bridge the gap: Article Hospitals must educate nurses about health care costs

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Article talks about bridging the gap for nurses to have clinical skills and business skills to improve health care and patient care.

Specializes in Geriatrics, Home Health.

Why is cost containment nursing's job?

Eru Ilúvatar

576 Posts

I read the article and I found it non-sensical quite a bit. In the article she mentions gauze packages costs and that if nurses were to stop hoarding them costs would be controlled. I have never seen a nurse hoard supplies, i see them carry an extra package of gauze, some extra sealed saline flushes, maybe an IV kit or 2 in their pockets. But all this is done to save time and provide better patient care, instead of having to go back to the supply room and grab those which would be a time waster, time which is better used in patient care.

She also mentions faulty or mislabeled lab tests, well educate whoever is in charge of sending the labs to label them correctly, be it nurses or technicians, simple as that. And i have never seen a lab done that wasnt ordered or was done because of protocol. Doing lab tests in my opinion is never a waste of money since they show the internal status of the patient, which cannot be seen from the outside during assessment.

Without insulting the author I can tell this is one of these opinion pieces that come from a person enthralled in Academia that hasn't been in bedside for some time, so probably has many misconceptions about whats going on the floors. You can see that in the article it says she is a professor but nowhere it says she is practicing bedside nursing.

Yes I agree that costs need to be controlled as wasteful spending is never good for any kind of organization, but if we start to micromanage every CBC, every gauze package, it is gonna be unbearable to be a healthcare professional; and then it will be more expensive just to get someone to work for your organization. How to control costs in a realistic way escapes the scope of my current intellect, but certainly it isn't about such trivial minutia, that will certainly add even more responsibility to an already overworked nursing workforce.

Specializes in Critical Care, Trauma, CCU/MICU/SICU.

I'm in academia as a PhD candidate but I'm also a bedside ICU nurse so I don't see the article as anything far removed from realities of nursing care delivery, and will very candidly say that part of the reason Nursing doesn't get ahead is because we refuse to acknowledge realities of healthcare delivery in this country.

Unnecessary labs without orders is a compliance issue that costs money because hospitals don't get reimbursed. Grabbing that extra med out of the pyxis or omnicell that isn't billed to a patient adds up if every nurse does it. Every time a medication is taken out through an over ride or not accounted for, say if you take out 2 lopressors but didn't adjust the count to reflect that, it gets billed to the unit rather than a patient. A levophed drip can cost several hundreds of dollars depending on the concentration, so don't spike a new bag if the patient is arriving from the OR with one already infusing just because its easier and doesn't require untangling. That adds up to thousands of dollars per quarter right there. These are just two examples of how nursing can help in cost containment. We are the largest part of the healthcare workforce and could wield enormous power if we got over this attitude that anyone who presents new ideas must not be a current bedside nurse or is too removed to understand nursing care.

Cost containment is partly in nursing's domain because nursing departments operate on budgets. So being budget conscious with good nursing leadership means more funding for nurses, and that translates to FTE's, raises, funds for staff development, vacation hours, lunches for staff, that sort of stuff.

Eru Ilúvatar

576 Posts

I'm in academia as a PhD candidate but I'm also a bedside ICU nurse so I don't see the article as anything far removed from realities of nursing care delivery, and will very candidly say that part of the reason Nursing doesn't get ahead is because we refuse to acknowledge realities of healthcare delivery in this country.

Unnecessary labs without orders is a compliance issue that costs money because hospitals don't get reimbursed. Grabbing that extra med out of the pyxis or omnicell that isn't billed to a patient adds up if every nurse does it. Every time a medication is taken out through an over ride or not accounted for, say if you take out 2 lopressors but didn't adjust the count to reflect that, it gets billed to the unit rather than a patient. A levophed drip can cost several hundreds of dollars depending on the concentration, so don't spike a new bag if the patient is arriving from the OR with one already infusing just because its easier and doesn't require untangling. That adds up to thousands of dollars per quarter right there. These are just two examples of how nursing can help in cost containment. We are the largest part of the healthcare workforce and could wield enormous power if we got over this attitude that anyone who presents new ideas must not be a current bedside nurse or is too removed to understand nursing care.

Cost containment is partly in nursing's domain because nursing departments operate on budgets. So being budget conscious with good nursing leadership means more funding for nurses, and that translates to FTE's, raises, funds for staff development, vacation hours, lunches for staff, that sort of stuff.

