Nurses as Costs for Hospitals

roser13, ASN, RN · Mar 16, 2015

Charge the patient (insurance company) for nursing services. As it stands, professional nursing care is lumped in with housekeeping services, laundry services, meals and plastic bathing tubs.

BrandonLPN, LPN · Mar 16, 2015

I've heard it said nurses wouldn't be seen as money pits if we billed our services the way other disciplines do.

I'll admit, I don't know enough about the financial and reimbursement side of things to have an informed opinion. My gut feeling, though, is that there is something sleazy about the idea of a bedside nurse billing for services such as administering a medication or changing a dressing.

Home Health Columnist / Guide · Mar 16, 2015

Moved to allnurses Nursing Activism / Healthcare Politics forum as many discussions here on this topic.

Facts and Controversies about Nurse Staffing Policy , Robert Wood Johnson Foundation looks at existing models, enforcement issues, and research needs

Nurse To Patient Ratios

Nurse to Patient Staffing Ratio

Nurse Staffing Laws: Should You Worry?

Nurse Staffing Costs

It's a Myth that it takes thousands of dollars to train a new Grad RN

The Impact of Nurse Staffing on Hospital Costs and Patient Length of Stay: A Systematic Review

KPMG's 2011 US Hospital Nursing Labor Costs Study

Costs, hospital resistance complicate nurse hiring

Health Affairs: The Role Of Nurses In Improving Hospital Quality And Efficiency: Real-World Results

OJIN May 2013: Delivering Nursing Care: Current Factors to Consider

roser13, ASN, RN · Mar 17, 2015

I've heard it said nurses wouldn't be seen as money pits if we billed our services the way other disciplines do.
I'll admit, I don't know enough about the financial and reimbursement side of things to have an informed opinion. My gut feeling, though, is that there is something sleazy about the idea of a bedside nurse billing for services such as administering a medication or changing a dressing.

I cannot even imagine how billing for services rendered at the bedside could be viewed as sleazy. In fact, that very statement seems offensive.

BrandonLPN, I've always been a fan of your posts, so I hope you won't be offended that I wholly disagree with your opinion.

Examples:

PT comes to the bedside and renders services. Do they bill for their time? Umm, yes.

Attending comes to the bedside during rounds. Do they bill? Hell yes!

Labs are drawn at the bedside by lab tech. Free? Hell no!

Why on earth should nursing services provided by a licensed professional be free of charge, allocated to the same category as the bar of soap in the bathroom?

BrandonLPN, LPN · Mar 17, 2015

I cannot even imagine how billing for services rendered at the bedside could be viewed as sleazy. In fact, that very statement seems offensive. BrandonLPN, I've always been a fan of your posts, so I hope you won't be offended that I wholly disagree with your opinion.
Example:
PT comes to the bedside and renders services. Do they bill for their time? Umm, yes.
Attending comes to the bedside during rounds. Do they bill? Hell yes!
Labs are drawn at the bedside by lab tech. Free? Hell no!
Why on earth should nursing services provided by a licensed professional be free of charge, along with the bar of soap in the bathroom?

Well, I admitted it was just a gut feeling. I guess I just find the idea of a patient (or insurance company) being billed for each individual care rendered to be sleazy? I'm not a huge fan of PT or lab billing every time they walk in the room, either.

allnurses Guide · Mar 17, 2015

Nurses are not an expense for a hospital. Hospitals exist because people need nursing

The only reason people are admitted to the hospital is for nursing care.

Here are research studies that show that sufficient staffing saves lives and is cost effective:

An observational study of nurse staffing ratios and hospital readmission among children admitted for common conditions

BMJ Quality and Safety in Healthcare online May 2013

Adding just one child to a hospital's average staffing ratio increased the likelihood of a medical pediatric patient's readmission within 30 days by 11%, while the odds of readmission for surgical pediatric patients rose by nearly 50%.

Nurse Staffing and NICU Infection Rates

JAMA Pediatrics: Published online March 18, 2013

There are substantial shortfalls in nurse staffing in US neonatal intensive care units (NICUs) relative to national guidelines. These are associated with higher rates of nosocomial infections among infants with very low birth weights.

Hospital Nursing and 30-Day Readmissions Among Medicare Patients With Heart Failure, Acute Myocardial Infarction, and Pneumonia

Medical Care: January 2013

Improving nurses' work environments and staffing may be effective interventions for preventing readmissions. Each additional patient per nurse was associated with the risk of within 30 days of readmission for heart failure (7%), myocardial infarction (9%), and pneumonia (6%). In all scenarios, the probability of patient readmission was reduced when nurse workloads were lower and nurse work environments were better.â€

State-Mandated Nurse Staffing Levels Lead to Lower Patient Mortality and Higher Nurse Satisfaction

Agency for Healthcare Research and Quality, September 26, 2012

The California safe staffing law has increased nurse staffing levels and created more reasonable workloads for nurses in California hospitals, leading to fewer patient deaths and higher levels of job satisfaction than in other states without mandated staffing ratios. Despite initial concerns from opponents, the skill mix of nurses used by California hospitals has not declined since implementation of the mandated ratios.

