What Is Utilization Review?

What Is Utilization Review?

Nurses working in busy clinical arenas often hear about nurses who have left the floor to work in administrative departments. Such nurses may be encountered when they come requesting an update regarding a patient’s condition. However, most clinicians are far too preoccupied with their own responsibilities to learn what those nurses actually do or where they fit in their patient’s care continuum.

Utilization review is one of the least understood but incredibly essential departments in managing the cost of health care. Experienced nurses can bring a valuable perspective to this field.

How Does Utilization Review Fit into The Big Health Care Picture?

Utilization review nurses perform frequent case reviews, check medical records, speak with patients and care providers regarding treatment, and respond to the plan of care. They also make recommendations  regarding the appropriateness of care for identified diagnoses based on the research results for those conditions. Furthermore, they also assist with determining whether a treatment meets the criteria for reimbursement by the insurance plan.

Utilization review nurses are also found in discharge planning roles to ensure that patients make a safe transition from acute to home care. They are involved in pre-certification, which determines whether a recommended procedure, medication, or therapy is appropriate for an individual according to the guidelines of their insurance plan.

How to Move into Utilization Review

The minimum credentials for working in utilization review are being licensed as a registered nurse and having a good base of general nursing experience in medical-surgical nursing. Many employers require a BSN over an associate’s degree, and sometimes specific certifications in utilization review or risk management.

Good communication skills, attention to detail, and the ability to excel under stress with minimal supervision are also critical for a successful utilization review career. Fortunately, on-the-job training is often provided for these roles.

The benefits of moving to utilization review can include a more regular schedule, a predictable salary, and perhaps even the ability to work remotely.

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Going Corporate: Becoming a Clinical Consultant or Educator for Medical Device Companies

Going Corporate: Becoming a Clinical Consultant or Educator for Medical Device Companies

Moving Nurses Out of Traditional Roles

Nursing careers can take us to creative places beyond the bedside , ED, or OR. For instance, certain specialties lend themselves to medical device and pharmaceutical corporations to serve as clinical support consultants and sales representatives. Particularly, these include critical care, cardiology, emergency care, wound care, and diabetes education.

Nurses Uniquely Qualified to Transition

Nurses are well-versed in basic science and human pathology and have first-hand experience with many of the products themselves, enabling them to bring their unique perspective to these roles. The job requirements and education may vary, but they commonly require at least a BSN degree.

Be Prepared to Go Mobile

These professionals often work remotely, so computer fluency is a must. Competency in Microsoft Office and G Suite is expected, while the industry’s predominant use of apps like Evernote, Slack, or Trello require you to be a smartphone and tablet superuser, too.

Speak Up! Personality Counts

An affinity for public speaking is crucial in medical sales and consulting. Speaking at seminars, trade shows, and in-services is common. Additionally, this field requires tenacity for success — you’ll need to discover your unique approach to what one medical sales professional calls “meaningful persistence.”

Travel is the Norm

These are mobile positions, so expect to spend significant time traveling locally, regionally, or nationally. Most likely you will be required to use your personal vehicle for travel and receive reimbursement for business-related travel mileage.

Regulation is Regular

Since health care is heavily regulated by the Federal Government, these positions often require regulatory reporting or audit duties. Therefore, you will need familiarity with any regulations pertaining to the device, medication, or equipment you’re representing.

These are just a few of the requirements for roles in medical sales and device consultation.

To explore other nursing careers, visit here.

Could Dialysis Nursing Be in Your Future?

Could Dialysis Nursing Be in Your Future?

About 650,000 Americans are currently affected by End Stage Renal Disease (ESRD), and this number is increasing by 5% annually. The primary causes of kidney failure leading to ESRD are poorly managed diabetes and high blood pressure, the treatment options for which are limited to kidney transplant and dialysis. Unfortunately, there are currently more than 93,000 potential recipients on the kidney transplant waiting list and 80% of those individuals are on kidney dialysis while they wait.

Demand for Nurses is Growing

The specialty of nephrology and dialysis nursing continues to grow with these rising ESRD numbers. In fact, nephrology nursing is expected to grow over 25% within the next 10 years. These nurses can expect an attractive salary and a diverse working environment. Nephrology nurses might work on a typical hospital unit, but those who perform dialysis also work in dialysis centers, nursing homes, inpatient hospice centers, and even in-home health.