Yeah the reality is that we spend to much money in things not related to healthcare delivery, we dont need fancy hospitals, we need well staffed , well supplied ones. Healthcare is not a luxury is a need, so the basics are the ones that need to be covered first, again that would be proper staffing, adequate supplies, clean environment. I know $1 dollar here and there adds up, And it becomes huge when put together. But if we start micromanaging every gauze package to the detail, is gonna become a waste of time, just account for the need of the unit and make it a part of the budged; so far I have never seen a nurse steal supplies from the hospital like I know it happens in offices across the country.

Yes medications are expensive, and why are those nurses that you mention taking more medication than what their patients are gonna receive? Thats a more serious issue than a cost problem, something is going on if more meds are being taken that what is supposed to be administered.

Educating nurses about being more cost conscious is never a bad thing, i totally agree with that. But I know when management sees studies like this they dont think about education, they say oh my god nurses are wasting supplies, NEW COMPANY POLICY, every paper clip must be accounted for and scanned; there goes half of your day scanning stuff for no reason.

And dont be delusional, any cost saving will go to the bottom line, never will it trickle down to the staff like you say. Not in the current corporate mindset; or do you forget that there are hospitals that post profits every year but still refuse to have proper staffing or at least give raises to their staff. Yes we have to save the hospital money because being wasteful is honestly a sin to nature and ourselves, but never think for a second that saving them money is gonna have it end in your pocket.

Specializes in Critical Care, Trauma, CCU/MICU/SICU.
Yeah the reality is that we spend to much money in things not related to healthcare delivery, we dont need fancy hospitals, we need well staffed , well supplied ones. Healthcare is not a luxury is a need, so the basics are the ones that need to be covered first, again that would be proper staffing, adequate supplies, clean environment. I know $1 dollar here and there adds up, And it becomes huge when put together. But if we start micromanaging every gauze package to the detail, is gonna become a waste of time, just account for the need of the unit and make it a part of the budged; so far I have never seen a nurse steal supplies from the hospital like I know it happens in offices across the country.

Yes medications are expensive, and why are those nurses that you mention taking more medication than what their patients are gonna receive? Thats a more serious issue than a cost problem, something is going on if more meds are being taken that what is supposed to be administered.

Educating nurses about being more cost conscious is never a bad thing, i totally agree with that. But I know when management sees studies like this they dont think about education, they say oh my god nurses are wasting supplies, NEW COMPANY POLICY, every paper clip must be accounted for and scanned; there goes half of your day scanning stuff for no reason.

And dont be delusional, any cost saving will go to the bottom line, never will it trickle down to the staff like you say. Not in the current corporate mindset; or do you forget that there are hospitals that post profits every year but still refuse to have proper staffing or at least give raises to their staff. Yes we have to save the hospital money because being wasteful is honestly a sin to nature and ourselves, but never think for a second that saving them money is gonna have it end in your pocket.

Where do you think the money comes from for supplies and staff? That's right, a budget. It's tough to justify much to management when a unit is over budget constantly, with costs eating away at the bottom line. Ideally, yeah, it should be about proper staffing and having the necessary equipment, but it's more complicated than that. I've actually worked in units where what I described happens so it's not some dream world, though you do work in Florida, so I can understand why you would think that.

But if you think this has to do with one gauze here or there, you're missing the point. It has to do with 80 nurses on a unit all engaging in wasteful activities. Making nurses aware of costs associated with care is pretty important, and I've seen cost sharing actually work in facilities where portions of savings go back to the nursing budgets.

This us vs them bitter victim mentality that's also anti-academic is why nursing practice and empowerment varies by region and facility. Hospitals are businesses and operate as such. Convince them of a good investment, and they tend to be resistant at first but with good nursing leadership, change is possible. So no, it's not delusional, it's having been around the block and working in various facilities at various levels in multiple roles from staff nurse to efficiency consultancies.

Eru Ilúvatar

576 Posts

Where do you think the money comes from for supplies and staff? That's right, a budget. It's tough to justify much to management when a unit is over budget constantly, with costs eating away at the bottom line. Ideally, yeah, it should be about proper staffing and having the necessary equipment, but it's more complicated than that. I've actually worked in units where what I described happens so it's not some dream world, though you do work in Florida, so I can understand why you would think that.

But if you think this has to do with one gauze here or there, you're missing the point. It has to do with 80 nurses on a unit all engaging in wasteful activities. Making nurses aware of costs associated with care is pretty important, and I've seen cost sharing actually work in facilities where portions of savings go back to the nursing budgets.

