Nice job: Nursing off the beaten path

Telephone Triage
Nurses don’t always have to be hands-on to help. Call center nurses (some of whom work from home) offer triage and health advice over the phone to those in need, using their extensive knowledge to make recommendations. Among the clients of Alicia McGrath, RN, a call center manager and triage nurse for Medcor, Inc., are retail businesses, restaurants and construction companies, which contact her when they need advice for injured or ill employees. She then makes recommendations on the steps the employer should take to assist their employees. (If it’s a life-threatening situation, of course, they’re advised to call 911.) Call centers also answer questions about adverse effects from drugs (“pharmacovigilance”) and medical devices.

McGrath and her colleagues come from all kinds of backgrounds, but work in urgent or acute care is helpful. “You need to be able to visualize injuries,” says McGrath. This niche nursing specialty has also proven popular with people who have strong computer skills—most call centers use triage software—or, as McGrath notes, who have paid their dues in high-pressure nursing jobs and are looking for something less demanding or with a better schedule. Given efforts to keep healthcare costs down, the field of call center nursing is definitely growing. “It’s the wave of the future,” says McGrath.

There are many triage call center companies, including Medcor, Inc.

The Jet Set
Patients come from all over the world to partake of healthcare in the United States and flight nurses are often instrumental in bringing them here. The idea of jetting around the world can be alluring. “But those who come to it enamored of flight quickly realize it has little to do with seeing the world,” says Christopher Manacci, ACNP, acute care nurse practitioner manager of the Cleveland Clinic’s Critical Care Transport and clinical director of the ACNP/Flight Nursing program at the Frances Payne Bolton School of Nursing, Case Western Reserve University, in Cleveland, Ohio. There isn’t exactly time for sightseeing since you may only be in the country 14 to 20 hours, and the conditions aren’t always ideal. “Sometimes we land in rugged places where people wouldn’t park their car,” Manacci notes.

“The biggest part of the job is using your therapeutic thought process to get a patient where she’s going safely,” he continues. Patients onboard a critical care helicopter or jet may require ventricular assist machines, intra-aortic balloon pumps or other special devices. Unlike nurses in bricks-and-mortar establishments, flight nurses need to use what they have (there’s no calling the pharmacy 5,000 feet aloft), and so must be creative and resourceful. “It’s very exciting, if you like that kind of excitement,” says Manacci. He clearly does, having brought patients back from locales as far-flung as Uruguay, Ecuador, Saudi Arabia and China.

Many other nurses also thrill to this line of work: There are more than 500 flight programs in the U.S. Besides having experience in intensive care and/or emergency medicine, the people best suited for this job don’t mind being immersed in the unknown: You never know when you’ll be called, or who or where your patient will be.

For more information, contact the Air and Surface Transport Nurses Association.

Nurse Detectives
One of medical auditor Rebecca Busch’s greatest coups was helping a client uncover a rent-a-patient scheme. Turned out, members of organized crime were paying employees with health insurance to have medical procedures (like plastic surgery), even though they didn’t need them. Some families spent as much as $500,000. “As a nurse, the last thing I thought I’d be doing was uncovering healthcare fraud,” says Busch, formally a trauma nurse in the Chicago area and the founder and president of Medical Business Associates.

Medical auditing, a growing field for nurses, involves reviewing financial and medical records to ensure that employers, government agencies, healthcare providers and individual patients are getting the medical services they’re paying for. Auditors also help attorneys understand medical bills and other facets of healthcare. Financial acumen is required for the job, but it’s something you can learn. “It’s a lot easier to take a nurse who can read a medical record and train her in finance than it is to take an accountant and train her to read a medical record,” says Busch, who once had to use the physical maneuvers she learned for moving large patients when a crooked pharmacist threw her up against a car. (Luckily, coming into contact with the frauds you’ve ratted out is a rarity.)

Medical sleuths can also help patients navigate the healthcare maze. Busch donates 10 to 15 percent of her time to people who are confused or taken advantage of by the system. “That’s the best part of the job for me,” she says. “I like educating people on how to be smart consumers.”

For more information, contact the Association of Certified Fraud Examiners or the American Association of Medical Audit Specialists.

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