Ethical? Nursing + commission

ckh23, BSN, RN · Jan 17, 2011

I can see the possible problems. However, if you think surgery is right for a particular patient and the practice want to pay you extra for something you would already recommend I say go for it. I think you just have to be able to not let money be a factor when surgery is not the right way to go.

regularRN · Jan 17, 2011

I'm erring on the "unethical". Is the regular pay so bad that commission is vital to pay the rent? To me, commission implies coercion...

**canoehead, BSN, RN** · Jan 17, 2011

I don't think it's ethical, but it's probably legal.

If you are seeing the patient to evaluate whether they are appropriate candidates for surgery, but you have an unstated motive to find them suitable, I don't think that's full disclosure.

diane227, LPN, RN · Jan 17, 2011

I have to say that I don't like this practice but you are in a different atmosphere from what would be expected in a hospital, LTC etc.

This is a plastic surgery practice and as such you have patients that are or might be interested in cosmetic procedures. Most of these procedures are great money makers for these physicians. When you work in such an environment your employer becomes the physician group that hires you. That organization has the right to provide bonuses to their staff in any manner they see fit. This is not illegal. You may book a patient for a surgical consultation but it is the responsibility of the physician doing the procedure to assure that the patient is well enough and that it is safe to do a particular procedure on that particular patient. If the organization wishes to offer you a bonus for this work, then they can do it.

PetiteOpRN · Jan 17, 2011

I don't think it's ethical, but it's probably legal.
If you are seeing the patient to evaluate whether they are appropriate candidates for surgery, but you have an unstated motive to find them suitable, I don't think that's full disclosure.

I, for one, make plenty at this facility (no idea what the other RNs make, none of my business). I have worked in sales before and I'm not questioning the legality.

I'm just concerned that patient care is being replaced by sales. When I worked in jewelry, if a customer who was knkown to be a big spender came in the door, we were at her service. If a customer with below-normal IQ came by for the 3rd time that week to ask the same 5 questions about the two cheapest things in the store, um, time for my 15 minute break x the entire department.

If there are 6 consults and the nurses really want to convert them, then what is the incentive to take their time with the 2 week s/p TRAM flap? I'm afraid we will compromise care for other patients, in addition to pressuring patients to book surgery.

But totally legal. No question about it.

tn1728 · Jan 17, 2011

I guess it also depends on the state medical boards. In California, payments based on either a per patient basis or on what they spend on medical procedures can be considered fee-splitting which is not legal. As far as I know there is not an issue for earning commission on products you sell.

dudette10, MSN, RN · Jan 17, 2011

If there are 6 consults and the nurses really want to convert them, then what is the incentive to take their time with the 2 week s/p TRAM flap? I'm afraid we will compromise care for other patients, in addition to pressuring patients to book surgery.

Is it idealistic to say I would hope it would be moral character?

Barring idealism, the woman who got breast reconstruction may not be the woman who comes back to get The Heidi Montag Special, but she did have surgery, and she is completely capable of referring your practice...or bad-mouthing it for rushed and/or substandard care.

Speaking strictly on an incentive basis, maybe the nurses in the practice need to realize the value of referrals and good word of mouth, just like salespeople do.

pacuRN26 · Jan 17, 2011

Work in a mindset that you don't let the Commission cloud your motivation as a nurse to help that patient. Think of the commission as a fringe benefit for doing your original job.

ChloBear · Jan 17, 2011

Interesting post... I'm leaning more towards unethical considering not all patients are good candidates for elective surgery. I'd be more comfortable with some sort of "year end bonus" for the nurses if the center reaches some predetermined goal.

nurse2033, MSN, RN · Jan 17, 2011

Just wanted to get some perspective.
I work PRN at a plastics practice. We have always done cosmetic procedures, but now there is a "bonus" attached to every new patient that a nurse sees who books surgery. Essentially, there is a $50-$100 commission when the patient 'converts.'
In addition, we are now starting to carry skin products and makeup. And every sale we make (to patients) earns commission.
So far I have not seen a patient approved for surgery who was not a good candidate, but I'm worried that there is too much emphasis on making the sale and not on providing the best care to every patient, regardless of their financial situation ability to buy lots of expensive makeup.
Am I making a big deal over nothing? If a similar program was started at your facility (ie, going from room to room and selling refreshments for bonuses and commission) what would you do?

There is a conflict of interest here. You need to look at the ANA Nursing Code of Ethics. Specifically- section 1.4 The Right to Self Determination, section 2.1 Primacy of Patient Interests and 2.2 Conflicts of Interest. This may not be all, I just took a quick look but this should point you in the right direction.

Batman25 · Jan 17, 2011

The surgeon will have the final say whether the patient is a good fit for the surgery so you really aren't the be all and end all here. As long as you are honest in your feedback regarding the patient's health and well being I don't see an issue. Do you find the doctors to be fair and ethical? If yes, I would be comfortable.

As far as getting as bonus for the products you sell I don't have any prob whatsoever with that. You are taking over a bit of a sales job where products are concerned and many people in those roles do get a bonus or commission. I get the feeling the doctors are trying to reward the staff for their additional duties which is refreshing as many would just have you do it and not give an extra cent.