Getting paid by the case

ShariDCST · Feb 8, 2008

does anyone work or have work or have heard about how this works where staff is paid by the case instead of number of hours worked? this was mentioned in a meeting this morning and it sounds like a horrible idea, especially when you count in long cases vs bmt's and tonsillectomies.
looking for some input on this subject

i agree with you - it does indeed sound like a horrible idea. probably some pencil-pusher's bad idea to try and cut costs again. and with absolutely no knowledge of how things actually work in the or. would the even begin to consider paying floor nurses for patient care like that?? of course not - that's ridiculous.

i wouldn't even give it the dignity of a reply, other than perhaps a rousing :down: and a :madface: :no: or two. the logistics of such a proposition boggle the mind. i can't begin to fathom how such a plan could be fairly applied over an or staff over the course of one day - much less on a weekly or even monthly basis. what a mess!! obviously whoever proposed this debacle needs a thorough education on the day-to-day operation of the operating department!

heather2084, BSN · Feb 8, 2008

Apparently there is some hospital in cape cod that is doing this and it is supposedly working well. I simply cant understand how it would work and be fair to staff.

I have a feeling if this somehow gets implemented in the future, that I will be changing jobs

GadgetRN71, ASN, RN · Feb 8, 2008

How can this possibly work well? Although, I work with some doctors that would a lot more tolerable if there was a nice little incentive to work in their rooms! :lol2:

hotdog19d · Feb 9, 2008

I don't see how it wouldn't work as long as every case earned a different amount of pay. Obviously a short ENT case shouldn't pay what a heart would.

heather2084, BSN · Feb 9, 2008

but then how do u figure in the pay scale for everyone? Do you say each person has their own certain rate and then you have a set multiplier for how much a particular case is worth? And what about overtime, and all the time you're spending cleaning rooms and getting ready for the case and running the autoclave and sterad tests.....not to mention the time you have to spend waiting on recovery to get rid of their patient, which only the rn can do

Batman24 · Feb 9, 2008

They want to save money. I hope all the medical staff involved in this fight it tooth and nail. Chances are you will make less money so don't believe what they say. You will also spend time fighting for the money for setting up and all the other things you mention above. Horrible idea on a lot of levels.

Please know this could also potentially effect your insurance,tax status, O/T, benefits including vacation, etc. I wonder if they are trying to switch you to contract employees. Hard to tell from the info given. Be VERY careful.

hotdog19d · Feb 9, 2008

but then how do u figure in the pay scale for everyone? Do you say each person has their own certain rate and then you have a set multiplier for how much a particular case is worth? And what about overtime, and all the time you're spending cleaning rooms and getting ready for the case and running the autoclave and sterad tests.....not to mention the time you have to spend waiting on recovery to get rid of their patient, which only the rn can do

Let me first say that I'm COMPLETELY against it because it rewards speed, which I think promotes poor patient safety practices. BUT:

All of the extra time spent could be calculated into a flat rate given each day or in addition to per case compensation you could also receive a lower hourly rate. Overtime could be calculated at 1.5 times each per case compensation or double.

ShariDCST · Feb 9, 2008

let me first say that i'm completely against it because it rewards speed, which i think promotes poor patient safety practices. but:
all of the extra time spent could be calculated into a flat rate given each day or in addition to per case compensation you could also receive a lower hourly rate. overtime could be calculated at 1.5 times each per case compensation or double.

sounds incredibly complicated, and the potential there for consistent case accountability errors is mind-boggling. :uhoh3: i can't fathom why anything fraught with this many possible variables is better than an hourly rate for people to come in and do the jobs they are trained to do - whether it's rns who circulate and scrub cases, csts who scrub all cases, whether they are bmts or cabg or trauma or what have you. shift work must come into play here as well - scheduled cases are generally done on the day shift, during the week - generally. then the other shifts are left to pick up the end of the day shift when it runs over, and deal with emergent only cases in the middle of the night. and then there's call backs......etc., etc., and so forth. what if it's a really slow night and you do nothing case-wise - would you get paid nothing for being there your whole shift? i know some hospitals never run an empty shift - and some run themselves ragged all night long. it's that kind of variable situation that must be considered to put something like this into play.

if it were me - i would be like you - completely against it under any and all circumstances. :nono: i don't care who says they are "doing it successfully" - your best bet is to contact the people who are doing it and find out the real story for yourselves. i bet it's not the proverbial bed of roses they want you to think it is - or it's indeed a bed of roses, and it's all thorns..........

good luck to you in fighting this - i wish you the best! :up:

ewattsjt · Feb 9, 2008

rushing through a case can only lead to mistakes.

also don't forget about the docs that take forever on cases. lol do i get to select my room to stay away from them? am i to think it is ok that a person made 3 times as much as me for doing several ent cases (finishing around mid shift) while i was doing two all day exploratory laps with dr. slow poke? not only do i see it as a patient safety factor but a morality killer for the staff. it is one thing if i pick dr. slow poke and another thing if i was assigned them.

OR male nurse · Feb 9, 2008

two all day exploratory laps with dr. slow poke

ha ha... we have dr. slow poke working for us also. 8 hours once to do an exploratory lap with a sigmoid resection. makes for a long boring day. i would agree with the rest, how can you get paid by the case ?

lindaloo51 · Feb 11, 2008

Well, let me throw in a light hearted reply. You see, I was a mechanic in one of my former careers. Your local mechanic works for flat rate. They are expected to charge out X amount of hours per day per job. They have a big flat rate book that tells them how many hours a job should take. There is a formula that is used for more complicated jobs. They get say 30 minutes to install a new tire on a standard car but if they find broken wheel studs in the process, they get perhaps 30 minutes plus 50%. They are allowed a certain amount of time for routine shop duties, (cleaning, ordering etc.) For those times they receive a basic wage. If the mechanic is very skilled, he can charge out 10 to 12 hours per 8 hour day. (Remember how much you pay your mechanic per hour) However, the mechanic is charged by the shop for his basic shop supplies, rags, cleaning supplies etc. He also has to buy all of his own tools.

Now lets look at how this could work to some nurses or techs advantage or disadvantage. We all have 1 or 2 people that we work with who always get out of the really tough jobs. They do the easy cases and really don't pitch in on the scut work that we know has to be done. On a flat rate system, you have to account for every minute that you are on the clock, so no more extra time in the break room waiting for the doc who is an hour late. Not productive equals no pay. Since we would own our own tools, it would lower hospital costs and we would be alto more careful in the care of instruments and equipment. (Maybe some of you remember when scrub nurses maintained their own needle books)

Those of us who always get stuck with the doc from Hades would be compensated appropriately. In time, the greedy lay abouts would be begging to pitch in and do some of the long hard cases that the same staff always gets stuck with. The staff member that works harder, gets more money and staff satisfaction could be increased. With the promise of more compensation, new nurses will be beating down our doors to come to work with us and begging to take our call. Mandatory overtime will become a distant memory and since the hospitals no longer have to provide us with our tools, those of us with most tools will be in great demand. We could rent our instruments out to other nurses and have another source of income.

Well, maybe it all wouldn't work out, but you all have to admit that we would all like to be compensated for the quality of our work and our value as nurses or techs. Not just compensated at the same rate as someone who has been there the same number of years as us and never increased their knowledge or skills.

Remember, this was a "fun" reply. I really don't want to go to work for flat rate.