Below are some exerpts from a discussion between myself and Canrckid that was on the ADN vs BSN string.. but.. as you can see.. we got off topic.. so.. we're starting here.. to find a way to make a CHANGE... so read... enjoy.. give it some thought..and CONTRIBUTE.. I know we can make a difference.. but HOW???
So... lets get talking about some ways we can "organize, and educate HMO's, the public, administrators, how good patient care, delivered by any qualified, experienced RN can actually decrease health care costs!" It's such a monumental task.. What do you think it will take to do that? ANA comes to mind but most of the nurses I work with are member of AACN rather than AACN AND ANA... unlike the AMA our specialty organizations are separate.. <sigh>
We nurses still have to overcome the fear of organizing and its association with "unions", and "strikes", and fears of patient abandonment that administrators and hospitals have counted on for so long to keep us under their thumbs and at each other's throats, (figuratively speaking). I know their are some RN professional organizations who support change in the political arena, but they need to INITIATE the change. Iam a member of AACN, and a CCRN, and have attended many NTI meetings over years.......after each meeting I always come away with the perception that we are all so wonderful and invaluable, but I don't see or hear of them in the media, pushing various causes. Why? Why not? We need a "grass roots" uprising of sorts, because so far the "educated" ones haven't done very much for us! (Am I cynical or what!)
So what's the first step??
Dec 26, '98
Well, has my cynicism been borne out or what!
No one has responded in this category........
We truly are a wishy-washy group of professionals! We are so involved at our own local levels/hospitals, that we can't see the bigger picture and how it ultimately affects how we deliver patient care AT the local level.....it is difficult to organize, and the repercussions at your place of employment can be profound...(Like, fired)! I don't know what the answer is.....we CAN support any federal, state or local initiatives to pass some sort of "Patient Bill of Right's" legislation, especially if it modifies the ERISA statute and allow HMO's to be sued.......When the consequences of denial/delay of treatment and services hits them in the pocketbook, maybe then they'll research and realize how nurses can have a COST SAVING impact on healthcare, by expanding their patient educational and preventative health functions......then the patients that are truly sick won't get harassed about pre-qualifying and length of stay....Anyhow, on this day after Christmas, and facing surgery myself on Monday, I can't help but "feel" more for the American public!
How's by you?
Jan 4, '99
<sigh> I have to say that I was a bit disappointed myself at the <ahem> lack of response.. but attributed it to my lack of creativity in titling the subject.. LOL..
i am definitely taking steps to get involved in how nursing is perceived in my state.. and even the legislation that is being introduced in Oklahoma to enable HMOs to be sued (why they can't be is BEYOND me!!)
in the mean time.. i'll do what i can.. and try to get other nurses to look outside of their immediate surroundings at the bigger picture.. and continue to believe i can and will make a difference..
by the way, i hope your surgery went well.. and THANKS for the great ideas..
mmmmmm anyone else???
Jan 8, '99
Hello to the both of you. Let me just say that you have found a fellow patriot. I came across this site just days ago, but have felt your pain.
I am an ADN graduate that, due to economic reasons, had to get to work to fund my future educational plans. I love nursing, but am disappointed at our lack of organization. I agree with you "Whole Hog"<i'm an arky> that nursing should have a BSN entry level. But, if I may, let me add a little insight to the "conflict" that I have come up against.
When, not if, the standard of a BSN is adapted, what will happen to all the LPNs and ADNs? People are afraid. I would be. Fear is a big hang-up here.
I don't have the time to give you all my thoughts. Morning is approaching. Just know that I am VERY interested in change. Would love to here updates. Will be in touch.<smile>
Jan 9, '99
Hey! I have a hair brain idea conceived in the middle of the night that I would like to bounce off you. Do you think that nurses would be considered more professional in there were a separate fee for nursing care instead of being figured in the the room charge? Doctors chare by the visit. Those physical theropists of yours charge by the service. Why not nurses????
Don't ask me how to do that yet. I will have to sleep on it, but do you think it is in the realm of possibilities?
Jan 10, '99
Pearl... I think you have a PEARL of an idea there!! We've been batting that thought around at work as well... The patient gets billed depending on the level of nursing care required... ie Critical Care or Oncology nursing might have a higher billing rate than medical nursing.. which would make sense.. the more intensive the care or the more expertise required the higher the rate...
