I could have physical resources at my fingertips (coding books and books I can’t lug around to the floor etc). I still call the experienced CDI with questions every day. I started to keep a Microsoft OneNote notebook with information in it so I can stop harassing her. Now with that being said, I do not think my experience is the normal. One of the CDI RN’s I work with has been doing this for 20 years, mostly MS-DRG and she said she has never worked at place like mine. She said it’s easy to review 25+ charts a day at other places and a lot of fun. I interviewed at two other CDI facilities. The first was a hospital with the same number of beds as we have, and they have 5 CDI RN’s and their manager. They work in a small office and only go onto the floor to find a doctor if they have a question or need to educate the MD. They seemed so happy and laughing and it was a cohesive environment it seemed. The 2nd facility was an exceptionally large hospital organization and they had 28 CDI RN (or something like that). They have an onsite educator who was a coder and a formal training as well as a manager. They did have a high chart review rate, but they are such a well-oiled machine I think they would have trained you the right way to look for what you need quickly so you could move onto the next chart. They also were laughing and having a great time while working. I think this could be a fantastic job. I just know that not every CDI department is the same.I am hoping to hone my skills and eventually apply at another hospital where I will have a better work/life balance in the future. Wow this was a little essay. I think I needed to vent :)

Hello all, I was looking for some input about being clinical document specialist. Nursing is my second career. I spent 15 years doing accounts receivable and a bit of human resources (Workers Compensation & Disability) for a medium sized company. I have been a Med/Surgical Nurse at a Hospital in Downtown Baltimore for 3 years. I am looking to find a job that combines my past and present experience together. Can you offer any advice on things I should study for applying for this position? I know it involves using your nursing knowledge to review charts and request clarification, so the hospital can be reimbursed correctly. Is there software you use to help generate query's? A reference book that shows what relevant services a doctor should have ordered for a certain diagnosis? Hot topics you need to be master of? I've only found a handful of threats on CDS and some of what I read make it sound like you need to be an ICU nurse with 20 years exp. And others seem to have no experience at all. Becoming a nurse has made me realize that I need to be in total control of my surroundings. I personally need to do an excellent job & be a master at my job, bedside nursing is to chaotic with so many unknown variables I feel like a wreck every day I come home. I was a resource to my co-workers in my previous job and I loved it and I hope to find a new position in nursing where I can be a Master and resource to others again. Any advice would be most welcome!

I am also interested in informatics. My hospital only has ONE person who has a degree in informatics. There are several "analyst" at the hospital but I am not sure if that would qualify as expierence. When I asked what they do, they said they basically review the doctors documentation and have them clarify information so they can submit claims for insurance reimbursement. Should I attempt to get a job doing this for expierence? I work at one of the lowest paying hospitals in Maryland apparently. We use Meditech and they don't have super users that I've heard of. Sounds like EPIC is where its at :/

Hi Everyone! I was hoping some of you seasoned Occupational Health Nurses could give me some pointers! Before I became a nurse, I used to work for a small installation company that maintained a warehouse for 16 years. Some of my duties included handling all workers compensation & automobile accident investigations and reporting (to insurance); OSHA recordkeeping; Creating light duty positions for employees; Safety walk throughs with insurance company. I was never formally trained, but I loved my job but alas there was no where for me to move up in the company and I was maxed out on salary. I have been working as a medical surgical nurse in a local hospital for 3 years now. I must say bedside nursing is not where I want to be. I miss my old job and having a relationship with my fellow employees. From what I read, I think I would enjoy Occupational Nursing considerably. I have a few questions however… Do you have to have a BSN to apply for these positions? I read you need Get at least 3,000 hours of experience in occupational health to become certified. Many of the jobs I was looking at said you need to be certified. Where can I start to get the experience I need? What type of skills or special training do you need for this job? Do you draw blood? Do you need critical care or case management experience? What is the salary like? Is it comparable to working in a hospital? Do you have chance to go up the pay ladder? I also have a lot of student loan debt I am trying to pay back. I am working towards Public Service Loan Forgiveness which say I need to work for: Do you know of any organizations I could apply for that would fit these criteria? The Employee health department at my hospital is staffed with nurses who hurt themselves at work and can no longer work on the floor and no openings.I appreciate any input you guys could put in! Have a great day!

