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Q&A: How One Nurse Went From the Bedside to Risk Management

Team of healthcare professionals wearing scrubs and white coats meeting in a glass-walled conference room.

Imagine one day you stop loving your job. It might be due to burnout or a change in corporate culture. Or perhaps, you’ve found a new area you want to dive into. That’s what happened with Rebecca De Leon, an RN who moved from bedside nursing to healthcare risk management.

She’s not the only nurse leaving the traditional nursing specialties. The rate of nurses shifting away from the bedside has risen from 20% to 30% since 2019. These kinds of job changes were happening even before the onset of the COVID-19 pandemic and came about because of a variety of factors:

By default, nurses learn how to manage risk. Preventing mistakes and errors that can harm someone (and cause a significant financial loss to healthcare facilities) is a critical part of their careers. So moving to this specialty is a natural fit. Plus, there’s been a rise in risk management jobs available since the COVID crisis. But what does this job entail, and what is it like to leave the bedside behind?

What Is Risk Management?

Simply stated, risk management focuses on identifying, analyzing -- and responding to something that may have a negative impact on a person or the company. In healthcare, risk management is critical to help prevent medical mistakes, errors, and injuries that could either cause someone harm or bring about their death. Ultimately, effective risk management plans can help healthcare professionals:

  • Prevent or reduce the number of patient deaths resulting from medical errors
  • Promote the well-being of patients and staff
  • Avoid or reduce financial loss for the healthcare institution
  • Minimize the number of medical malpractice claims made against staff
  • Increase the level of trust and respect patients have for the facility and its employees

What Jobs Can You Get With Risk Management Experience?

Having experience in risk management allows you to work in various settings, including some that are outside the healthcare industry:

  • Pharmaceutical companies
  • Insurance companies
  • Financial companies
  • Government agencies

If you enjoy working independently, can work calmly and effectively in various stressful situations, have a good understanding of the policies and procedures set forth by your institutions, and like to create and lead organized processes, then a job in healthcare risk management could be a great fit for you.

Margarita David, DNP, RN, PCCN, caught up with Rebecca De León, BSN, RN, CRMP, to talk about her transition to work in risk management and what effect this change has had on her career.

MD: What did you do before going into risk management?

RC: I worked as a certified nursing assistant (CNA) for 4 years and then went back to school to become a registered nurse (RN). It took me about 5 years to complete because I went on a part-time basis. Once I became an RN, I accepted a position in surgical stepdown. After working in stepdown for two years, I went to the intensive care unit (ICU) and worked in the hemodialysis department. I stayed with the same facility for 15 years.

MD: When did you decide to leave the bedside?

RC: Leaving the bedside was a hard decision for me, as I only knew the bedside. However, it came to a point where the long shifts and the constant short-staffing became overwhelming.

When one of our patients almost died from an error due to working 17-hour days, I noticed that errors were being made that could have been prevented, such as medication errors, no dual RN verifications for high-risk medications, wrong patient bracelets, and no limb alerts placed on patients with hemodialysis access.

Not to mention that the staff wasn't able to take their required breaks due to short-staffing. This was when I realized that it was time to leave the bedside and go into a position that would allow me to educate others on preventing these errors. Although I stayed at the bedside while I was searching for a new job, once I found the ideal position, I left the bedside for good.

MD: What about risk management was attractive to you?

RC: I wanted to make an impact on patient outcomes. And being a risk management nurse allows you the opportunity to:

  • Properly assess areas that can have the potential to cause negative patient outcomes.
  • Assess clinical situations that can have a significant impact on the lives of patients and the financial stability of the facility.
  • Develop systems that prevent errors from occurring.
  • Reduce errors.
  • Minimize risks for staff, patients, and facilities.
  • Educate on proper documentation and patient rights.
  • Work with many different specialties and learn their day-to-day operations and tasks.
  • Work a Monday-Friday schedule.
  • Work in a leadership role.

MD: Did you receive special training to work as a risk management nurse?

RC: Many employers require you to have a minimum of a bachelor's degree, with some managerial or legal experience. When I started working in risk management, I had a bachelor of science in nursing (BSN). I was enrolled in a master's degree program focusing on the legal aspect of nursing. Although there are no specific degrees in risk management, there are many courses that offer a certification and help you become familiar with the role.

MD: How did you land your first job in risk management?

RC: In 2019, I attended a conference on legal issues in nursing and was introduced to a member of the American Society of Risk Management. This was around the same time that I became interested in the risk management role.

I remember asking so many questions that the member gave me his card and said, "Let's set up a meeting."

A few days later, I reached out, and we scheduled a virtual meeting. Coincidently, he knew a few facilities in my area that were looking for a risk management registered nurse and were willing to train. At that exact moment, I decided to take a leap of faith and agreed to an interview with one of the facilities where he was part of the hiring board.

A week passed after our virtual meeting, and there I was, interviewing for the risk management position that I had been thinking about for two years!

The interview went well, but I still had questions. I think making such a big decision leaving the bedside was giving me cold feet. However, I decided to take the leap of faith and accept the on-the-spot job offer.

This job offer came with a 25% pay increase, four vacation weeks (which was a bump from the two I had previously), and great benefits.

MD: How long have you been in risk management? What is your favorite part of the job?

RC: I began in late 2019, right before the COVID-19 virus began. Everything was fine until the pandemic hit, and we started to deal with a slew of problems due to the number of patients being admitted with the virus and not having enough resources to provide to patients. We faced many challenges, including:

  • Inadequate supplies
  • Short-staffing in all units
  • Medication errors due to increased levels of anxiety as a result of the virus
  • Not enough ventilators for patients

These challenges were very stressful because, as part of the risk management team, we had the responsibility of finding solutions. But how can we find solutions to things that were out of our control?

Although these COVID times have been stressful, I must say that working during the COVID pandemic has been my favorite so far. I've had to deal with super-risky situations, assess them, and provide quick solutions in order to prevent negative patient outcomes.

MD: What advice do you have for those who may be interested in transitioning to risk management?

RC: I could have started in the risk management role way before I did, but I was scared to leave what I already knew — the bedside. My gut feeling was telling me, "Stay at the bedside," but my heart was telling me that I could make a difference in other places.

Seeing what happens when working in unsafe conditions, as well as the errors made that could have been prevented, made me realize that I had a love for assessing situations and trying to create valuable solutions that would be beneficial to all. Once I realized this and started networking with other like-minded individuals, I realized that risk management was where I belonged.


Image courtesy of iStock.com/Dean Mitchell


The views expressed in this article are those of the author and do not necessarily reflect those of Berxi™ or Berkshire Hathaway Specialty Insurance Company. This article (subject to change without notice) is for informational purposes only, and does not constitute professional advice.

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