CDI Career Ladder Two Perspectives Janet M Gentle

CDI Career Ladder: Two Perspectives Janet M. Gentle, RN, BSN, MSN, CCDS Clinical Documentation Specialist 2011– 2012 Nursing Clinical Ladder Council Chair/Michigan ADCIS Co-Leader Mc. Laren-Northern Michigan, Petoskey, MI Jennifer R. Love, RN, BA, CCDS, CDIP Area Director, Clinical Documentation Improvement Kindred Healthcare, Greensboro, NC

Institutional Career Ladder Perspective: Promoting Excellence and Opportunity For Nurses in CDI and Other Specialty Roles Janet M. Gentle, RN, BSN, MSN, CCDS

Northern Michigan Regional Hospital (NMRH) Copyright © NMRH Graphic Gallery

NMRH Background • 2011 Magnet designated regional referral center serving 22 counties in northern lower Michigan and the eastern upper peninsula • 202 beds • 512 nurses • Patricia Benner’s Novice to Expert model of nursing is the foundation of the current nursing clinical ladders Benner, P. (1984). From Novice to Expert: Excellence and Power in Clinical Nursing Practice. Menlo Park, CA: Addison-Wesley.

Evolution of Nurses in Specialty Roles Clinical Ladder • January 2010 NMRH chief operating officer/chief nurse executive Mary-Anne Ponti, RN, MS, MBA, CNAA-BC, requested of the nursing clinical ladder council members that the clinical ladder process be expanded to include the NMRH non-direct care specialty nurses

Purpose • The purpose of the expansion of the direct care nursing clinical ladder to include nurses practicing in specialty roles (52) was to: • Promote equity in professional growth and development • Afford an avenue for clinical advancement to all nurses at NMRH

NMRH Nurses in Specialty Roles (NSR) • • Acute rehab Care management Clinical education Diabetes center Human resources Infection control IT application support Magnet program • NISUS research • Performance • • improvement Revenue cycle (CDIS) Service line management Stoma therapy Surgery

Nursing Clinical Ladder Objectives • Provide guidelines, opportunities, and support for career advancement • Provide alternative pathways of career development • Allow for upward mobility for nurses • Provide for a constructive, objective evaluation process

NMRH Nursing Clinical Ladder Copyright © NMRH Graphic Gallery

Methods • Human resources compiled a list of the nurses in specialty roles (52) • Interest was solicited among the NSR via a mass e-mail from the nursing clinical ladder council • A literature search for this type of specialty clinical ladder was conducted • A telephone survey of Michigan hospitals was completed

Result of Literature Search and Telephone Survey • There are many direct care nursing clinical ladders • There are some ancillary department career ladders • NO clinical ladders were found for nurses in specialty roles

The Edge of Discovery • The development and implementation of a nursing clinical ladder for NMRH non-direct care RNs/nurses in specialty roles had the potential for adding to the body of nursing knowledge by creating opportunity for professional growth among this classification of nurses where none currently existed

Formation of a Steering Committee • A steering committee was formed of: – Nurses in specialty roles (7) – Nursing clinical ladder council chair – A member of the nursing clinical ladder council – A human resources representative – A nurse manager representative • Monthly meetings were scheduled

Initial Process • The colleague performance appraisals of the NSR were compared using nursing process to assess for similarities in practice • The steering committee members discovered that although the NSRs have very diverse roles and responsibilities, their practices had many similarities upon which to build the NSR ladder requirement criteria

Nursing Process • Assessment – Data collection • Patient data • Quality measures • Statistics • Documentation – Fiscal responsibility • Planning – Education – Collaboration – Consultant role – Advocate: • Patient • Physician • Staff – Communication – Quality initiatives

Nursing Process (cont. ) • Implementation – Evidence-based practice – Analysis – Documentation – Program development – Resource management • Evaluation – Performance appraisal – Professional development – Data analysis/metrics – Leadership role – Performance improvement

Clinical Ladder Documents • Overview – minor revisions made • Checklist – minor revisions made • Peer feedback form – unchanged • Clinical ladder requirements – Level III, IV, and V combined and revised

Clinical Ladder Requirement Components • • • I Clinical expertise in specialty role II Knowledge III Leadership/credibility IV Communication V Productivity

Clinical Ladder Specificity Direct care RNs – Clinical ladder entry level for direct care RNs is Level I – Level II and III achievement are through natural progression for the direct care RNs based on years of experience & competence – Level I, III, IV, and V requirements are separate documents for the direct care clinical ladder Nurses in specialty roles – Clinical ladder entry level for NSRs is Level III due to the advanced nature and scope of their practice – Level III, IV, and V requirements were included in one document for ease of use

Level IV Eligibility Proficient • > 5 years of experience and meets or exceeds 85% of level IV ladder criteria • Bachelor of Science in Nursing preferred • Certification in current specialty within previous 12 months, OR • 35 Continuing Education (CE) hours earned with the previous 12 months, 50% of which must be in current specialty.

