Good news: The demand for ICPs appears to be increasing. Bad news: If you got the recent secret salary survey results from the MegaSurvey, you may be disappointed. I’d like to think that my qualifications speak for themselves, but it’s important that we speak for ourselves also. This is not an easy job, or not a job that’s easy to do well. It requires advanced knowledge and constant education. Because crap just keeps happening out there in the world. There is literally a new IC disaster of major proportions every year, if not more often. From Ebola (horrible), to meningitis from contaminated pharmaceuticals, measles and mumps outbreaks, Zika, endoscopes, whooping cough, CRE...it’s never ending.
So it’s important that your next employer recognizes your value, bringing all this apocalypse-averting knowledge with you. When you go for an interview, I hope you use the opportunity to interview the job, too. Don’t sit there like a scared duckling, trying to cross the road, hoping to not get hit. Ask questions. Because bad jobs suck. Employers are not likely getting a flood of qualified candidates when they post an ICP job. You are holding the cards right now. Get a good job.
I like to read other people’s CMS surveys. You can find some of them online here: http://www.hospitalinspections.org/. It’s like lawyers chasing ambulances: I want to see the gruesome ones. I want to see bad jobs where things go horribly wrong, so that it doesn't happen to me. Here is a piece of one that I keep posted on my desktop. Possibly one of the worst:
VIOLATION:
INFECTION CONTROL OFFICER RESPONSIBILITIES
Based
on the request of documents and interviews, the hospital failed to ensure that
there was an ongoing system in place for identifying, reporting, preventing,
investigating, and controlling infections which included the following issues:
• Failure to conduct ongoing active
surveillance.
• Failure to perform program evaluation and
revision.
• Failure to maintain a sanitary hospital
environment.
• Failure to maintain safe air handling in
sterile processing.
• Failure to practice safe food handling and
sanitation techniques.
• Failure to clean and disinfect environmental
surfaces.
• Failure to use
disinfectants, antiseptics and germicides in accordance with manufacturers'
guidelines.
The
findings are:
A.
Review of the Infection Control Program Manual did not indicate that the
hospital had an active infection control surveillance program. In interview on
04/13/11 at 9:45 am, the Acting Infection Control Officer (ICO) stated that she
walks around the hospital campus, takes notes and asks questions. However,
review of the Infection Control Log revealed that none of her findings are
recorded in that document.
B. On
04/13/11 at 9:45 am, during interview, the acting Infection Control Officer
(ICO) was asked several questions regarding her knowledge and understanding of
the hospital's infection control program. She made the following admissions:
• That she had not been to all parts of the
hospital during her rounds as the ICO.
• That she did not document
entries in an infection control log, but instead only sent e-mails to the
Director of Quality (DOQ).
• That no collection of
infection control data had been done. She stated, "I probably would not
have anything [infection control data] to show you at this time."
• That no analysis of infection control data
had been done.
• That she had not monitored any negative
trends identified from infection control data.
• That she does not have a
full understanding of how the infection control program is integrated into the
hospital-wide QAPI. She stated, "I have not had an orientation to how the
Infection Control program works with the Quality Assurance committee."
• That she identifies and
manages the Multi-Drug Resistant Organisms (MDRO), but just for the purpose of
"seeing what is growing."
• That she is unaware of how
the operating rooms, intensive care units and isolation rooms' air handling
system works.
• That she had not observed a terminal
cleaning of the operating rooms.
• That she had not observed
any aseptic technique practices used in the operating rooms while surgery was
being performed; neither had she observed any aseptic technique employed
outside of the operating rooms.
• That she has not observed
the sterilization process of surgical instruments. She admitted that she only
knows where sterilization of the instruments is done.
• That
she was not able to ensure that disinfectants, antiseptics and germicides were
being used according to manufacturers' instructions.
• That her orientation to the infection control
process has been inadequate.
The Director of Quality Management commented
on 03/29/11 that the acting Infection Control officer "has caught on to
the IC program very quickly and is doing a great job."
This is an infection control program that is NOT INTEGRATED into the facility’s operations. The ICP does nothing and nobody notices, not even her. If you are at your job and you are not pretty busy, something may be wrong. She doesn’t even know what she doesn’t know. If you fell into IC like this person, get yourself a mentor. Immediately. A certified, qualified mentor. [Or call me. I’ll Skype you through it.]
At your interview, you should ask: Who do I report to/ work with/ fall under and WHY? IC doesn't really belong anywhere, because it’s everywhere. Quality, nursing, education, patient care, administration? You want to know where you fit in. Above all, you want to know HOW INFECTION CONTROL IS INTEGRATED INTO THE FACILITY’S OPERATIONS. Ask a million questions, but get that answer.
Some facilities just don’t know what they don’t know. They simply do not have the infrastructure to run a hospital (or surgery center or care home, etc). Even a place with a small number of patients needs a strong structure with qualified staff filling key roles. And that costs money, and it’s hard to do when you have very few patients. Some facilities simply fail to recognize the value of the IC role, or at the very least, the CMS mandate to fill that role and develop a program. Some places pay lip service to the IC role, but offer no support.
An unsupported ICP role can be very lonely. You may find that there is nowhere to bring your issues, or no structure to get something improved or resolved. I often say, “I can’t wash their hands for them.” And I can’t. So how do you improve hand hygiene? You need a team, you need leaders, you need accountability. You can’t just walk around in a giant hand costume by yourself, trying to get staff to notice. It is very frustrating to work in a place that has no systems for action. If you are a team of one, who is helping you get things done?
During your interview, you want to ask how the IC piece fits their puzzle. When they are done asking about your strengths and weaknesses, ask “Can you tell me about a recent IC issue and how it was resolved?” If there are none, you should be concerned. Or this, ”How is the ICP informed about issues that arise?” If you get blank stares, this is not the job for you. “Can you tell me about a recent PI project regarding infection control? Who was involved in that?”
You want to know if you have support in your role. Not on paper, but for real. You want to talk to a few nurse managers on your second interview. You want to talk to the facilities director, maybe the kitchen manager. Who was involved in that PI project? You want to talk to them, and ask how they see their role in IC. Do not take a job where you will sit in an office writing policies, never looking at or dealing with any issues. Because you are still responsible for the issues, even if you don’t deal with them!
Where does your data go? If you have a million of one kind of infection, who knows about it, when do they know it, and is there a process improvement process? If there is moldy food in the patient refrigerators, and the nurses say Dietary should manage it, and Dietary says Nursing should manage it, what happens? That’s a real world, every day type of problem which will be labeled an infection control issue, which will land on your desk, and unless you plan on inspecting and cleaning out refrigerators every day, you need to know what happens next here. Do you have the authority to call a meeting? Is there an IC committee? Do you have liaisons or champions in different departments or units? If you ask nursing to manage it, will they? Who are they accountable to? Or are you out there alone (cue tumbleweeds)?
Do not be afraid to walk away from a position that isn’t right. There are more of them out there. If you do find a great job, where you will be respected as the infection-preventing, staff-educating, regulatory-reporting beast that you are, then be sure to tell them what you’re worth. Because they truly don’t know.
I hate to think that this female-dominated field is the victim of the gender wage gap...but seriously, it needs to be fixed. So pull out your MegaSurvey results, find that measly median salary number, and bump it. By 15% at least. That’s your asking price. You will not be sitting in an office crunching numbers. You will be improving patient safety, educating staff, and integrating infection control into the facility’s operations--from Purchasing, to Facilities, to Food Service, to Employee Health, to Patient Care. Show them what an integrated program looks like.
