Nursing Careers Beyond the Bedside
Refresh Yourself with a Nonclinical Hospital Role
When providing bedside care loses its luster, working in a nonclinical specialty can renew your love for nursing and draw on your clinical experience. The following positions exist at most healthcare institutions and are well-suited to experienced nurses. However, only a few such jobs may be available at a given facility.
Case managers choreograph all aspects of patient care, coordinating the nurses, doctors, therapists and other practitioners who treat patients. As hospitals discharge patients more quickly and managed-care organizations increasingly oversee patient care, the need for case managers has blossomed. The aging population is generating more opportunities in long-term care and home healthcare as well.
"The demand for nurse case managers is tremendous," says Margaret Leonard, MS, RN,C, FNP, a certified case manager and board member of the Case Management Society of America. She notes that some employers are becoming more discriminating, looking for nurses who have both strong clinical experience and certification in case management.
The two primary certifying bodies are the American Nurses Credentialing Center and the Commission for Case Manager Certification. Other certifications are available through specialty associations, says Leonard, vice president for clinical services for Hudson Health Plan in Tarrytown, New York.
Since they're expected to achieve the shortest possible patient stay with the highest possible outcome, case managers must be proactive and able to evoke change. These professionals should be patient, extremely diplomatic and politically astute.
Clinical nurse educators help patients and their families understand the patient's condition prior to discharge, and they work in such outpatient areas as cardiac rehabilitation, diabetes education or childbirth preparation. Besides orienting and supervising new nurses, clinical nurse educators conduct in-service training for staff nurses.
Most clinical nurse educators possess at least a BSN as well as advanced clinical training in a specialty.
While they must be patient and able to write education plans, nurse educators must enjoy teaching and, above all, have a passion for their profession. "That passion comes through when you teach," says Diane Goodman, BSN, RN, a clinical nurse educator for Lake Forest Hospital near Chicago. "Your students pick up on it and become passionate, too."
"Is there a better way of doing this?" Nurses involved in quality improvement constantly ask that question as they review a healthcare institution's methods and processes. Their work is evidence-based and outcome-focused. By studying patient populations, they analyze systems to determine how to correct problems and improve quality of care. In short, they strive to prevent future problems by studying past mistakes.
Employers commonly look for a bachelor's degree in a healthcare field and possibly a master's. "Many facilities don't require certification or even realize that it's available," says Joan Boldrey, RN, MEd, MS, a certified professional in healthcare quality (CPHQ). Employers that do know about certification consider it "the gold standard," says Boldrey, senior market medical expense management specialist for UnitedHealthcare in Urbandale, Iowa, and a board member of the Healthcare Quality Certification Board, which oversees CPHQ testing.
Closely tied to quality improvement, risk managers also search for the root causes of mistakes to help improve systems and processes. With the upsurge in medical malpractice suits, opportunities for risk managers are increasing at hospitals, insurance companies, ambulatory-care surgical centers, long-term-care facilities and home-care companies.
Working with top medical and administrative staff members, risk-management nurses review patient records before and after lawsuits are filed. These pressure-cooker jobs require immense patience, tact and political savvy plus excellent communication and writing skills. "Risk managers need to be leaders with good conflict-resolution skills," says Kenneth Nanni, PhD, program director of the healthcare risk-management certification program at the University of South Florida Health Sciences Center.
Most risk-management nurses hold at least a bachelor's degree and risk-management certification, which is available from the American Hospital Association Certification Center, the American Board of Quality Assurance and Utilization Review Physicians and colleges, such as the University of South Florida.
Experienced nurses can fill these other nonclinical positions typically found in hospitals:
- Chart Auditors: Financial chart auditors review patient charts after discharge to ensure appropriate documentation for proper billing and coding. Others work in quality management.
- Patient Advocates: Working on the customer-service front lines, patient advocates handle patient complaints.
- Mentors or Preceptors: More and more hospitals are creating formal positions for experienced nurses to guide new nurses through that critical first year on the job.
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- Up-and-Coming Nurse Niches
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