A Paradigm Shift in Nursing Practice - page 2

by mamain

CONGRATULATIONS, YOUíRE 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 many, including myself, which I... Read More


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    since florence practised in the battle field, of years gone by, nothing has changed. Nurses can do nothing, without a dr written order,
    lindarn likes this.
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    Funny, I just wrote about it as a way for nurses to gain power. Good to see it is out there. I began exploring this four years ago.There are revenue codes for billing and it has been tried with good results. Look up the work of Dr John Welton and Joyce Batchelor. Talk about upsetting the apple cart. Imagine at a board meeting them having to say that nursing services brought in twenty million dollars in revenue. A CNO worth half her measure in gold would say. "And we want this...."
    lindarn and Chaya like this.
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    One of nursings greatest assets is the trust patients have that we will advocate for them whilst providing the best care we can, that the care we provide is not directly related to our reimbursement. Unfortunately this model of care will open us up to the old jokes about boat payment must have been due .

    I think it would set up a more adviserial relationship between bedside nurses and management, we may gripe about staffing shortages and inability to get breaks etc. but can you imagine the arguments over acuity levels and time charged for care of patients. It is hard enough now for many nurses to get paid for the time they work, imagine how hard it will be if staff and management have to agree to what acuity a patient was, how long a procedure took etc.

    The examples given show how problematic this system would be , The nurse would be paid for the service provided, yet if they only cared for the patient for 50% of the day they would receive 50% payment? ( am I understanding that correctly ), would there be a set payment for a procedure ( based upon what timing?) or would reimbursement be related to the actual time spent upon a procedure eg. If a patient codes will you recieve 15 minutes payment or the actual 25 minutes it took?.

    I am sorry for being skeptical but I simply see this as yet another tool for admins to use to beat up the bedside nurse, and because unlike other professionals, rather than support each other nurses run for cover, nurses will get the worst end of this improvement .
    Last edit by Joe V on Feb 17, '12 : Reason: spacing
    lindarn likes this.
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    I 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!!!
    lindarn likes this.
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    The 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.
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    I 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 .
    lindarn likes this.
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    Quote from rnpatrick
    There are revenue codes for billing and it has been tried with good results.
    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.
    Last edit by Joe V on Feb 17, '12 : Reason: spacing
    lindarn likes this.
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    Quote from hey_suz
    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.
    That 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 .
    lindarn, Aurora77, and cdsga like this.
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    Its 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!
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    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.
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