Nurse Staffing and Inpatient Hospital Mortality

New England Journal of Medicine, March 17, 2011

"Studies involving RN staffing have shown that when the nursing workload is high, nurses' surveillance of patients is impaired, and the risk of adverse events increases." "â€¦ We found that the risk of death increased with increasing exposure to shifts in which RN hours were 8 hours or more below target staffing levels or there was high turnover. We estimate that the risk of death increased by 2% for each below-target shift and 4% for each high-turnover shift to which a patient was exposed."

Implications of the California Nurse Staffing Mandate for Other States

Health Services Research, August 2010

The researchers surveyed 22,336 RNs in California and two comparable states, Pennsylvania and New Jersey, with striking results, including: if they matched California state-mandated ratios in medical and surgical units, New Jersey hospitals would have 13.9 percent fewer patient deaths and Pennsylvania 10.6 percent fewer deaths. Because all hospitalized patients are likely to benefit from improved nurse staffing, not just general surgery patients, the potential number of lives that could be saved by improving nurse staffing in hospitals nationally is likely to be many thousands a year,â€ according to Linda Aiken, the study's lead author. California RNs report having significantly more time to spend with patients, and their hospitals are far more likely to have enough RNs on staff to provide quality patient care. Fewer California RNs say their workload caused them to miss changes in patient conditions than New Jersey or Pennsylvania RNs

Overcrowding and Understaffing in Modern Health-care Systems: Key Determinants in Meticillin-resistant Staphylococcus Aureus Transmission

Lancet Infectious Disease, July 2008

This study finds that understaffing of nurses is a key factor in the spread of methicillin-resistant Staphylococcus aureus (MRSA), the most dangerous type of hospital-acquired infection. The authors note that common attempts to prevent or contain MRSA and other types of infections such as requirements for regular and repeated hand washing by nurses are compromised when nursing staff are overburdened with too many patients.

Survival From In-Hospital Cardiac Arrest During Nights and Weekends

JAMA, February 20, 2008

A national study on the rate of death from cardiac arrest in hospitals found that the risk of death from cardiac arrest in the hospital is nearly 20 percent higher on the night shift. The authors highlight understaffing during the night shift as a potential explanation for the death rate. Most hospitals decrease their inpatient unit nurse-patient ratios at nightâ€¦ Lower nurse-patient ratios have been associated with an increased risk of shock and cardiac arrest,â€ the authors stated.

Staffing Level: a Determinant of Late-Onset Ventilator-Associated Pneumonia

Critical Care, July 19, 2007

Understaffing of registered nurses in hospital intensive care units increases the risk of serious infections for patients; specifically late-onset ventilator-associated pneumonia, a preventable and potential deadly complication that can add thousands of dollars to the cost of care for hospital patients. Curtailing nurse staffing levels can lead to suboptimal care, which can raise costs far above the expense of employing more nurses

Nurse Working Conditions and Patient Safety Outcomes

Medical Care,Journal of the American Public Health Association, June 2007

A review of outcomes for more than 15,000 patients in 51 U.S. hospital ICUs showed that those with higher nurse staffing levels had a lower incidence of infections, such as central line associated bloodstream infections, a common cause of death in intensive care settings. The study found that patients cared for in hospitals with higher staffing levels were 68 percent less likely to acquire an infection. Other measures such as ventilator-associated pneumonia and skin ulcers were also reduced in units with high staffing levels. Patients were also less likely to die within 30 days in these higher-staffed units.

Hospital Nurse Staffing and Quality of Patient Care

Evidence Report/Technology Assessment for Agency for Healthcare Research and Quality, May 2007

A comprehensive analysis of all the scientific evidence linking RN staffing to patient care outcomes found consistent evidence that an increase in RN-to-patient ratios was associated with a reduction in hospital-related mortality, failure to rescue, and other nurse sensitive outcomes, as well as reduced length of stay.

Quality of Care for the Treatment of Acute Medical Conditions in U.S. Hospitals

Archives of Internal Medicine, Dec 2006

A national study of the quality of care for patients hospitalized for heart attacks, congestive heart failure and pneumonia found that patients are more likely to receive high quality care in hospitals with higher registered nurse staffing ratios.

Longitudinal Analysis of Nurse Staffing and Patient Outcomes - More About Failure to Rescue

Journal of Nursing Administration, Jan. 2006

Increasing RN staffing increased patient satisfaction with pain management and physical care; while having more non-RN care "is related to decreased ability to rescue patients from medication errors."

Correlation Between Annual Volume of Cystectomy, Professional Staffing, and Outcomes - A Statewide, Population-Based Study

Cancer, Sept. 2005

Patients undergoing common types of cancer surgery are safer in hospitals with higher RN-to-patient ratios. High RN-to-patient ratios were found to reduce the mortality rate by greater than 50% and smaller community hospitals that implement high RN ratios can provide a level of safety and quality of care for cancer patients on a par with much larger urban medical centers that specialize in performing similar types of surgery.