Hi Guys, hoping someone can clarify this for me. I made some very poor borrowing choices while getting my degree and now I have a humongous amount of student loan debt. I am working at a local hospital and have applied for PSLF. I have 8 more years to go. I have only been a med-surg nurse for 3 years and I am starting to have issues with my joints, and I can't foresee that I will be able to do bedside nursing for another 10 years. When reading the information below, am I understanding correctly that I do not necessarily have to be working as a nurse to continue with the PSLF? That I could in fact get a job with the government in another capacity and still qualify? Any help will be greatly appreciated! Public Service Loan Forgiveness | Federal Student Aid

I'd like to join the FB page too.

GCU already reviewed my transcripts and I do not need any pre-reqs (unless they try to surprise me). I only need statistics which is built into their program already. Local colleges want me to retake Algebra and statistics (even though I have A's in both classes my credits wont transfer for some reason), Chemistry and Nutrition and 3 Humanities classes.

Hi Guys, I'm looking into [COLOR=#003366]Grand Canyon University online RN to BSN program. For the people who are already involved can you give me some feedback? What was your total cost of the program? Did the college offer any kind of scholarschips or grants? The facility I work in right now will not offer any kind of tuition assistance and I am unable to take any more financial aid out... so I am paying out of pocket and looking for some ways to offset the cost. I am afraid to engage my contact at GCU about this because she is some what aggressive and i need time to make my mind up. The local colleges around me want me to take 6 pre-req's before I can start their program, where as I will not have to take any at GCU. That sounds very appealing to me, but its about 2x the cost from what I can gather from their website. Next question is how are the papers and group projects? I haven't had to write a paper in some time and always struggled to come up with good content for my papers in college. I'm worried I will be eaten alive by instructors. Thanks in advance!

Hello all like many the SNF/LTC facility I am working in did not offer much of an orientation like I hoped. I find it very difficult some days because nothing is written down. There are no manuals or protocols etc. We're extremely short staffed, half the time I can't find a supervisor or my GNA. I ask many questions but not all of the staff here wants to be bothered by my inquisition of questions. I work 11-7 and I miss out on a lot of the learning experiences in the facility. A couple questions I'd like to ask (and please excuse my rambling and idiocy in advance): What medications absolutely must be given daily? I know this sounds silly, but when I first started working here, if a person's medication wasn't in yet, a nurse would "borrow" the medication from someone else. The state came and there was an issue with this of course, and the DON said that was a big no no. Also there were many times when a new order was written in the MAR, but the medication took a day or two to get to the facility. Nurses were circling that date that medication wasn't given, so the DON said the start date needs to be when the medication arrives. The day after I was told about this I pressured into working 3-11. It was crazy, I was moving the whole shift trying to do my med pass & tx's... and I got to a patient who had a new order for Warfrin. It wasn't in yet from pharmacy and I skipped over it. Looking back I realize that was a huge error on my part. I should have went to the omnicell and tried to pull that medication or even "borrow" it from another, but I was so flustered I had a massive brain fart. So what medications would you say MUST be given? What should I be looking for before I send a patient to the ER? I really feel there should be some criteria written down here somewhere! What would you include in a good progress note? For the night shift workers... when your checking your charts, what kind of errors are you looking for? Thanks in advance!

