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New and emerging roles for nurses.

Monday February 11, 2013
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In recent years, technological growth, healthcare reform and increased interest in issues such as behavioral change, patient safety and emergency preparedness have spawned new career possibilities for nurses. These jobs generally are for experienced nurses who want to expand their horizons.
The following are examples of emerging fields that present nurses with opportunities to use their skills in fresh ways to improve patient care.

Field: Care coordination

Care coordinator, care manager, transitional care coordinator, nurse care coordinator, patient care coordinator, patient navigator.

Job description: Care coordinators help patients navigate among multiple healthcare providers and systems, manage chronic conditions and avoid unnecessary ED trips. This may entail making appointments, tracking medications and lab results and educating patients and families about their conditions. Care coordinators almost always are part of a multidisciplinary healthcare team.

Education and experience: Transitional care coordinators, who work with hospitalized high-risk or fragile patients, often are master’s-prepared nurses. Most other types of care coordinator positions require at least a BSN and specialty experience, although nurses with years of specialty experience may not need a four-year degree.

Where to apply: Healthcare systems, medical offices, home health agencies, long-term care facilities and accountable care organizations all employ care coordinators. Healthcare reforms that reward facilities for preventing readmissions and unnecessary hospitalizations have spurred interest in the role.

Rewards and challenges: Care coordination is an alternative way to provide nursing care and make a difference in patients’ lives, said Doreen Esparza, RN, renal care manager at Kaiser Permanente Bellflower Medical Offices in Southern California. “This gives me an opportunity to still be involved with the patient even though I’m away from the bedside,” she said. One of the greatest challenges, she said, is getting patients to make lifestyle changes when they can’t see immediate benefits.

Resources: “The Value of Nursing Care Coordination,” by the American Nurses Association, at www.nursingworld.org/carecoordinationwhitepaper.

Field: Patient safety
Patient safety officer, patient safety nurse.

Job description: Patient safety officers develop, implement, monitor and maintain systems and protocols to reduce factors that contribute to adverse patient outcomes. They educate other practitioners on system-based causes of errors, lead safety assessments and share evidence-based patient safety strategies. The position is becoming more of an option for nurses, especially those with a background in risk management and quality care, said Patricia McGaffigan, RN, MS, interim president of the National Patient Safety Foundation.

Education and experience: In the past, most nurses learned about patient safety while on the job. Emerging patient safety programs allow students to formally study the science of safety and how it applies to healthcare. In larger settings, nurse patient safety officers usually need a master’s degree or higher, with certification in patient safety.

Where to apply: Large facilities are more likely to have stand-alone patient safety officer positions, though the job sometimes is combined with another position, such as chief nursing officer. Some hospitals hire patient safety nurses to improve and maintain safety in specific areas such as OB/GYN or the ED. Private healthcare companies also may hire nurses as patient safety experts.

Rewards and challenges: “You get to make things safer for patients,” said Jane Englebright, RN, PhD, chief nursing and patient safety officer and vice-president of the clinical services group at Hospital Corporation of America. “You can see the changes, and how errors are no longer happening.“ But if the administration is not supportive, and the staff isn’t sure what the mission is, improving patient safety can be a struggle, McGaffigan said.

Resources: The National Patient Safety Foundation website at www.npsf.org.

Field: Disaster and emergency preparedness
Emergency preparedness director,emergency management director.

Job description: Emergency planning and response has evolved rapidly since the 2001 terrorist attacks on the World Trade Center and the Pentagon. Many healthcare organizations have emergency preparedness managers who develop and test systems for responding to everything from multifatality traffic accidents to natural disasters to disease epidemics. They coordinate with other responders in the community, schedule drills and develop protocols. During an emergency, they guide implementation of plans, assess those plans and make changes to better prepare for the next emergency.

Education and experience: Some schools offer master’s degrees in the field, but it’s hard to get a full-time job with a degree only. Most employers want people with experience in disaster training and emergency preparedness, said Gina M. Smith, RN, director of emergency management and preparedness at UMass Memorial Medical Center in Worcester, Mass. Experienced BSN- or MSN-prepared nurses with emergency management certification, training and volunteer experience with local emergency response groups and preparedness committees make great candidates for jobs in emergency management, Smith said.

Where to apply: Almost all large healthcare systems have emergency preparedness directors. Smaller organizations may have part-time positions in conjunction with other roles. Schools, large businesses, local governments and community organizations also may have disaster planning positions.

Rewards and challenges: Smith worries that when budgets get tight, emergency preparedness programs may be at risk. But as the programs prove their value following new disasters, she expects the field to grow and expand.

Resources: The Federal Emergency Management Agency at www.fema.gov.

Field: Coaching
Nurse coach, health coach, lifestyle coach.

Job description: Nurse coaches help clients define and achieve goals through evidence-based behavioral change techniques. Coaching may be done in person, by phone or by video calling. Coaches usually focus on health and wellness issues, but also can support staff or faculty development, business development or general lifestyle goals. Nurse coaches may specialize in specific types of clients, such as families with children with autism or people who want to lose weight.

Education and experience: Certification is available through the American Holistic Nurses Credentialing Corporation (www.ahna.org). To become certified, RNs must have: a bachelor’s degree, two years of full-time active practice as a nurse or a minimum of 4,000 hours over the past five years, 60 hours of nurse-coach training and 60 hours of supervised nurse-coach experience. Coaches should receive a minimum of 10 hours of personal coaching to understand the process, said Darlene R. Hess, RN, PhD, AHN-BC, PMHNP-BC, ACC, nurse coach and director of Brown Mountain Visions in Los Ranchos, N.M., and co-author of “The Art and Science of Nurse Coaching.”
Where to apply: Many coaches are self-employed, working with individual clients or contracting services with private companies. Most staff positions are with health management organizations, but Hess said more universities and healthcare facilities may be interested in hiring nurse coaches.