Is More Better? The Relationship Between Nurse Staffing and the Quality of Nursing Care in Hospital

Medical Care, February 2004

Survey of 8,000 RNs in Pennsylvania hospitals found workload and understaffing contributed to medical errors, patient falls and a number of important nursing tasks left undone at the end of every shift.

The Effects of Nurse Staffing on Adverse Events, Morbidity, Mortality, and Medical Costs

Nursing Research, March/April 2003

Increasing nurse staffing by just one hour per patient day resulted in a 9% reduction in the incidence of hospital-acquired pneumonia. The cost of treating hospital-acquired pneumonia was up to $28,000 per patient. Patients who had pneumonia, wound infection or sepsis had a greater probability of death during hospitalization.

Hospital Nurse Staffing and Patient Mortality, Nurse Burnout, and Job Dissatisfaction

Journal of the American Medical Association, Oct. 22, 2002

For each additional patient beyond four assigned to an RN, the risk of death increases by 7% for all patients. The effects imply that, all else being equal, substantial decreases in mortality rates could result from increasing registered nurse staffing.â€

Strengthening Hospital Nursing

Health Affairs, Sept./Oct. 2002

"The implications of doing nothing to improve nurse staffing levels in many low-staffed hospitals are that a large number of patients will suffer avoidable adverse outcomes and hospitals and patients will continue to incur higher costs than are necessary."

Nurse Staffing and Healthcare-associated Infections

Journal of Nursing Administration, June 2002

"There is compelling evidence of a relationship between nurse staffing and adverse patient outcomes," including serious bloodstream infections in hospital patients.

Nurse Staffing Levels and Quality of Care in Hospitals

New England Journal of Medicine, May 30, 2002

Poor hospital registered nurse staffing is associated with higher rates of urinary tract infections, post-operative infections, pneumonia, pressure ulcers and increased lengths of stay, while better nurse staffing is linked to improved patient outcomes.

Health Care at the Crossroads: Strategies for Addressing the Evolving Nursing Crisis

Joint Commission on Accreditation of Healthcare Organizations (JCAHO), 2002

JCAHO found that low staffing levels were a contributing factor in 24% of patient safety errors resulting in injuries or death since 1996.

Intensive Care Unit Nurse Staffing and the Risk of Complications After Abdominal Aortic Surgery

Effective Clinical Practice, Sept./Oct. 2001

Patients treated in hospitals with fewer ICU nurses were more likely to have medical complications, respiratory failure or need a breathing tube inserted.

roser13, ASN, RN · Mar 17, 2015

Well, I admitted it was just a gut feeling. I guess I just find the idea of a patient (or insurance company) being billed for each individual care rendered to be sleazy? I'm not a huge fan of PT or lab billing every time they walk in the room, either.

But seriously, how else would they (PT, OT, Lab, et al )be paid appropriately? Nursing is the ONLY discipline that does not charge for services rendered. And that is why we can be short-staffed, abused, and administered all to hell.

Nursing has not, as a profession, proved itself united enough to make progress. I hope the next generation of nursing professionals will be able to do so.

BrandonLPN, LPN · Mar 17, 2015

But seriously, how else would they (PT, OT, Lab, et al )be paid appropriately? Nursing is the ONLY discipline that does not charge for services rendered. And that is why we can be short-staffed, abused, and administered all to hell.
Nursing has not, as a profession, proved itself united enough to make progress. I hope the next generation of nursing professionals will be able to do so.

You make a good point. It's a subject I ought to give more thought.

I feel more comfortable with the idea of advanced practice RNs billing for their services than I do LPNs or bedside RNs.

Chisca, RN · Mar 17, 2015

I have been repeatedly told through my career that nurses services are covered under the room charge. I am surprised how few nurses even know what the unit they work in charges per day for a room. Most become quite agitated when they realize how cheap their labor is valued and how much they are adding to the hospitals bottom line. And that's what it's going to take to change this situation, a bunch of pissed off nurses that aren't going to take it anymore.

toomuchbaloney · Mar 17, 2015

Most nurses don't care.

Most nurses are young women who are happy to make the pay that they make, happy to have a job, happy to have benefits, happy to have the opportunity to pay off student loans. The system sacrifices those who would complain. Nurses with fewer than 5 years experience are not eager to be fired and "black listed" in their health care communities. As labor unions are unempowered across GOP led states, the ability of nurses to engage in discussion of important issues in their workplaces is diminished. The nurses continue to show up for abuse and mistreatment because they are taught to put their patient's needs above their own. Corporate health care encourages that. Powerless nurses are the fodder of the money machine that is health care today, they are numerous and replaceable.

Red Kryptonite · Mar 17, 2015

If you think you're chained to a computer by "paperwork" now, wait until you're trying to itemize each service you provide and bill for it.