Country Mouse Goes to the City

After some time away, I went back about 6 months ago.   I had been working in a post-acute setting, helping a former director set up a good program.  When I accomplished that, I decided to move on.  Imagine my surprise to hear a recruiter tell me I was “not a competitive candidate” for a job in acute care since my last position was in post-acute. My job search took much longer than I expected, and I suspect this was part of the issue.  

It is unfortunate that hiring managers are often unfamiliar with the actual work of infection control.  Skills in one setting are nearly entirely transferable to another setting.  One doesn’t immediately lose all of their past knowledge when they haven’t used it in a couple of years.  Maybe you need to brush up on some things, but resources are readily available. I haven’t driven to Pennsylvania in a decade, but I know which direction to go, and I know where to find a map.  I didn’t forget how to drive, and I won’t end up in Toronto.

I was also looking for part-time work, which appears to be an infection control unicorn. I don’t know why employers don’t offer part-time positions in this field around here.  So I took a full-time job at a mid-sized academic medical center-- a little different from the community hospitals, rehabilitation, and psychiatric settings I was used to, but I wanted to work with other people.  I’d almost always worked by myself in the past.  It’s been quite a change in some ways, but there are really no infection control things that are different.  What I learned from working alone for many years is, well, everything.

Being the sole practitioner is a bit like being the country doctor.  They deliver babies, set broken arms, treat coughs and stomach pains, provide palliative and end of life care, and everything in between.  Same with the country ICP.  I’ve given thousands of flu shots as I’ve worked with Employee Health in the past.  This year, I gave none: we’ve got a department that manages that.  I’ve taken all that vax data, sorted it (sometimes by hand on paper), to enter into NHSN.  Not here: they’ve got a fancy employee scanner machine that uploads all that.  I’ve planted and read hundreds of TB skin tests, but now we use blood tests. In the past, I’ve answered dozens of phone calls from staff about their own symptoms, an infection their mom had, or a rash on their child.  Not here. Not one.

Once upon a time, I did lots of education: orientation sessions for new employees, covering BBP and tuberculosis, demonstrating PPE, talking about the failure rate of exam gloves, and using good hand hygiene. Every other Monday, for 40 minutes, for years.  I did small group sessions with the new medical residents, talking about our IC policies and infection-related quality metrics.  I met with new nurses and new nursing aides each month for an hour to review precautions, specimen collection and diagnostic stewardship, and appropriate infection documentation.  Not here: other people do all that.  Too bad, it was a nice opportunity to meet staff and build relationships.

Elsewhere, I went to nursing staff meetings to talk about new initiatives and policies.  Now, everything is delivered through an education department. I don’t really talk to staff directly.  I used to work on process improvement projects from the annual risk assessment. I’d research them, develop them, engage other leaders, and move forward.  Now, if I want to initiate something, I need to review it with a lot of people.  Policies go to many committees.  Things take a very long time. In the big hospital, infection control projects are going on in other areas, and nobody asks for help from us.  Sometimes we find out later about departmental initiatives.

I used to manage all of my own PI data (and some other departments’ data, like antibiotic stewardship), and present it at half a dozen meetings--regulatory preparedness, process improvement, clinical operations, environment of care, safety and emergency management, etc.  Here, we have a data analyst to manage most of that, and the doctors present everything at meetings. You might be wondering what it is I do all day now: Surveillance, lots of electronic surveillance.  Thousands of surgical cases, dozens of potential device-related infections. I’ve gained about 8 pounds in 7 months sitting at my desk. Some days, I never leave the office.

But what I do have is other people. Most importantly, they are people who know infection control. I don’t have an ID physician who comes to the monthly meeting and is never seen again.  I have FIVE ID docs who work in the hospital, all day long.  And I have a hospital epidemiologist, who is a walking encyclopedia of every piece of infection prevention and control knowledge written since the beginning of time.  I could call any one of them, at any time, and they’ll have something thoughtful to say about an issue.  They have an ID case conference each month, where they discuss interesting things.  The microbiology staff and the pharmacy staff join in, and it’s a very nice learning environment.

When there was an outbreak of something in the past (food illness, TB exposure, influenza), I’d call the health department, fax all the records, call or interview patients (have you ever done a food illness investigation? Brutal: 5 pages of food--have you eaten any sausage? Bratwurst? Knockwurst? Weisswurst? Kielbasa? Chorizo? Hot dogs? Chinese sausage? Chicken sausage? Breakfast sausage? How about cheese?), create any internal messaging, help set up a phone line, and work 18 hours some days.   

Here, we had a little outbreak thing.  An executive team member deftly led an emergency meeting.  The communications team created the messaging and notifications, the epi MD spoke to the board of health, nurses notified all affected inpatients, telecommunications set up a big phone bank, and nurse leaders called all the discharged patients, and pharmacy helped secure vaccine while nurses vaccinated anyone who needed it. I wrote the phone script, and went home at 4pm.  I called zero patients. I gave zero vaccines. I spoke to the health department just once. I am definitely not in Kansas anymore.

My past experiences gave me both a broad and deep knowledge of much of the infection control discipline, mostly out of necessity. I’ve worked in a variety of settings, purposely, to gain more skills.  I don’t regret any of it.  I find that my varied experiences have made me much better at this job. And while some may not like my resume of shorter stints, I find that most people who’ve worked at the same place for 30 years have a very narrow and often unmoveable view of how to do something, as they’ve literally never seen any other way.  It’s like never leaving your house. I’ve seen 6 ways to do everything, and can usually see, or at least present, a solution for a certain situation.

There’s so much to see in this field.  Go see it.