2010 Salary Survey Results

On the mend: IPs rebound with new demands, new opportunities

CMS compliance needs create jobs in ambulatory care

Infection preventionists appear to be on the rebound with the national economy, gradually regaining program resources and improved compensation as healthcare associated infections (HAIs) continue to draw unprecedented public attention and regulatory activity.

"Clearly the IP role has become very important to organizations overall," says Ruth Carrico, PhD, RN, CIC, an infection preventionist and assistant professor of health promotion and behavioral sciences at the University of Louisville, KY. "There has just been an incredible amount of attention, scrutiny and concern about HAIs. I think that bodes well for the longevity and substantiality of infection prevention."

Wages are climbing with the higher profile. The 2010 Hospital Infection Control & Prevention salary survey and economic report found that IPs drew a median salary in the $70,000 to $79,999 range — up a bracket from the $60,000 to $69,999 reported the previous year.

In salary percentage breakdowns, 10% were making $49,999 or less; 15% were paid $50,000 to $59,999; and 23% had salaries in the $60,000 to $69,999 range. Another 17% were in the $70,000 to $79,999 range and 15% were drawing $80,000 to $89,999. In addition, 12% received compensation in the $90,000 to $99,999 range. Most (58%) received pay raises in the 1-3% range. However, 25% reported no wage hikes.

When the economy was in freefall, infection control programs cutbacks were widely reported by members of the Association for Professionals in Infection Control and Epidemiology (APIC). A recent APIC member survey on Clostridium difficile efforts found many programs reporting some measure of resource recovery.

"It showed somewhat of a reversal in that 21% of respondents indicated they have additional resources — including staffing," says Russell Olmsted, MPH, CIC, APIC president and epidemiologist in Infection Prevention & Control Services at St. Joseph Mercy Health System in Ann Arbor, MI. "The [economic recovery] helped change that, and on top of that there have been increasing requirements for data both for existing public mandates and now a lot of focus on CMS requirements."

The Centers for Medicare and Medicaid Services has targeted HAI reductions with a number of quality improvement strategies that include reporting requirements tied to reimbursement. For example, hospitals meeting CMS quality measures are eligible for the 2% market payment update reimbursed by Medicare annually. "This first CMS step is 'pay for reporting,' but certainly I think the next step is going to be 'pay for performance,'" Olmsted says. "That's not going to be very far behind. Clearly, HAIs will rise near the top in terms of concerns."

The new normal

Even with that considerable leverage, securing program resources will continue to be a problem in the new normal of the American economy. For example, sharing clerical support with other departments may go from a stopgap measure to a permanent arrangement. Hospitals understandably have become less aggressive in filling open positions, trying to offset new expenses as long as possible.

"The down side of that is that it really disrupts continuity and the work flow," Carrico says. "Somebody comes in to fill a job and they are already behind the curve. It makes it very difficult for people trying to do the work. I guess the bright side of that is if we haven't done some actual evaluation of our jobs — this is the time to do it."

Indeed, one effect of the Great Recession is that it has forced IPs to take a hard look at their program activities and determine priorities. As a result, IPs have had to "right size" their efforts, putting everything on the table and seeing what can be taken off.

"This really is an opportunity for infection preventionists to step back and do some serious program evaluation," Carrico says. "Are we doing the best job that we can? Are these the best activities we can do? Are these the activities that are likely to give us the best outcomes for out patients? Assess every aspect of your program in trying to get the right outcome. This is an excellent opportunity for IPs to have really serious discussions with their facility leadership."

Olmsted concurs, noting that APIC has tools on its website to help IPs determine what resources they need for various program activities. "The benefit of that is that it walks you through what resources you have currently and helps you identify gaps," he says. "The way to tee this up — if I were meeting with my organization — is to say here's where we are, and here are the new demands and the new requirements."

Jobs beyond the hospital

Some of those new requirements may extend beyond the hospital, as ambulatory care settings are drawing increasing attention from regulators in the wake of highly publicized hepatitis outbreaks.

"The sector where we have seen a dramatic increase in need is the ambulatory surgery centers," Olmsted says. "With new CMS conditions for coverage there has been a significant increase in the needs for personnel in those [IP] roles. APIC has a standard course now on ambulatory surgery centers. My sense is that we have maximum [attendance] every time we have offered it."

While the trend may translate to increased responsibility for hospital-based IPs, freestanding centers also appear to be an independent, expanding job market for the profession. "We don't have hard numbers on that, but clearly most freestanding ambulatory surgery centers are going to need a dedicated infection preventionist," Olmsted says.

Overall, there continues to be no shortage of jobs for qualified infection preventionists. "We see jobs posted and frequent emails from headhunters looking for IPs to fill roles," Carrico says.

Still, since small hospitals dominate the health care system new hires can expect to draw multiple duties in addition to infection prevention. "They are going to continue to have to wear multiple hats — education, risk management, nursing supervision, and staff development," she says.

All the while a massive demographic shift continues as new IPs come into a rapidly changing field. "Primarily, it still continues to be nurses that are in the position of infection preventionists," Carrico says. "I'm not sure that that is the best [fit], necessarily. I'm not sure infection prevention can really be called a nursing job as it has been in the past. The skill sets that we need to have in infection prevention extend beyond traditional nursing skills."

Today's IP has to understand epidemiology, biostatistics, health behavior and health education, environmental and occupational health sciences, she says.

"I think sometimes we bring new people into a field that is so broad, the expectations of the job are so vast, that it's very difficult for somebody to get into the profession," she says. "They need somebody available to mentor them, get them up to speed. The challenge we have now is bringing people into a job [that may be] filled with more dissatisfiers than satisfiers."

Still, those who master the craft and grow to love the challenge will not want for work. "My philosophy has always been, if you are good at your job you have job security," Carrico says.

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