My first thought is how the insurance companies would respond... and how does one go about proposing such a dramatic change?? does it start with our state nursing organizations??
Seems that hospitals would jump at the chance to catch some billable revenue that may be missed... i suppose the suits would say that the cost is already figured into the room... mmmmm this deserves more thought..
As for the fear factor of ADNs and LPNs... I'm sure the current ADNs would be "grandfathered" in when the change was made... perhaps an idea is to follow other allied health examples and rather than eliminating ADN programs after the transition... use the program for a Nurse Tech position.. similar to Physical Therapist vs Physical Therapist Assistant... as for LPNs.. sigh.. I just don't know... the hospital i worked for in florida has already eliminated LPNs as staff nurses and only uses them as Personal Care Assistants (glorified nurses aides) on the team... which for some of the LPNs that have been around for 20+ years who know more than most doctors is sad indeed...
Jan 11, '99
Your idea is NOT hare-brained, unless I am too, because I've considered it myself! It would be an interesting accounting exercise to first, find out what the hospital actually charges for DIRECT BEDSIDE nursing care per patient per shift/year, then take the annual budget for ALL nursing. The difference, one would assume, would be the cost of nursing management, administration and education. It would be interesting to see what percentage of the nursing budget is actually devoted to direct patient care. I suspect however, that WHO gives the care, and HOW often would be difficult to pinpoint. Managers may be counted as care givers, but may actually infrequently do so.
Secondly, take a GOOD HARD LOOK at those non-patient productive (my term..hee, hee) managers and evaluate what they do in terms of whether they really need to be performed by an RN. Consolidate those tasks, assign them to clerical personnel and start eliminating those management positons, and use those FTE's for bedside RN's. As soon as we can delineate those bedside positions from an accounting perspective, the sooner insurance plans might be willing to reimburse more directly and the sooner hospital administrators might look to where money can be saved by eliminating some of the deadwood in nursing administation instead of the bedside! Forgive me, I'm a little jaded right now, because fully 50% or more of what my manager does could be done by clerical workers. I'm sure there are other hosptials who make much more productive use of theri managers.....
Anyway, this is enough for now, I have some other ideas in mind, but I'm tired of typing....some other time!
Jan 12, '99
well, guess what? my facility DOES charge for individual nursing care to patients. in the ED, we use a computer accuity and pt. charge system. every service we administer is listed with a number value. we may also type in services rendered. it is printed out and becomes a part of the chart for billing purposes.
also...we will never an organized, united front as long as we (as a group) cannot even agree on whether an ADN is acceptable to BSN, etc. Come on!!!!! we are all overworked and underpaid, especially now, and the shortage is only going to get worse. let's don't chew off our own feet arguing about what shoes to wear. managed care was slipped right by us, and is partly to blame for the decrease in hours (downsizing in depts). we have to blame our selves for not standing united and letting the administration know what is and what is not acceptable for patient care.....it goes on and on. such a big debate--so little sleep. niters
Jan 17, '99
As long as nursing is seen as acost center instead of a revenue center(which we are) nursing will be under valued and targeted for cuts. Acually we need to remind those making fiscal decisions that nursing is the product of the hospital.People come in patient to receive nursing care.Every thing else can be obtained outpatient. It is bad business to constantly cut the quality of the product. Every one in business for more than a day knows this!(except hospital administrators).
Jan 17, '99
Excellent point! I've never really thought of nursing as a revenue center, but I guess it's true.....after all, insurers do reimburse for nursing care. So I guess our revenue-producing activities are used to support other hospital services at the expense of patient care! Maybe, if we teach ourselves some business acumen, we can propose to administrators how we, as direct bedside caregivers are a financial asset, and when they choose to eliminate nursing positions,it would be those non-patient productive positions I was refering to earlier! Well, I can dream!
Jan 20, '99
I just found this site and registered today. I'd like to add a little to the discussion. In 1987, when I graduated, the idea of separate billiing for nursing services was being kicked around. Now, I'm back in school completing a BSN (no thoughts on what is better for someone else in that area). An instructor stronly encouraged organizational participation because of lobbying influence in Washington.
I would like to hear from Canadian nurses. their efforts to reform in Canada have led to disaster in public health care. Perhaps we can avoid some pitfalls with their input.
Southeastern Michigan has many nurses coming from Windsor and Sarnia Ontario and beyond because of the lack of jobs and low pay in Canada.
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