Experienced Clinical Documentation Nurse Consultant Samantha Ryan reflects on the leap from clinical nurse to CDS.
The Australian CDI profession is enriched by CDSs from a wide range of backgrounds. However, for those with a clinical background, the change from a clinical to a non-clinical role can be difficult. The clinical world is unpredictable and challenging, often with no two days being the same. However, there is a sense of structure, identity, and clarity within its unpredictability. Transitioning from this to the role of a CDS can present new challenges.
A New Structure
As a clinical nurse educator and specialist, I was well accustomed to thinking on my feet and adapting to change, and these skills were easily translatable to my CDS role. However, I had been direct care nursing for around twenty years and was used to the largely structured routine that any rotating roster affords. To someone who hasn’t worked a shift work role, this might sound like an oxymoron! However, shift work allows you to plan ahead, leave your work behind you when you head home, and, most importantly, go to the bank and the post office!
When I started the CDS role, suddenly my working hours were Monday to Friday. This was something I had never really experienced, and it took some time to adjust to. I really embraced this new structure and I enjoyed incorporating some early mornings into my week. This helped me to engage with specific VMOs that conducted early rounds, and this helped as it felt like I was on an early shift.
A New Identity
When I commenced the role, it was decided also that I would not wear the hospital uniform. This was a big thing to get my head around. I had worn a nursing uniform since 1992! It contributed to my identity as a nurse, and not wearing it made me feel out of place and quite vulnerable. Here I was, a new CDS in a role that nobody had done before within the hospital, newly trained, and feeling, let’s face it, scared! Without the uniform to identify me to others, I felt like a student on my very first prac!
One of the reasons I love my job with CDIA is helping new CDSs find their identity. In our one-on-one Coach sessions, I get the unique opportunity to be with the new CDS as they make the transition to their new role. It’s wonderful when I observe that moment that they find their confidence and realise the difference they and the CDI program can make to the patients, staff, and the organisation.
“Am I doing it right?!”
Often CDI programs and the role of the CDS have not been seen before within healthcare organisations. A CDS can feel a sense of not doing enough or wondering “am I even doing this right?”, and this is often apparent in the initial stages of taking on the role. I felt very lucky as I worked in a team, this really helped me when I did have these feelings of “am I doing this right??” as I had others to bounce off and share with.
In addition to feeling overwhelmed with new knowledge, and what is essentially a new language, the CDS is also grappling with a sense of needing to demonstrate their purpose. This pressure can often lead CDSs to question if the role is right for them and this can be awfully unsettling. It is essential that the CDS is well supported in this initial period, not only from within the organisation but also from external sources such as a mentor, community, or coach program.
When delivering CDS training, I enjoy really putting the CDS role under the microscope. We look at CDI processes and talk about opportunities and challenges that the CDS role brings. This helps the CDSs understand what their actual day-to-day work might look like.
I was extremely fortunate to work within a very dynamic CDI team. There was a real drive to succeed and address the behaviour behind documentation through education and positive engagement. Saying that, I did still find myself having an occasional wobble and second guessing myself! That self-doubt was very uncomfortable for me.
During my coach sessions, I encourage CDSs to identify their pain points and concerns as well as the areas where they feel confident. We use these sessions to encourage, support, and strategize to assist CDSs to forge their own pathways during these periods of uncertainty.
“What is it you do anyway?”
Relationships change, and dynamics alter. Medical and nursing staff that I had previously known well were wary of my new CDS role. A lack of understanding often contributes to challenges around engaging with clinical staff. Clinicians who knew you in your clinical role may find it difficult to relate to you in your capacity as a CDS. This is especially true if the clinicians don’t see value in the CDI program.
To combat this, it’s important that CDI programs have the backing of their executive team. The CDS themselves also needs to take ownership of defining themselves in their new role, and this can be both exciting and perturbing at the same time. For me it was a case of engaging with the early adopters and chipping away at the relationship I had with those that were wary of my role. The most successful outcomes I experienced was when I made CDI meaningful to those that I engaged with.
“Where do I belong?”
Frequently CDSs feel a sense of isolation and lack of belonging, particularly if they are practicing independently in their role. This can apply to CDSs that are both new to the organisation and those that are recruited inhouse. Feeling like this can really feed into those areas that have already been mentioned in terms of questioning yourself, struggling to define your role, and getting used to a new structure.
The CDS role engages with so many different teams: health information management, clinicians, executive, safety and quality…the list goes on. While this is a dynamic and exciting place to be, it can make the CDS feel that they don’t quite “fit” anywhere. My experience was that I had enjoyed a strong sense of ‘team’ and connection within my clinical environment and also with my team of educators. These bonds remained strong throughout my role as a CDS and there were many times these connections I had not only enhanced my development professionally, but positively impacted the CDI team as a whole.
We know that CDI programs rely on a strong collaborative relationship between the health information manager, the clinical coding team, and the CDS. Strong pre-existing bonds within these teams may make you initially feel like an outsider. Coders may feel threatened by the CDS role particularly if they haven’t been educated on the program’s processes and aims.
I have learnt that CDI program success comes when there is sharing of knowledge and inclusivity. Hospital wide clinician education can really raise the profile of the Health Information team. Not only does this add value to the program, but it often facilitates a sturdy relationship with the CDS. Often the most positive outcomes arise when members of the clinical coding team attend the sessions.
Final Thoughts
Having shared with you my own experiences of adapting to a CDS role, and looking at some of the challenges it may bring, I want to reassure you that the role is pretty amazing, and I wouldn’t change my experience for anything! I celebrated as a CDS, and continue to celebrate every day in my current role, how CDI programs ultimately increase transparency in the medical record, contributing to the delivery of safer care to every patient.
Sam’s Top Tips for Adapting to the CDS Role
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