This us vs them bitter victim mentality that's also anti-academic is why nursing practice and empowerment varies by region and facility. Hospitals are businesses and operate as such. Convince them of a good investment, and they tend to be resistant at first but with good nursing leadership, change is possible. So no, it's not delusional, it's having been around the block and working in various facilities at various levels in multiple roles from staff nurse to efficiency consultancies.

I am well aware where the money for operations comes from, a budget of course; are you also aware that budgets can be modified right? So if a hospital is posting a profit year over year then it should have more money to pool into budgets overall. I agree about accountability, thats why managers should educate their staff about the need to be conscious of wastefulness. I said that very clearly on my previous post.

You also didnt address my regards to why is medication being taken that is not to be administered, and why isnt the units that are more cost efficient seeing the benefit of this. I am sure many on the forum could vouch as receiving a crappy if any raise over the years, while seeing their hospitals expand and expand.

Hospitals should not be for profit organizations, they are institutions for healing not a Macy Store. But that is an argument for another day. Since the reality is that they are run for profit then thats fine, but the staff and patients need should be taken care off before a profit is made.

There is no us vs them victim mentality, no business can be run without employees, so I think someone holds more power than the other; so at least all employees should be treated fairly. Business resist change as much as they can as long as it cost them money; it should not be rocket science to understand that proper nurse to patient ratio, fair wages, good working conditions ; will boost morale and improve outcomes.

No need to toot your own horn, being around the block... I didnt ask for credentials, but since we are sharing here are mine... I used to run a multimillion company that treated all their employees fairly and because of that we had almost double the efficiency of competing companies, till communism came knocking on the door. So i know how a business operates from the bottom to the top, but I have very clear that the biggest asset a company has are its employees.

Specializes in Critical Care, Trauma, CCU/MICU/SICU.
I am well aware where the money for operations comes from, a budget of course; are you also aware that budgets can be modified right? So if a hospital is posting a profit year over year then it should have more money to pool into budgets overall. I agree about accountability, thats why managers should educate their staff about the need to be conscious of wastefulness. I said that very clearly on my previous post.

You also didnt address my regards to why is medication being taken that is not to be administered, and why isnt the units that are more cost efficient seeing the benefit of this. I am sure many on the forum could vouch as receiving a crappy if any raise over the years, while seeing their hospitals expand and expand.

Hospitals should not be for profit organizations, they are institutions for healing not a Macy Store. But that is an argument for another day. Since the reality is that they are run for profit then thats fine, but the staff and patients need should be taken care off before a profit is made.

There is no us vs them victim mentality, no business can be run without employees, so I think someone holds more power than the other; so at least all employees should be treated fairly. Business resist change as much as they can as long as it cost them money; it should not be rocket science to understand that proper nurse to patient ratio, fair wages, good working conditions ; will boost morale and improve outcomes.

No need to toot your own horn, being around the block... I didnt ask for credentials, but since we are sharing here are mine... I used to run a multimillion company that treated all their employees fairly and because of that we had almost double the efficiency of competing companies, till communism came knocking on the door. So i know how a business operates from the bottom to the top, but I have very clear that the biggest asset a company has are its employees.

I didn't bother addressing your mentioning of nurses pulling meds that end up not being administered because it was irrelevant to the greater point. Nurses will at times pull an extra medication anticipating it being needed. Whether its needed or not is irrelevant as it doesn't always get billed to the patient, and is there not reimbursed, thus the unit takes a loss.

What you don't seem to get is that healthcare is a business but not like other private sector industries because while there are private hospitals, for profit hospitals and not for profit hospitals, their reimbursement and customer base is a wide range of reimbursement types depending on insurance status, type of insurance etc. We also provide a different type of service, like you said. But, nursing being the largest workforce, and woefully unprepared, as evidenced by this fruitless back and forth, for the responsibility that involves, business types with accounting degrees and MBA's run the show and budgets. In institutions where you see nursing leadership with more education and higher positions within the organization, you see tend to see better staffing, better continuing ed resources and other things like that.

I think the IOM report on the future of nursing puts it best at basically saying that nursing will be a driving force in healthcare delivery modeling. It's just woefully unprepared for that level of responsibility and involvement because most can't see the bigger picture beyond staffing ratios. Or rather, they can't see that better ratios come from having a seat at the table and the other things that I already mentioned.

Also, I'm ignoring the communism comment because it's absurd and you're from Florida.

Eru Ilúvatar

576 Posts

I didn't bother addressing your mentioning of nurses pulling meds that end up not being administered because it was irrelevant to the greater point. Nurses will at times pull an extra medication anticipating it being needed. Whether its needed or not is irrelevant as it doesn't always get billed to the patient, and is there not reimbursed, thus the unit takes a loss.

