Nursing is viewed as an expense by US HCO’s and is recognized as such by the “market”....each HCO looks to the local “market” to determine pay for every level of nursing staff within their organization. Obviously, no HCO is benchmarking this to force competition, so wage improvements for new hires are extremely difficult because it would require increases for existing staff to ensure internal equity. And let’s face it, there are enough nurses that will say yes to what they pay so they are never forced have to actually find stainable measures to improve pay and hours.
Why is nursing viewed as an expense? Short answer is it because you cannot bill for what the nurse can offer. Nursing care in an acute care setting is packaged into the care for the diagnosis, procedure, or process meaning that when a nurse comes in and does something they cannot bill $37,000 like a provider who just did a cardiac cath. In a non-acute care such as LTC, HHC, or rehab, there is a small billable portion for “skilled nursing“ this amount usually will not even cover the costs associated with the logistics for the nurse to get to the room or the house, so you have to dip into the operating budget for every nurse visit.
It all comes down to revenue for the business, nurses bring in much less revenue than they cost. This requires a strict containment on expenses “nurses“. We all know most organizations have pretty deep pockets Especially the non-profits, they will build a new wing, heavily recruit physicians for obscene amounts of money, or introduce a new technology (that would sustain increases for a decade for the nursing staff), prioritizing and investing in human collateral is imperative, but obviously not required in nursing because we say yes and it goes on.