Hi everyone! I was wondering if I could get some advice about Share/Shadow days. I have been on two so far. The first one I had a small list of questions, and the nurse explained everything she did for about two hours. Between seeing patients and telling me about the facility she didn't give me many options to ask questions. I almost felt like I didn't need to because she was answering most of them as we went along. After the 2 hours she very kindly sent me on my way (without saying, it's a hassle having you're here). My friend helped me get my interview, and I found out they had already hired someone. I am glad though they gave me the opportunity to shadow. My 2nd Shadow day was for a small hospital about an hour away from my home. I live in Baltimore City so the atmosphere was drastically different. I stayed for 3.5 hours. The Floor Manager told me this would be like a 2nd interview and she would ask the nurse I shadowed about me. When I got there in the morning, no one knew I was coming and they just tossed me with a nurse on the Observation side of the floor. The facility and nurse had a very relaxed atmosphere and it was a more comfortable experience for me. The nurse was very busy, but chit chatted with everyone in the halls or at the medstation. I had prepared a ton of questions to ask but again, I felt like I never had an opportunity to really ask any questions. The questions I did ask, she never really gave me a clear answer either. I would ask "How do you deal with difficult patients on the floor?" (There was a man making a ruckus in his room who was getting aggressive). She told me something like "we get more difficult (acuity) patients on the other side of the hallway" *blinks*. Right before I left I asked her if she could give me any parting advice, or if there was anything I should be aware of about the facility, she thought about it for a good 60 seconds and told me not really. It was a confusing experience lol. For the nurses who have had some one shadow them, what kind of questions do you expect them to ask you? And how? I felt like I was slowing her down or interrupting her whenever I tried to ask a question. I am not sure how to make a good impression since this is like a "2nd Interview". Any advice appreciated!

I'm not sure, but I do know JHU is very intense to work for. I'll try to ask my classmates that went there.

How is the position at FMH going? I have an interview there Monday, getting nervous as I still haven't found a job as a new Grad!

How did your interview go Tenacious? I have an interview Monday with a Tele manager!

Hi TerpsGal02, any tips on interviewing at FMH? I scored an interview for Monday and from what little I can find on internet, they sound pretty tough! I bombed my only other interview and want to make sure I do a great job! Any advice is appreciated.

My last tip, if you know you got into nursing school and feel up to the challenge when you have down time (Winter Break/Summer) try to do some pre-reading. The most difficult classes/topics at least for me were Fluids and Electrolytes and Peeds. I would purchase the Fluid & Electrolytes made Incredibly easy book and start reading it during your winter break (sooner if you feel adventurous). I failed Concepts 1 because I failed my F/E exam (I got a 50%)! I was so nervous and unprepared and everything just kind of blended together. A symptom for having too little of one electrolyte could be the same as having too much of another. Some electrolytes have inverse relationships. What my tutor said (after I failed) was to make Venn diagrams. Like this Pin by Lindsay Moldstad on Nursing Fall 2013 | Pinterest . If you don’t want to spend the money on the books, you can do an advanced search on google. To get a college website you would want your google search to be something like “Nursing Fluid and electrolytes site:edu” the “site:edu” makes sure you are always going to a schools website. If you wanted just a pdf or power point, through the words .pdf or .ppt before the site:edu portion. I found a lot of times I would google other professors ppt’s to see if it was explained better than our teachers. (BEWARE I also wasted a lot of time doing this also). Peeds is usually your 3rd semester. I would spend a little bit of time during the summer reviewing Growth & Development. It’s a lot of information you need to know for each age group. I would try to find a contact in the class ahead of you and ask them to share their ppt. with you. Mrs. Bianco is an incredibly smart nurse, if I remember correctly she held a position on the MD Board of Nursing. With that said, her ppts could be confusing and contradicting. One slide might say a 6 month old can make a stack of 6 blocks and the next 3 blocks. You need to clarify with her. Her tests where difficult if you didn’t know your growth & development forward and backwards. If you can get a jump on it, do it!

FitMom – From what I understand Catonsville is a bit different then Essex, but in a good way. When I failed Concepts 1 I had to go to Catonsville to speak to the retention officer. I can’t remember her name, but she had white hair and glasses. She handed me all these study sheets Catonsville uses, I wished Essex offered the same thing. I give you and all the other parents who go to nursing school big props!!! YOU CAN DO IT!