Level V Eligibility Expert • > 10 years of experience and meets or exceeds 85% of Level V ladder criteria • Master of Science in Nursing preferred • Certification in current specialty, AND • Working toward a higher degree in healthrelated field, OR • 45 continuing education (CE) hours earned within previous 12 months, 50% of which must be in current specialty

Application Process • Letter of intent and application form • Current Level IV or V colleague performance • • • appraisal Prior year’s goals with a statement of how they were met Two (2) peer feedback forms Level IV or V clinical ladder requirements Portfolio highlighting exemplary practice for bolded Level IV or V criteria based on level sought Interview with nursing clinical ladder council

Clinical Ladder Promotional Compensation • Direct care RNs receive an hourly wage • NSRs are salaried • Clinical ladder promotion is valid for a period of two (2) years at which time the ladder application process must be repeated • Clinical ladder promotional compensation: – Level IV = $1. 00 per hour – Level V = $1. 50 per hour – The award is added to the hourly base wage for both direct care RNs and NSRs

Implementation • Scheduled for implementation in January 2012 – Lengthy administrative approval process – Provision of education to the NSRs and their managers, many of whom are non-nurses • Many of the 52 NSRs expressed interest in applying for promotion • Current statistics through April 2012

Document Revision to Align With Magnet Components This revision is a 2012 work in progress • Magnet components – Structural Empowerment – New Knowledge, Innovations, and Improvements – Transformational Leadership – Exemplary Professional Practice

Contact Information • Janet M. Gentle, RN, BSN, MSN, CCDS Certified Clinical Documentation Specialist Michigan ACDIS Co-Leader 2011– 2012 NMRH Nursing Clinical Ladder Chair Northern Michigan Regional Hospital 416 Connable Ave Petoskey, MI 49770 231 -487 -7509 jgentle@northernhealth. org

CDI Career Ladder: Achieving Marked Individual Success & Distinction by Following Your Own Unique CDI Career Path Jennifer R. Love, RN, BA, CCDS, CDIP

Objectives: Individual CDI Career Ladder • Introduce CDI professionals to a variety of unique career opportunities in the field • Discuss CDI-related job searching & interviewing tips from trusted recruiters • Review CDI career Q&A from when I ‘queried’ fellow ACDIS members • Evaluate vital skills that preferred CDI employers are looking for

Pretest: True or False True False 1. Your networking abilities will be one of the real keys to successfully advancing your CDI career 2. It’s natural to feel unsure or insecure when considering a job change 3. A recruiter is someone hired to locate individuals with a very wide list of qualifications

Special Thanks CDI Search Group Devon Santoro & Scott Entinger 3 M Health Information Garri L. Garrison, RN, CPC, CMC, CPUR Accretive Glenn Krauss, RHIA, CCS-P, CPUR, FCS, PCS, CCDS, C-CDI HCPro, Inc. Lynne Spryszak, RN, CCDS, CPC-A, AHIMA-Approved ICD-10 CM/PCS Trainer Navigant Consulting Tiffany M. Murriel, BSN, RN, CCDS

My CDI Career Change Experience

Jennifer R. Love, RN, BA, CCDS, CDIP Kindred Healthcare Area Director – Clinical Documentation Improvement Source: www. Khgreensboro. com Link to explore job openings: http: //www. kindredhealthcare. co m/careers/job-search TRAVEL PROTOUCH LTAC CMR TRACKER Source: www. Kindredrichmond. com

Long-Term Acute Care Hospital Source: Kindred Healthcare License Acute hospital Manage critically ill Yes; tele monitoring, patients IV pressors, dialysis Medicare certification Long-term acute hospital Patient characteristics Typically after illness from resp. disease, stroke, or infection; many concurrent illnesses Admitting criteria Meets acute criteria Vent weaning major focus; established programs Length of stay An avg stay is about 25 days but may be shorter or longer depending on the pt’s needs Respiratory therapy 24/7 – in-house Yes Physician involvement Daily visits by internists with multiple medical subspecialties; consultation Rehab therapy Approximately 1 hour per patient day range 0– 3

When Is It Time to Move On? • Are my professional/personal aspirations • • • being met? Am I burned out? Is my pay not adequate? Am I frustrated with the lack of physician and/or administrative support? Is this still the “right” job for me? Am I reaching for my fullest potential? What is it that tips the scale to do a job search?

