A Paradigm Shift in Nursing Practice - page 2
CONGRATULATIONS, YOU'RE JUST A NURSE JUST a nurse. I am JUST a nurse. No big deal, had I been more adventurous maybe I would have gone to medical school. These thoughts are the thoughts of... Read More
Feb 15, '12 by gcupidI actually thought of this a year ago. The only thing that differed was that I believed in a process that rewarded admits and discharges. I believe your process is too far complex. There are so many variables. The system will never be 100% fair across the board.
If we are concerned about new grads taking on too many complex patients, there should be a scoring that limits the acuity of a new grad and there should also be a limit on even an experienced nurse. Patient safety should be our highest priority.
We should not bill for services for each individual nursing intervention bc there are a lot of times our assessment prevents interventions. I'd rather you catch something before something bad happens and you have to fix it. Lets keep it simple.
We all have charge nurses that like to give admits to a few that seem to be unjust. (friends get the last admit or no admit).
The trend will shift to charge nurses now asking their friends do they want to get an admit for extra money. And in my mind, as an agency nurse yall heifers can give me as many admits and discharges as you all want as long as my *%$@! check is correct.
Here are the rules:
Each nurse must take a minimal of 3 patients on a med-surg floor and the maximum allowed is 7 patients under the primary care model with ancillary help (CNA, secretary,etc.). He or she also has the power to refuse admits without backlash. & a back up nursing matrix program is implemented in order to staff accordingly. (bc some nurses may only choose to work with 3 patients and no admits)
An admt is worth 75 dollars extra and a discharge is worth 50.
Hourly pay rate should be maintained at the same base pay rate you are now currently receiving.
Could you imagine how much better this system would be on floor nurses? The stress level would be dramatically reduced. The only problem is more rules would have to be arranged in order to set up correct staffing. Quick someone come up with a program so that we can get this implemented!!!
Feb 15, '12 by nicurn001The simplest answer is the one we have here in CA . A safe patient ratio law . The law sets the MAXIMUM number of patients the nurse cares for , acuity sets the actual number of patients ( upto that maximum )that a nurse cares for .As it is at present individual hospitals can set whatever staffing levels they wish without input from bedside nurse re. those alogritms.
Feb 16, '12 by cdsga, BSN, RNI have seen doctor's perform miraculous procedures on people, many man hours and follow up and not get reimbursed anywhere near the cost of the service. Especially those with no insurance. I do agree that the nurse should be paid based on amount of procedures, acuity of the patient, complexity of the procedure etc. I think you could do it with patient classification as a start. The higher the classification, the higher the potential for poor outcomes. But as far as work, even the lower classification of patients may have less work involved, but you would then have the volume to consider. For example in surgery-I may have a spine procedure that requires x number of hours in surgery, plus the amount of equipment and time to prepare for the procedure. I may have 2 cases of the same ilk in one 8 hour period. Or I may have a breast biopsy, that takes less than 30 minutes, and I may do 6 of them in an 8 hour period. Most nurses would love to do the less complex procedure, and that leaves less nurses to learn and do the complex cases. If you paid by the complexity, you would have people then wanting to learn more complex procedures and less problem finding people who would want to assist with them. I also agree that no matter what classification the patient may be, there is always the possibility of an untoward event, whether medical or undiagnosed problem, so you can go from simple to complex in a heartbeat. I think this deserves a look .
Feb 16, '12 by SHGR, MSN, RN, CNSQuote from rnpatrickIn our clinic we have very recently started billing for nursing services on a 1-5 scale in a similar way that the docs do. Apparently we are indeed bringing in revenue, via E&M codes. For instance, I could just check a BP...or I could also do teaching, review the med list with the patient, etc, which allows higher billing-- for something that is very valuable about nursing.There are revenue codes for billing and it has been tried with good results.
We offer a service to the patient that the automated machine in the drugstore does not.
I don't see this money personally, but it makes me feel good that our nursing services are valued the way society shows it values something (paying for it) and also helps keep our lights on, so to speak.Last edit by Joe V on Feb 17, '12 : Reason: spacing
Feb 16, '12 by nicurn001Quote from hey_suzThat is my fear ie. managment would simply use this method of billing to enhance the facilities income whilst doing nothing to enhance the nurses income ( probably would turn it against the nurse for not generating enough profit ) then use it as an excuse to reduce the nurses income .In our clinic we have very recently started billing for nursing services on a 1-5 scale in a similar way that the docs do. Apparently we are indeed bringing in revenue, via E&M codes. For instance, I could just check a BP...or I could also do teaching, review the med list with the patient, etc, which allows higher billing-- for something that is very valuable about nursing.
