Struggling as a new CDI specialist? Don’t give up

By Allen Frady, RN-BSN, CCDS, CCS, CRC

CDI has a steep learning curve. Sometimes it can take several months, if not longer, to start seeing good documentation reviews from a new CDI specialist. The initial days of being a CDI specialist are almost exclusively task-focused. Before new CDI staff members can become pros, they must first figure out how to access the work queue, how to use an encoder and/or code book, and how to consult the DRG Expert. They have to be trained on what a query is and how to format one.

The early days working as a CDI specialist are all about procedural steps, so much so that it’s easy to lose sight of the work being done in favor of metrics and benchmarks. Without enough care, “CDI” will become more about doing things and less about accomplishing things. As the old saying goes, “don’t confuse effort for progress.”

After a few weeks, new CDI specialists can quickly discover that they’ve put in a huge amount of effort and accomplished almost no actual work. By that, I mean they can review a large number of records and place queries, but have little to no impact on the actual medical necessity, quality indicators, or assigned DRG.

Sound familiar? It should.

For those of you with a nursing background, this is not unlike new grads who have impeccable paperwork while all their patients seem to be in horrible shape, with lots of complaints, myriad medical fires having to be put out by fellow staff, and additional calls to those poor residents. It is noteworthy that this stage of a coder’s transition into doing CDI work is decidedly easier, as coders come into the job already understanding most of the reporting rules and knowing what “buzzwords” will result in what changes.

When I trained staff in a facility (as opposed to the training I do now as a Boot Camp instructor), I used the four stages of onboarding to gauge where my trainees were:

• A trainee starts as an enthusiastic beginner. This person has a very high level of commitment and a very low competence level.
• Once that honeymoon period is over, the trainee becomes a disillusioned learner. A disillusioned learner has a limited competence and a low commitment to the task. This, of course, is the stage where you’re most likely to lose your trainee.
• The next phase is the cautious contributor. This trainee is competent enough with his or her assigned tasks but has variable levels of understanding regarding the work, and variable levels of commitment.
• Finally, the last stage is the self-reliant achiever, who exhibits both a high competence and a high commitment. People in this last group sometimes still contact me with questions, and I often reply, “This is not a student-teacher relationship anymore; we are equal colleagues. I am not even sure how to answer your question, but here are a couple common views.” When that happens, it always makes me (dare I say) proud.

I often see an accelerated transition from enthusiasm to disillusionment when RNs try to transition to a CDI specialist role (though, again, I don’t notice it as much in coders making the jump). Where the honeymoon period in a typical job onboarding might last for months, I often witness these new staffers get disillusioned within the first week or two, complete with all the trimmings: second-guessing, anger and frustration, and even emotional breakdown.

As the saying goes, “this too shall pass.” I do, however, see a few new CDI specialists get stuck at the disillusioned learner stage for weeks or months. The learning curve is steep, and not everyone progresses at the same level.

Once they break through, though, the block at the cautious contributor level can sometimes be even worse. Many CDI specialists get stuck here for months, years, or even permanently. These employees exhibit a fair amount of skill getting through the day and may consider themselves accomplished—yet when pressed, they can’t answer even some of the simpler DRG, coding, or advanced pathology tenets. These staff members can be particularly hard to deal with. You see, it’s not a talent block, but a mental one. They simply declared victory and closed their minds to further learning.

My advice to these staffers is: “Have faith in yourself. You can move to the next level. All it takes is a commitment to daily learning and an open mind.”

To conclude, I want to tell you about a recent encounter with a past student. When he first started, I did not think he had a chance to succeed. He was stuck at the enthusiastic beginner stage for a month and then bombed out, complete with tears and talking about quitting at the disillusioned phase. After eight weeks, he asked me, “What is CHF?” one day and wasn’t joking. I lost track of him for a few years, until I noticed he was speaking at this past year’s ACDIS Conference and working as a consultant. While you can’t see the smile on my face as I type this, let me assure you that it is genuine.

If you are considering giving up, don’t. At least, not yet. We need you, and you may be passing up on a distinguished career.

Editor’s note: Frady is a CDI education specialist for HCPro in Middleton, Massachusetts. Contact him at AFrady@hcpro.com. For information regarding CDI Boot Camps, visit http://hcmarketplace.com/clinical-doc-improvement-boot-camp-1.