Hi Again! I apologize in advance if I am rambling or not making sense, its past my bedtime =^.^= Nursefelly in my program there were several students who had jobs similar to yours and they did fantastic. Looking back I think I made things a lot more difficult for myself in nursing school, hopefully you guys will learn from my mistakes. Again not trying to scare anyone, just being honest. Find a place to study with no distractions. I tried to study at home and was not very successful. My bed a few feet from my desk was always calling my name, or I had to get onto Facebook, or I had to watch NCIS because I hadn’t watch TV in weeks, or my Niece needed to talk to me, or my mom wanted me to check her blood pressure…. Go the Library. If you get distracted with the Internet, don’t take your computer with you. It wasn’t until my last semester that I stopped stressing over my notes. I had a bit of OCD when it came to notes. I would import the ppt into Word, format the page, and add notes from class and notes from my reading. What ended up happening is I spent all night formatting my “notes”, that I didn’t do very much reading, let alone re-reading my notes. What I learned to do was print the ppt in the “note” format. (This is where there is a slide at the top of the page and half of page is blank for note taking). Use one color pen in class & another color for notes from the text book, or whatever works for you. Just don’t waste time trying to make everything look pretty. This is Nursing School! Things are Dirty! *CODE BROWN* Record your lectures in class and listen to them when you can. I would listen to them on my 45 commute to work/school. Take advantage of the teacher’s office hours and e-mail. Tell them you’re just not grasping whatever topic and ask for some clarification. In Fundamentals you learn the basics of nursing. It’s a lot of content and they do not spend a lot of time on each topic. One of the most important things a nurse does is assess her patient. We had one lab dedicated to it and my teacher spent the entire two hours on the head. We never got to the rest of the body (lung sounds, heart sounds, edema etc.). I struggled with my assessments for two more semesters until I finally pulled my clinical instructor to the side and asked her to do one with me. Learning how to move patients in and out of bed is similar. What I recommend, if you feel like you didn’t learn everything you needed in lab, when you get to clinical talk to your instructor and ask her if she could spend a day showing you guys how to do assessments, and a day on how to safely transfer a patient. Sometimes I would ask the tech’s. We would spend half the day giving some one a bed bath and changing their linens when techs can do it in 10 minutes or less. Ask the Pro’s. Try to think things through. Like I said earlier, you can’t just memorize everything. The questions you will have to answer require you to critically think. So if you can visualize how a system works, talk yourself through it, ask yourself questions… why when my blood pressure drops, does my pulse go up? It will help you answer questions better. I was a loaner. I didn’t do study groups, but the ones that did, did well. If you’re not grasping a topic, pick up the Prentice Hall book for that class. It’s like cliff notes and it gives you pre & post questions with rationale! And check out your ATI books, they are down and dirty with the basics and you will have to take ATI tests anyway. Take your notes to clinical. Once you are comfortable with clinical and you get an idea of how your instructor is, bring your notes and study when you can. Once I started Concepts it seemed like my entire clinical group was giving out meds every day. So we spent a lot of time hovering outside a patient’s room waiting for my instructor to mosey on by so we could hand out meds. We would review our notes on our clipboard, and sometimes we could get our clinical instructor to go over topics we had a hard time with in post conference. Also, clinical are 8 hours. No nurse spends 8 hours in her patient’s room; she has 6 patients to take care of. In fact some patients are a little irritated a student spends so much time in their room (some love it though). So go in, do your assessment, change those linens and give them their bath (though they have a right to refuse one *wink wink wink*, as long as you ask them).. give them their meds and then get out of that room. Help your classmates if they need help. Then find a nurse who can teach you things and follow her around. I so wish I made friends with those nurses. They can teach what it really means to be a nurse and possibly give you tips or a point of contact when you are ready to apply for a job! Do not show fear during clinical. :) Some of those clinical instructors have a bit of a sadistic streak. I was terrified during my first clinical rotation and my instructor new it. She gave me an Egyptian doctor as a patient once who quizzed me every minute on why his urine was orange (because he was on Pyridium *pumps fist* I remember that from lecture). Half of my clinical group dropped out. She was one of the hardest instructors I had, but looking back she was one of the best. Just do your best! Figure out what she is looking for and give it to her. Don’t let them intimidate you, they’re trying to see if you can handle the pressure. Soldier on! The first few weeks of nursing school will be a bit of a shock. I’ll be honest. I had no idea what a nurse truly did. I never heard of nursing diagnosis before, and I didn’t know what a care plan was. It can be really overwhelming, and it is hard, especially if you do not have a support system at home. But just remember, you worked very hard to get into the nursing program. They picked you. When things get tough, re-group, re-prioritize, think things through and remember its only two years. YOU CAN DO IT!

