I agree that it might seem insulting to be included in the room charge, but I sure don't want to be the nurse who has to jot down all my supplies and time and effort used at the bedside so that I can bill for it later...what a nightmare! Can you imagine the time and energy expenditure? Here's an example:
Patient admitted to ICU in septic shock, hypotensive, intubated in ER, on multiple pressors, lots of anxious family, combative requiring sedation in order to treat. So..lets see what we would do:
1 Get report
2 Get patient into bed
3 Attach to noninvasive BP, monitor and pulse ox
4 Call resp therapy to attach and set up vent
5 Page MD that pt has arrived
6 check vs on monitor- decide if they're Ok or not
7 Quick physical assessment for abc
8 Get ER linens out
9 Cycle BP for another set vs if they were relatively ok before if not you already rechecked them and dirty linens are still there....Call MD again so you can get orders to titrate pressor meds up, or get original order.
10 draw labs
11 enter labs in computer and send labs
12 Get specimen collection containers and get sputum and urine cultures, send them.
13. titrate pressors becaus of BP change
14. Get ABG results back-call mD
15. call respratory and make vent changes.
16. set up for line insertion
17 talk to family while assisting with line insertion so you can get more detail and get advance directive info.
18. Do the assessment on paper after doing full physical assessment afetr line done
19. I forgot preparing transducers and hooking up cables, zero, etc,
20. sterile central line dressing
21. cxr-call to have done, assist with film position
22. call md to tell him film is done and needs viewed
23. reposition endo tube and retape because in to far. (no wonder we needed so much sedation (forgot to mention titrating that too)
24. ask nursing assistant to restock line insertion cart
25 etc, etc, etc
I personally don't want to keep track of all this so I can later bill for it-especially since we get a flat rate fee for at least half of our patients, and not item or fee charge reimbursement. I'd rather acknowledge that the fee charged for a bed in my area includes the services of nursing, housekeeping, electricity, plumbing, depreciation, case management, dietary, general supplies....etc. I also am glad that I do not save all those stickers off of items by wearing them until I can place them on a charge board so they can be charged...that was a pain.
I would love to think that we could quantify our costs, but the time and energy involved in the nursing department, in addition to th efinance department doesn't seem worth it fo rmy ego's sake. I'd rather look at it as the daily charge is for the care and services, and you just happen to get billed for it as a room rate because that's where it happened.
Sorry for the disjointed entry-got called to the phone half way through so didn't finish this lengthy(and some would say painful) post immediately and somehow sent it off before finishing.