Rewards and challenges: “It involves working with [people] and helping them access their own internal resources as well as external resources,” Hess said. The challenge for nurses is adapting to a model in which the client directs the care plan and the RN offers advice and resources when the client requests them.

Resources: The International Nurse Coach Association at www.inursecoach.com.

Field: Informatics
Chief nursing informatics officer, chief clinical informatics officer.

Job description: Chief nursing and chief clinical informatics officers figure out how to implement technology to improve care quality. They keep abreast of the latest trends, look for system problems and find ways to solve them. They work with vendors to ensure technology meets the facility’s needs and work with management to implement, assess and improve systems.

Education and experience: Most CNIOs and CCIOs have informatics backgrounds. They are at least bachelor’s-level prepared, with many organizations requiring a master’s degree or higher. Most nurses in these positions started out in tiny informatics departments and took on more responsibilities as the technology expanded, said Cheryl D. Parker, RN-BC, PhD, FHIMSS, CNIO for Rubbermaid Medical Solutions and a contributing instructor in nursing informatics for Walden University’s MSN program. She expects in the future nurses will need certification and higher degrees for this position. RNs interested in a CNIO position at a large facility should have solid clinical experience, at least a master’s degree and certification in informatics, she said. Nurses coming into the field should focus on analyzing and applying the data collected in electronic medical records to assess and make improvements in care, Parker said.

Where to apply: Large healthcare systems often will hire a nursing informatics officer and a medical informatics officer. Smaller systems may hire a CCIO — a physician or a nurse — to oversee medical and nursing technology. Some healthcare product companies hire CNIOs. As healthcare technology expands in areas such as community health, home health and long-term care, more nurse informatics specialists will be needed, Parker said.

Rewards and challenges: “The whole challenge and the whole reward is around redefining healthcare and how we provide technology-enabled healthcare,” Parker said. “Being part of that growth and change is wonderful.”

Resources: The Healthcare Information and Management Systems Society at www.himss.org.

Cathryn Domrose is a staff writer.Write to editor@nurse.com or post a comment below.
Are you ready for something new?

New fields including informatics, care coordination and coaching provide possibilities that didn’t exist 10 years ago, and because of healthcare reform, technology expansion and an aging population, opportunities for nurses are expected to keep growing.

In addition to education and experience, emerging fields require require foresight, commitment and, at times, a willingness to convince employers of the value of a position that had not previously existed.

“It has to be something you believe in,” said Gina M. Smith, RN, director of emergency management and preparedness at UMass Memorial Medical Center in Worcester, Mass. Smith loved her job as an ED nurse and never imagined leaving the bedside. But after she joined a federal Disaster Medical Assistance Team and assisted in the response to the 2001 World Trade Center terrorist attack in New York City, she became convinced healthcare centers needed to start preparing for emergencies rather than just responding to them.

Her manager agreed and gave Smith eight hours per week to focus on planning drills and assessing the department’s readiness to response to an anthrax attack or other emergency.

Eleven years later she is responsible for full-time emergency planning for the entire facility. She also heads her regional DMAT team.

Here’s some expert advice for nurses who want to expand their horizons:

• Ask yourself where you want to be in five years? Do you want to be pushing for a quality initiative, caring for a certain patient caseload, or working more independently? If your goals are to retire or pay off your bills, it’s probably not the right time to make a career move.

• Join committees, organizations and nursing associations in your field of interest. This will help you determine whether you like a specific type of work and make connections. Talk to nurses who do the job you are interested in and ask how they achieved their goals. “One of the top questions to ask them is, ‘What do you love about this type of nursing?’”, said Cheryl Wagner, RN, PhD, MSN/MBA, associate dean of graduate nursing programs at American Sentinel University in Colorado.

• Complete your education requirements. If your dream job requires an advanced degree, plan how long it might take to earn and how much it will cost. Many schools offer online courses, and your employer might give you time off to get the degree. Find out what certifications you may need. In some cases, you may only need a certification to practice in a certain field, but if you want to teach, you will probably need a degree, Wagner said. If you want to be an entrepreneur such as an independent practitioner, consultant or health coach, consider an MBA or business classes.

• Use your experience as a steppingstone to a new field or setting. Often nurses discover something in their job that sparks an interest. Doreen Esparza, RN, became a renal care coordinator at Kaiser Permanente Bellflower Medical Offices in Southern California partly because as a chemo dialysis nurse she saw how patients needed help navigating a complex system.

• If the job you want doesn’t exist, try to persuade your employer or a contracting company to create it. But be sure to do your homework before presenting your proposal, Wagner said. For example, use research to show how a patient safety nurse prevents errors or how a health coach helps improve employee well-being.

• Watch the headlines to see what’s coming in healthcare. Keep up with nursing research and policy-making reports, such as those produced by the Institute of Medicine, Wagner said. Follow nursing association websites to stay abreast of healthcare trends and new laws, and what those might mean for nursing. Think ahead to logical next steps.
For instance, after electronic health records are installed, someone will need to figure out what to do with all that data, said Cheryl D. Parker, RN-BC, PhD, FHIMSS, chief nursing informatics officer for Rubbermaid Medical Solutions and a contributing instructor in nursing informatics at Walden University. “Data analytics in the coming years is going to be huge,” she said.