What you don't seem to get is that healthcare is a business but not like other private sector industries because while there are private hospitals, for profit hospitals and not for profit hospitals, their reimbursement and customer base is a wide range of reimbursement types depending on insurance status, type of insurance etc. We also provide a different type of service, like you said. But, nursing being the largest workforce, and woefully unprepared, as evidenced by this fruitless back and forth, for the responsibility that involves, business types with accounting degrees and MBA's run the show and budgets. In institutions where you see nursing leadership with more education and higher positions within the organization, you see tend to see better staffing, better continuing ed resources and other things like that.

I think the IOM report on the future of nursing puts it best at basically saying that nursing will be a driving force in healthcare delivery modeling. It's just woefully unprepared for that level of responsibility and involvement because most can't see the bigger picture beyond staffing ratios. Or rather, they can't see that better ratios come from having a seat at the table and the other things that I already mentioned.

Also, I'm ignoring the communism comment because it's absurd and you're from Florida.

What the heck does being in Florida has to do with anything? This is one of the biggest healthcare markets in the country. You are making no sense, and the communist comment was a serious one, read up on the advance of modern communism on Latin America, and how it destroyed entire countries economies.

MunoRN, RN

8,058 Posts

Specializes in Critical Care.

While I strongly agree with the premise of the article in the title, the author is disturbingly misinformed about how inpatient hospital billing works, and mainly what I took from the article that there is something very wrong with nursing education.

Individual gauze rolls are not reimbursed for separately, ALL payers reimburse based on bundled services, and one thing that is common to all payers is that they anything that can be considered "floor stock" is not separately reimbursed. Medications are also not reimbursed for separate from the bundled reimbursement, the only exceptions being blood factor products which medicare will reimburse for separately, other payers do not, observation status patients, and outpatient surgery/procedure patients. This is not well understood by direct care staff nurses, but I would hope that a UCSF professor who teaches Financial Management for Nurses should definitely have a better understand than she appears to.

I do agree that nurses in general need to take a more active roll in controlling healthcare costs, we need to evolve beyond our traditionally submissive roll and more actively challenge unnecessary treatments, tests, courses of care, etc.

Specializes in Reproductive & Public Health.

I do agree that nurses in general need to take a more active roll in controlling healthcare costs, we need to evolve beyond our traditionally submissive roll and more actively challenge unnecessary treatments, tests, courses of care, etc.

All of us would be better served if the cost of health care was more transparent. As it stands, even the billing office is not able to give a price quote for services rendered due to the different prices contracted with different insurances, vs the full out of pocket cost, in network vs out of network, and possibly fees associated with different providers (ie a doctor wants their colleague to assist vs a resident or whatever).

The whole thing is ridiculous. And I don't think the problem is nurses grabbing an extra role of gauze- the problem is that a roll of gauze is priced at 20 bucks! Our fragmented system has made it so costs vary from facility to facility (and patient to patient), as well as created an absurd level of opacity that makes it impossible to really gauge the "cost" of a given procedure or medication.

Specializes in Critical Care, Trauma, CCU/MICU/SICU.
While I strongly agree with the premise of the article in the title, the author is disturbingly misinformed about how inpatient hospital billing works, and mainly what I took from the article that there is something very wrong with nursing education.

Individual gauze rolls are not reimbursed for separately, ALL payers reimburse based on bundled services, and one thing that is common to all payers is that they anything that can be considered "floor stock" is not separately reimbursed. Medications are also not reimbursed for separate from the bundled reimbursement, the only exceptions being blood factor products which medicare will reimburse for separately, other payers do not, observation status patients, and outpatient surgery/procedure patients. This is not well understood by direct care staff nurses, but I would hope that a UCSF professor who teaches Financial Management for Nurses should definitely have a better understand than she appears to.

I do agree that nurses in general need to take a more active roll in controlling healthcare costs, we need to evolve beyond our traditionally submissive roll and more actively challenge unnecessary treatments, tests, courses of care, etc.

You make a really important distinction here in what's technically reimbursed vs floor stock since nursing budgets are usually built into room rates in some fashion. What's crazy is that some hospitals take inventory and floor stock to more extremes than others. I've seen hospitals that keep all of the personal care items in omnicells. The nurse actually needs to log in and take out tooth brushes, mouth wash, iv tubing etc under the patients name so that it's billed or at least associated with the patient. So while things are technically considered floor stock, they're still budgeted in some way through the room rates of the unit. It gets into a whole other issue of how nursing services should actually be billed, but i think that's a whole other thread in itself.

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