Nurses Develop Deeper Relationships with Patients

Renal failure is a chronic condition, so those who suffer from it must access care frequently. This means nephrology nurses will see their patients regularly. Dialysis nurses often have the ability to work with patients one on one, providing an opportunity to give care in a much more personal, attentive way. They also care for their patients through the continuum of the disease progression, so they get to know their patients quite well.

Certification and Advanced Education for Leadership

A nephrology nurse may elect to pursue certification or even further education and their Nephrology Nurse Practitioner certification. These nurses take their practice deeper, providing primary care for their patients who battle ESRD during dialysis and even after transplant—if and when that becomes possible.

There are plenty of worthwhile opportunities for nurses to make a difference in the lives of renal patients whose prognosis can be dire. Examples of such opportunities and further information on dialysis nursing can be found here.

The Unexpected Challenges in Labor and Delivery Nursing

The Unexpected Challenges in Labor and Delivery Nursing

Many student nurses become enamored with Labor and Delivery nursing and the infectious joy surrounding most births. This specialty, however, is not without its challenges to effective care. It requires nurses to remain vigilant and current on the advances in obstetrical care while working with pregnant patients from all walks of life.

Be Prepared to Teach

Many expectant women and young girls arrive unprepared for childbirth, having foregone prenatal instruction or obtained their childbirth education from the internet and YouTube. They may have misconceptions  that foster unrealistic expectations for delivery.

For example, in an effort to have a “painless birth,” an expectant mother may request an epidural in order to feel nothing at all. If not properly educated beforehand, she may panic as the loading dose of the epidural begins to wear off and she feels the pressure of the baby moving down. The primary responsibility for re-educating these women falls on the L&D nurse.

Go With the Flow

The pace of activity on the L&D unit can vary to extremes. There can be long lulls of relative inactivity suddenly interrupted by a dash to the operating suite. Potential emergencies can be as dire as a patient delivering prematurely due to deliberately rupturing her own membrane. Therefore, nurses must be able to perform well with the ebb and flow of activity and under a variety of circumstances. A nurse who needs constant stressors to stay sharp may not adapt well to these fluctuations. Fostering good teamwork is critical to staying attentive at all times.

Put Your Game Face On

Nurses in Labor and Delivery must also be capable of maintaining a calm demeanor and appearance even in the face of tremendous stress and even fear. For example, they must have the fortitude to deliver a stillborn infant and care compassionately for the mother, despite this being the most unpleasant outcome.

On most Labor and Delivery units, the nurses will look out for each other. They may take measures to protect each other emotionally where stillbirths are involved by sharing those assignments. This ensures that no one nurse is assigned a disproportionate number of stillborn deliveries.

To learn more about the ins and outs of Labor and Delivery nursing, go here.

Considering a Career in Forensic Nursing?

Considering a Career in Forensic Nursing?

Forensic nursing involves working with the aftermath of violent situations. Violence is both a health care and a legal issue, so this places forensic nurses in a unique leadership position to connect health care, science, and the legal system. Forensic nurses partner with law enforcement and other agencies to investigate and resolve events such as domestic violence, sexual crimes, child and elder abuse, homicide, and suicide.

What Education and Certifications are Required?

Registered nurses with an associate degree or a BSN and a good foundation of clinical experience can pursue this specialty through a certificate program or an advanced degree (MSN, DNP, PhD) and board certification. Forensic nurses also have their own professional association, the International Association of Forensic Nurses (IAFN), which provides opportunities for networking and professional development as well as education and certification resources. The Commission for Forensic Nursing Certification (CFNC) currently offers two certification options: Sexual Assault Nurse Examiner-Adult/Adolescent (SANE-A) and Sexual Assault Nurse Examiner-Pediatric (SANE-P).

What Do Forensic Nurses Do?

These specialized nurses work in emergency rooms, coroner’s offices, police departments, and even the FBI. They examine the victims of violent crime, collect and analyze evidence, and document injuries. How the nurse treats the patient—the victim of violence or the family left behind—can have a tremendous influence on the ability of that individual, their families, and loved ones to recover post-trauma.

Success Through Adaptability

Forensic nursing requires the ability to cope well with the stressors of working around extreme circumstances. The work involves public health, behavioral health, pediatrics, geriatrics, and even medical legal consulting. The versatility of the highly trained forensic nurse enables them to better care for those citizens who are most vulnerable in our society.

Interested in exploring various career paths for nurses? Visit the DailyNurse nursing specialties directory to learn more.