Should nursing charges be separate from the room charges?

cwazycwissyRN, RN · Mar 9, 2003

There is a system intact in alot of hospitals where the pt. is getting charged for the individual task nursing is carring out. It just does not go to nursing. Next time you check a blood glucose, lab will get paid, draw a ABG and respiratory will get paid, Push a amp of D50, hang a bag of LR or pass a pill and pharmacy will get paid. Ever done nebulizing treatments, set up a vent uhhhmmm sure their is more. I believe their are some hospitals that have adressed this.

deespoohbear · Mar 9, 2003

I forgot about accu-checks...and lately I have been doing quite a lot of accu-checks....probably no less than 6 per 12 hour shift.

Why shouldn't nursing be allowed to charge for individual procedures like every other department in the hospital? Yeah, I know you can't put a price tag on critical thinking skills or emotional support....I am talking about tangible nursing procedures. Maybe if nursing would start charging for each procedure we performed, maybe we wouldn't be considered expendable. Our administrator use to say that nurses were a dime a dozen....(probably not as true with the current nursing shortage). But it is no small secret in our hospital that our administrator doesn't care for nurses. He sees us as the biggest expense the hospital has to incur...and if there is a way to get by with less of us, he would do it in a heartbeat....Maybe if it was printed out for him on paper just how much nurses do in a shift (and CNA's also) maybe his tune would change. Plus if he thought he could get an extra buck he would probably be willing to try it out.... :rolleyes:

**canoehead, BSN, RN** · Mar 9, 2003

How about the tough IV sticks, NG tubes or Foley catheters. At my hospital, if the doc inserts them we can charge extra, but if you get the skills of a 20 year RN we can't charge. Doesn't make any sense.

deespoohbear · Mar 9, 2003

Originally posted by canoehead
How about the tough IV sticks, NG tubes or Foley catheters. At my hospital, if the doc inserts them we can charge extra, but if you get the skills of a 20 year RN we can't charge. Doesn't make any sense.

My point exactly canoehead.....:stone

Home Health Columnist / Guide · Mar 9, 2003

some food for thought articles:

1998: nursing nomenclature and classification system development

classification is a rather new idea in nursing. it began as a movement to develop a language that would describe the clinical judgments made by nurses. there was great support by clinicians for describing problems that nurses are educated and licensed to treat which are not in medical language systems. currently there are major efforts nationally and internationally to develop a nursing language system that includes nursing diagnoses, interventions and outcomes. these are the basic elements in a nursing classification for practice, minimum data set for health statistics, in costing out patient care, developing computerized patient records, and for education and research.

gordon, m. (sept. 30, 1998): nursing nomenclature and classification system development online journal of issues in nursing. http://www.nursingworld.org/ojin/tpc7/tpc7_1.htm

1998: the international classification

for nursing practice project

the rationale for standardised languages and classifications for nursing applies all over the world. development in the usa was earlier than in other countries because of the imperatives of reimbursement systems, accreditation; and litigation. however, translation of languages developed in and for the usa may not be appropriate for other countries' practice; cultures, or health care systems. many countries are already developing their own systems in their own languages, but others have no system. the international council of nurses' project to develop an international classification for nursing practice will provide a unifying framework for existing systems and a system which can be used in countries which have none. only when we have such a tool will we be able to describe and compare nursing practice across nations, and test the commonalties and differences of its concepts, values and practices.

clark, june dbe, phd, rn, rhv, frcn (sept. 30, 1998): the international classification for nursing practice project online journal of issues in nursing. http://www.nursingworld.org/ojin/tpc7/tpc7_3.htm

2001: classifying nursing work

...the erasure of nursing

nursing work has traditionally been invisible, and its traces have been expunged at the earliest opportunity from the medical record. this has been accomplished both externally, by hospital administrations, and internally, by nurses themselves....

bowker, g. c., star, s. and spasser, m. (march, 2001) "classifying nursing work" online journal of issues in nursing. available http://www.nursingworld.org/ojin/tpc7/tpc7_6.htm

other articles can be found here:

what's in a name?

this current posting of ojin brings to light issues on standardized nursing language, vocabularies, and taxonomies. the need for a common language to communicate with consumers, health care providers and policy makers on both national and international levels is long overdue and is essential as we approach the 21st century. authors in this issue concur that a common language will improve the delivery and documentation of patient care and enhance research efforts.

http://nursingworld.org/ojin/tpc7/tpc7toc.htm

Edward,IL · Mar 10, 2003

Thank you, Karen. Correct answer!

The articles mentioned above and the authors are the real authorities on this.

Anyone interested in this VERY important topic should visit the NANDA web site (and links to NIC, NOC and NDEC. Consider becoming a member of NANDA (I think it's still

Edward.

psychonurse · Mar 10, 2003

I totally agree, even though I am not a hospital nurse anymore. But I can remember that some patients took up a lot more of my time than others and some just needed you to pop in now again and check them. I also know that it would be better as a patient if you go in for just a small thing that you wouldn't get charged as much as someone that was really sick.

The last time that I was in the hospital was with a wound infection after my hyst. The nurses only came in when I needed IV antibiotics and when they changed my wound dressing. I would also tell them to bring in my sleeping pill and pain pills when I was going to get my antibiotics, so I didn't cause them any extra steps. But then I got charged the same amount as the patient that was much sicker and on thier call light every twenty minutes......that doesn't seem fair either. :mad:

**canoehead, BSN, RN** · Mar 10, 2003

Don't you think that different pay for equal tasks smells of discrimination? I wonder if ANA has identified this as an issue they want to work on.

mattsmom81 · Mar 11, 2003

I remember discussing this in nursing school 27 years ago. See how far we've gone with this? LOL!

MoJoeRN,C · Mar 18, 2003

Exellent idea. I remember, during the downsizing craze, after a "nurse shortage" then there was not a nursing shortage, now there is one again. I think it has more to do with whether they are hiring or not. A lot of money is made and saved by having nurses work short. Anyway back to the downsizing. Doctors, Physical, Respiratory Therapy, Lab, Pharmacy etc were viewed as "revenue producers" Nurses were, because their services were not billed directly, were and still are viewed as "revenue consumers" This is part of the image problem we have to overcome in order to be acknowledged as essential professionals in the medical field. Not just hand maids to the Drs., or butt wipers, I've had to do everything from empty the trash, mop and buff floors, because janitorial services were reduced during downsizing. We provide 24/7 care, when the docs gone, janitors, dietary, and all other services are enjoying their time with their families, we have to be there to provide much needed care to an ever increasing sicker population with insurance mandated shorter stays. We do produce revenue and it's about time this is recognized!!!!! Now I'll step down from my soap box.

Chaya, ASN, RN · Mar 30, 2003

deespoohbear:

IMHO,The nursing shortage stems from the phenomenon that nurses are, on the whole, invisible in society unless you or someone you love is in immediate need of one. We must insert the awareness of our existance as well as a realistic perception of what we do into the fabric of our society. Nurses must be shown in realistic numbers and prominence in TV shows portraying the medical field as well as in magazine and newspaper articles. They should be used as spokespeople side by side with the MD's when there is any public affairs-type release of information by hospitals, news stations or universities. AND- hospital charges should be re-apportioned without raising rates to more accurately reflect the overall contribution of nursing care during the hospital stay. I feel that Oh, say, 60% of the room charge would be about right. :idea: