So I am taking a graduate level research class, and my textbook keeps talking about how there are all of these great care models shown to improve outcomes for patients that aren't being utilized in practice. I just keep thinking about how nurses NEVER have ANY time, and this is probably contributing greatly to the lack of research in practice. It seems like the problem is getting worse and in some cases practice is not only not evidence-based, it's not even safe. Then good nurses stop being nurses because expectations are impossible.
I guess I'm wondering if anyone has any ideas on how to improve staffing ratios? There is evidence out there that the role of the nurse as an educator is as important. How do nurses get the time they need to serve as effective clinicians?
I've read other posts with suggestions like, "cut the CEOs salary", which is a nice idea, but not likely to happen without some sort of catalyst. Does anyone know what the catalyst could be?
As long as a nurses' professional services, are rolled into the room rate, housekeeping, and the complimentary roll of toilet paper, we will never have worth. We will continue to be seen as an expense, and show up in the negative column of the balance sheet.
That is why nursing needs to start billing for their services. I would like to remind everyone, that the reason the patients are admitted to a hospital, is because they are in need of NURSING SERVICES THAT ARE NOT AVAILABLE, OR SAFE, OUT SIDE OF A HOSPITAL!! They are in the hospital because they need US! Not administration, not manager, but bedside nurses.
Nurses could start by filling our the charge slips, that are used for other charges to a patient's bill. And submit it. See where it goes from there. When ALL nurses start to do that, the management will get the message.
Specializes in Psych, Addictions, SOL (Student of Life).
Even though all these specialties MD, PT , OT etc charge for their services it doesn't mean that they get paid what they charge. Reimbursement rates are set by insurance companies, medicare and medicaid under a system called capitation. An anesthesiologist might charge a private pay patient $1500.00 dollars for services rendered but if that patient has insurance that doctor has agreed to accept the capitated amount. When I worked L & D an anesthesiologist told me he got paid $18.00 to place an epidural by medicaid most physicians and specialists who work in the hospitals get paid far less than most people think they do. I'll take my hourly salary over have to fight with insurance companies over pittance.
Two large hospitals in my area just refused contracts with Anthem Blue Cross because the capitated rate they were being offered did not meet the cost of doing business.
But the fact that nursing charges for its services, means that we are not negatives on the balance sheet. We are not invisible, nor are our services. The hospital will eventually get paid something for our services. That is the point.
Hospitals always try to downplay our services and worth, when it comes to contract time, or asking for a raise time. Unless we have something concrete to show at the bargaining table, we will be shouted down, and our contributions to positive patient outcomes, will be negated.
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.
At the same time, nursing can't charge for services everytime a nurse enters a patient's room. Technically, since nursing is 24/hrs, we're talking about ongoing billing. It just won't work. It will deter people from going to the hospital when they're injured or sick.
At the same time, nursing can't charge for services everytime a nurse enters a patient's room. Technically, since nursing is 24/hrs, we're talking about ongoing billing. It just won't work. It will deter people from going to the hospital when they're injured or sick.
How about when hospitals are forced to cut their charges because their main expense (nursing salaries/benefits) is no longer under their control and no longer a part of their balance sheets? I have no idea how the charges would be set up, but there were certainly be more patient/insurance $$ available to pay for skilled nursing care.
At my hospital the billing department deals with the insurance companies. Our group of providers met with the billing department and structured our admission notes and daily progress notes that help meet the requirements to get the full amounts reimbursed that we can.
I guess my situation is different from the anesthesiologist. I'm not paid based on my individual billing, everything that I bill for goes to the hospital. I get paid a preset salary that is negotiated with our medical group and paid per my contract.
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.
Yes! Physicians and mid-levels bill for their services. If RN hours were billable, that would be a big change.
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.
Its true. And if PT can't get to all their patients on Monday, some get moved to Tuesday, etc. Some patients only get seen 2x/week instead of 3x. They bill per visit, and they fit in what they can, and no more. If a NURSE can't get to everything because there is too much.....well then they better stay late, get spoken to by management, and find a way to fit it all in because their time is not worth anything. Only the pills they bring and the supplies that they use.
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.
But we essentially do this already. When you chart a central line dressing change, it is not JUST to document the care that the patient received. It is also to show that a dressing change happened and the supplies can be billed to the patient. Supply omnicells are to track the same thing - billable supplies. I already itemize every single task that I do and service that I supply in the patients chart.
Except my time and expertise. As far as those go, I might as well just be part of the furniture in the room.
I'm not paid based on my individual billing, everything that I bill for goes to the hospital. I get paid a preset salary that is negotiated with our medical group and paid per my contract.
I think this would be how it could work with RNs too. Still paid hourly or whatever per contract, but there is a bill specifically for nursing care.
lindarn
1,982 Posts
As long as a nurses' professional services, are rolled into the room rate, housekeeping, and the complimentary roll of toilet paper, we will never have worth. We will continue to be seen as an expense, and show up in the negative column of the balance sheet.
That is why nursing needs to start billing for their services. I would like to remind everyone, that the reason the patients are admitted to a hospital, is because they are in need of NURSING SERVICES THAT ARE NOT AVAILABLE, OR SAFE, OUT SIDE OF A HOSPITAL!! They are in the hospital because they need US! Not administration, not manager, but bedside nurses.
Nurses could start by filling our the charge slips, that are used for other charges to a patient's bill. And submit it. See where it goes from there. When ALL nurses start to do that, the management will get the message.
JMHO and my NY $0.02
Lindarn, RN, BSN, CCRN (ret)
Somewhere in the PACNW