Congrats to everyone! I graduated CCBC Essex in 2013, and it was hard! I worked full time and didn’t really have any idea of what I was getting myself into. If I could offer a few words of advice it would be: Fundamentals is a gravy train, do not think the rest of the semesters will be the same! My first exam in concepts one was on DM with Ms. M. I did fairly well on the test and thought the next exam would be the same. *WRONG* Ms. Thompsons F/E exam was tough! I ended up failing Concepts 1 by .5pts ! CCBC does not give breaks, when they say you need an 80 to pass the class, they mean it. If you can afford to not work, then don’t. I had to move back home with my parents and drop my hours to 30 a week to keep my insurance. Now looking back, I should have gotten a job as a tech. Most hospitals will give you insurance if you work 16 hours a week (2 days, or 1 longggg day). Working and commuting like I did, it was hard to focus in class and even harder to study on my own. Take advantage of whatever resources they offer. Study Groups, Study days before class, Books with NCLEX type questions (the sooner you master these types of questions, the easier testing will be for you)… Tutoring, VEN diagrams, Diagrams on Pharmacology etc. To understand how things work, you really do need to look at the bigger picture – you may need to brush up on you’re A/P, or spend a little time on Youtube, or google some animations to full understand a concept. Memorizing content is great, but you need to put it all together on the exams. (Example: Learning how heart pumps blood into circulation will help you fully understand concepts like preload, afterload, cardiac output and how some cardiac medications work. The same goes for learning about ABG’s and how the body exchanges oxygen & carbon dioxide. If you can try to visualize what is happening inside your body, it will help you answer some questions easier. Concepts 3 - Randy Weir *sp* is a great teacher, but her ppt’s are literally from the smeltzer website, jazzed up with some of her content. Her tests are from the text book. So you really do need to read the textbook when it comes to her. Concepts 3 - Community Nursing with Ms. Hill. Sweet Baby Jesus I am sorry, you just have to soldier through it. You will NEVER FORGET these classes, though you may wish you could. Ms. Hill’s test was hard. She expects you to look at all her modules and extra content she gives you. She will have you do a web based module; there are optional practice questions at the end. I suggest you do them because some of those questions are on the exam. Concepts 3 – Cancer class. A Oncology nurse taught the class and she was awesome, but the exam was written by Ms. Hill. Really study your pharmacology for this exam. During Clinical try to do as much as you can! Not all clinical instructors are the same. There are some really great ones, and then there are some that just want to sit around and check off med’s while you spend 2 hours trying to give someone a bed bath. Those instructors are there to work for you. If you want your teacher to find you some Rhonci lungs to listen to, you ask her. If you don’t understand how coverage works with insulin, ASK. If you didn’t get to put a catheter in yet, ask the nurses on the floor to let you know if they have one, and tell your teacher you really want to do it. I sincerely regret that I did not do these things. It seemed every semester I just had normal patients with nothing too exciting going on. To be honest I was somewhat terrified, and relieved that my days weren’t too hard, but looking back, I regret it. I wish I made a teacher sit with me when I did my assessment and make sure I wasn’t missing anything, or asked what you do when you have a combative patient. Just because I didn’t experience it in clinical, doesn’t mean I won’t once I’m on the floor. Also – don’t be afraid to ask the nurses questions. Some of them put off a “leave me the heck alone” vibe, but others love to show students things. Find these nurses and stick to them like glue. Get a job in the hospital before you graduate & Network. It wasn’t until my last class that my teacher said we’re going to start recommending students spend more time networking during fundamentals. (THANKS A LOT CCBC). This is the best way to get a job as soon as you graduate & refine your skills. It’s hard finding a job as a new graduate. I still haven’t found a job yet and there is a lot of competition. I hope that helps and doesn’t scare anyone. I don’t mean to scare anyone, I just don’t want to see people making the same mistakes I did! Good Luck!

I also am looking for more info on BWMC. Can anyone answer question about rate of pay and add any info on working conditions? Also what type of questions should we be prepared for during the interview? I had an interview at a Medstar hospital and was caught off guard by the questions they asked. They definitely were not in my professionalism text book =) Any advice is appreciated.