Should nursing services be itemized on patient's bill?

webbiedebbie · Aug 8, 2003

I work with some lazy nurses who just copy what the assessment prior said. This might be a fly in the ointment if nurses were paid for what they actually do. Who would monitor the charges that the nurses made? Unfortunately, I think some nurses would make charges for what they didn't do.

WhiteCaps · Aug 9, 2003

Some really good points here. I know nurses look like a big, if not biggest lump of the budget to the administrators.

But, I also see even more reasons not to list nursing charges. Esp. legal consequences (I'm paranoid like that). The pt might see a big nursing charge and decide to try to recup some if they were unhappy with their care or stay in general.

It could make us more of a legal target. Do you agree???

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Monica RN,BSN · Aug 9, 2003

DebraLynn,

You might be on to something here. An ad like that, full page would be thousands of dollars, but imagine if enough people were interested in contributing to the cost in the name of RECRUITING future nurses, and EDUCATING the public to appreciate and understand what we as nurses are responsible for, it might be worth a couple dollars per person to donate to the cause to see this in print... ??? Consider starting a public awareness fund to this purpose???? Might be a good thing... Hospitals and clinics may even be willing to donate to the cause as well... Just a thought!!

Monica RN,BSN · Aug 9, 2003

Ok As I got to thinking I wondered just how one could itemize a nurses bill for services......... would it be like ...........

Nurse gets report on your condition..... 50.00 ( more costly cuz she/he has to know how to care for your needs)

Nurse Med pass ................... 20.00 flat fee, or shall we charge by the pill ??( I have some on like 20 pills at a time!)

Nurse answers call light..... 1.00 ( expensive for the call bell

abusers) Clip board at door to tally the light totals.

Nurse gets ice water, fetches extra pillows, hunts down the TV remote (fell under bed)... Extra charge to crawl under bed

IV starts.. per nurse who attempts? Or per stick ?? ( Hope this nurse is good...Save the patient lots of money in some cases)

Admission... flat rate?? Or by the page?...

I vote the NURSE be paid a bonus PER PAGE!!

Ahh.. how do we charge for documentation?.. Tedeious work here... The more I have to write, the more it's gonna cost...

Discharge : Very cheap charge here, as we are glad he is going home...(One less person on our census.)

Can we charge double to those who demand more time? What about the ones who are IMPOSSIBLE!!!

Just kidding with all of the above, in all actually, I don't see how they could itemize a nursing bill.. We are PRICELESS...

Nurses are:

Secretaries, Housekeepers, Dietary personnel, Lab drawers, IV starters, drug pushers, inventory controllers, record keepers, and on and on and on.....

But we are who we are because We love our jobs.... right???

flashpoint · Aug 9, 2003

I don't think the idea of individual nurses getting paid more for doing more is a good idea...there would be fights over who got the more difficult patients and the expereinced nurses would not give the new nurses a chace to get in on the tougher cases. I do, however, think it would not be inappropriate to bill based on accuities and the actual amount oif work done for the patient. There is a huge amount of diffrence in the amount of care for a 20 year old appy who gets up and dangles and gets moving post-op and the 20 year old appy who refuses to bend her own straw...big difference when patients can't do for themselves and when they refuse to do for themselves...

ainz · Aug 19, 2003

This has been a debate for years. I am in full support of nursing services be separated out and billed for. This would cause some significant changes in the way nursing care delivery systems are structured, but, perhaps that is something that should be done. There would be many challenges but I think we could develop a very good and effective system.

In my opinion, there are several benefits for nursing in having the nursing services billed separately and based on services provided to the patient. A couple of significant ones follow. First, it would help shape nursing to look and be more professional and finally get rid of the blue collar, paid-by-the-hour characteristic of our profession. It not really the mark of a profession. It would also cause some major changes in the attitudes of nurses which I think would be a good thing overall.

Second, and probably most significant, it could possibly be structured so that NURSES ARE REMOVED FROM THE HOSPITAL'S PAYROLL. This would have a significant impact.

Think about this, if you control your own finances, you control your own destiny, in America anyway. If nurses do not cost the hospital anything then we have much more influence on how care is delivered and much more control over our working conditions. Imagine this, the hospital MUST have nurses to justify the patient's stay. If we bill for our own services and we are not employees of the hospital, then the hospitals will be coming after nurses because we are needed and we are not a financial burden. We then can make demands on how care is delivered and have more influence.

It is a great idea that needs to be pursued aggressively.

Hellllllo Nurse, BSN, RN · Aug 19, 2003

Short answers to original questions posted:

Yes and yes. Definately.

RNIAM, BSN, RN · Aug 19, 2003

ainz

I see what your saying but how would you implement it?

CraigB-RN, MSN, RN · Aug 19, 2003

The second you can convince CMS (Medicare) to accept an itemized bill, then hospitals would jump on the band wagon. Doing your own billing is a lot more work than its worth. As an NP I"ve done both and I much prefere a salary. It's easier, yes I make less money, but in my case, I don't care about that.

At mimimum educating the public is needed. Maybe Jonhson & Johnson would be willing to add that to their nurse recruiting campaign.