Reasons to Work With a Recruiter • Lack of time • Knowledge of the market • Human resources

Reasons to Work With a Recruiter • Helping understand your “value” in the market • Helping identify the “right” job for you in your CDI career as opposed to the “next job”

CDI Hot Jobs LTAC/ STAC Exposed! Interim positions. Outpatient Regional manager CDI consultant CDI Coding manager CDI educator. Traveling CDS . Associate director RAC coordinator

‘Getting Started’: Top Secret Tips From Trusted Recruiters v Give proper notice to your past employer v Don’t talk badly about your current employer v Speak to specific examples when interviewing v Be prepared for personality profile testing v Get business cards of everyone you meet v Take hard copies of your resume v Be prepared for CDI assessment testing v Send a thank-you e-mail after the interview

CDI Interview Questions: “The Favorite Five” 1. How have you managed to educate physicians and 2. 3. 4. 5. elicit physician response? What is your relationship with your coding staff like? How do you deal with multiple personalities/cultures? Would you consider yourself someone who has a backbone? What did you like least about your current job?

CDI Career Q&A #1. If you could explore a new direction of CDI, what would it be? • Lynne says: Auditing medical records for the OIG or working with the Department of Justice • Glenn says: Focusing more upon the clinical documentation from a quality of care and efficiency of medicine standpoint, as opposed to primarily focusing upon clinical documentation to enhance hospital reimbursement • Garri says …

CDI Career Q&A #2. How would other CDI professionals find out about openings at your corporation? • Garri says: We are anticipating new positions in preparation for the regulatory changes occurring in the next three years. http: //jobs. 3 m. com • Tiffany says: We anticipate openings for traditional CDI & support related to ICD-10. www. navigant. com

CDI Career Q&A #3. What would you recommend folks do when they think they may be ready to change CDI jobs? • Garri says: Really look at a facility’s objectives for the CDI, & ____ and _____ to assist them in their job • Glenn says: Decide where they wish to be and develop a road map to achieving their career goals and objectives • Lynne says …

CDI Career Q&A #4. In your opinion, what are the most desirable jobs in the CDI profession now? • Tiffany says: Ability to work from home. A position where they can leverage others’ strengths with CDI. (example: nurse educator, MBA, project manager). • Glenn says: Outpatient CDI opportunities in the face of the myriad of issues governing documentation requirements in support of medically necessary, cost-effective care delivery provisions.

CDI Career Q&A #5. What strengths are required in your field? • Tiffany says: Strong communication skills, _________ skills, negotiation skills, writing skills, technological skills • Glenn says …

Packaging Yourself for Success! What are preferred CDI employers looking for? q Knowledge of medical terminology, disease processes, & pharmacology q Quality & integrity skills q Knowledge of inpatient & documentation requirements for correct & accurate coding q Clinical expertise q Ability to make independent decisions q Thorough knowledge of the Medicare inpatient prospective payment system q Understanding of coding practices, official coding guidelines, & federal regulations

Packaging Yourself for Success! What ELSE are preferred CDI employers looking for? q Ability to work with all levels of personnel from coders to senior management q Proficiency in Excel, MS Word, & general PC applications q Auditing skills for coding quality & documentation q Ability to develop & present effective education via a variety of medias q Understand common coding/ sequencing errors & what to look for q Credentials! CCS, CCDS, CDIP, RN, RHIA, RHIT, BSN, BA, MHA, MSN, & more

MOST CDI SPECIALISTS (97% ACCORDING TO THE 2010 CDI SPECIALIST’S SALARY SURVEY) WORK IN SHORT-TERM ACUTE CARE (STAC) FACILITIES.

CDI STAC Pros Cons • You have the ability to create • Salaries fairly static • May be challenging to cope a niche where you are an expert • Sleep in your own bed every night • Comfort in going to the same place every day & knowing what’s expected with internal politics • Opportunities for professional growth may be limited or nonexistent • Hospitals all in a revenue crisis; jobs may be eliminated with no advance notice

CDI Consulting Pros • Get to meet lots of new Cons • You only have 1– 2 days/week people; great for networking to live your “real life”: laundry, later on family, etc. • Don’t get entangled in a • Sacrifice time with family & hospital’s politics—you’re only friends—miss lots of there for a short time milestones: birthdays, etc. • Gives you valuable • Many companies expect you experience & opportunity to to work 24/7: work all day & see “outside the box” of what all night, too, if the client you’re familiar with needs something

CDI Consulting Pros (cont. ) Cons • You accumulate lots of • Lots of downtime in airports frequent flyer miles & hotel points which can take you on vacation free • Money is typically beyond what a hospital will pay • Eligible for bonus incentives (depending on the company) • Benefits are usually good and wasted time • You begin to feel like a stranger in your own home because you’re never there • You live your real life in hotel rooms—sometimes not very nice ones

Who Am I? Name This ACDIS Advisory Board Member! • I am employed by • • Compliance Concepts, Inc. (CCI) I have published two books for AHIMA I am a mother of twins I love to SPIN for exercise I assist clients in governmental audits ? Donna D. Wilson, RHIA, CCS, CCDS

Questions? In order to receive your continuing education certificate for this program, you must complete the online evaluation which can be found in the continuing education section at the front of the workbook.