We offer a service to the patient that the automated machine in the drugstore does not.
I don't see this money personally, but it makes me feel good that our nursing services are valued the way society shows it values something (paying for it) and also helps keep our lights on, so to speak.
Feb 16, '12 by rnpatrickIts great that your employer wants to recognize the contribution nurses can make. Our services are traditionally built into room charges. I was an OR nurse for many years. If an OR could not run because of not enough nurses the facility lost $60 per minute. Or if it was able to run because of my availability, it earned $3600 an hour. So, $43,200 of revenue for 12 hours while I cost less than $500 for the 12 hours to the hospital. Do you see what a deal the hospital gets? And how de valued we have been treated all these years? All I want is more say so about my practice and to be treated respectfully by management. If I get that watch me fly!
Feb 16, '12 by RoxyDi, BSNSorry, but the grammatical errors made it difficult to follow this post. If you want to elevate the nursing profession, please be sure your thoughts are well expressed.
Feb 16, '12 by cdsga, BSN, RNAre you grading papers here or trying to get to the content. Please.
Feb 17, '12 by gcupidQuote from RoxyDiThe thoughts were expressed well enough for others to reply to this thread... If you want to elevate the nursing profession please clarify statements and/or questions that you don't understand instead of giving smart *!# irritable remarks that may interfere with the positive flow of this thread.Sorry, but the grammatical errors made it difficult to follow this post. If you want to elevate the nursing profession, please be sure your thoughts are well expressed.
Feb 17, '12 by RoxyDi, BSNActually, trying to understand how to read the intent of the post. Just being honest here. Really.
Feb 17, '12 by SHGR, MSN, RN, CNSThe intent is pretty clear. A PM offering to edit for grammar/spelling/clarification is sometimes appreciated and much more tactful. The author did ask for comments and state that the ideas are in development- as all nursing theories seem to be.
It's a worthwhile discussion. Money keeps the doors open and the lights on, no matter how idealistic a nurse may be.
Feb 18, '12 by RoxyDi, BSNYou know, readers decide in the first few sentences whether or not they will continue to read a post. This is what I was trying to say - I did not go further due to the errors in the beginning. The "hook" was not there for me. Professionals need to keep this in mind when publishing something for all to read. I have no intention of offering to edit a post for someone who is trying to convince me of an idea or concept. I'm sure the discussion is a valid one - that was not the point of my post.
Feb 21, '12 by edrnbaileyQuote from joyouterAs a nurse in a non- socialized medicine socieity/country I can only speak to how that system is run. One of the primary components facing nursing here (USA) is lack of recognition so to speak for nursing care and nurses. Nursing care is "built in" to other charges on the facility bill. That is part of the reason that Tylenol is $40 a pill, or other medications/services are greatly inflated. Most systems now do not take acuity into account period when making decisions regarding staffing/ productivity. It is all about the numbers. And yes census should be a part of the algorithm, but not the entire algorithm. As an ED nurse we are instructed to "down-staff" periodically throughout a 24 hr period according to census or number of patients seen. The C-suite has determined that productivity should remain above 90% at all times and preferably more than 95%. The problem with this rationale is it doesn't take into account the acuity or severity of the patients being cared for. If a minimal number of patients are seen but are critical care in nature ( i.e. STEMI, trauma, sepsis, post- cardiac arrest, multiple critical care drips, etc, etc.) we are still expected to meet the same productivity guidelines. In addition, experience levels of staff are not factored into the algorithm either. It is much easier to care for those patients with less staff if most nurses are experienced. This is rarely the case. Many times you may find yourself as the only experienced nurse on shift.Socialised medicine has it own problems, obviously, higher taxes being one aspect. My question is how does your nursing management recognise the impact of the fee systems upon nursing staff and are there supportive approaches for the nurses employed there
So, it is a multi-faceted problem and a worthwhile discussion. While I am not sure how I think/stand regarding a strictly pay for services program for nursing there does need to be a change somewhere. The patients should see a charge for nursing care reflected in their bill. Nursing provides 90% or more of all care given to patients and yet is the only profession not represented in the billing. Every year our profession is voted "the most trusted profession" by the public, shouldn't they then know exactly how much of their care is attributed to that profession? Hospitals and other facilities have to acknowledge what nurses do, as well as consider that not all patients are created equal. Physicians do bill extra for critical care and that should be considered for nursing as well, in billing and other determinants.
We have many discussions and decisions that HAVE to be made for our profession but it is time WE THE NURSES started making them instead of others and then trying to change the decisions or undo them.. Be proactive not reactive.