I once interviewed with private duty agency, and when I asked for certain salary that I think is reasonable for a nurse with 18 months experience. She counter-offered me with much lower salary, saying that I don't have home health experience. Hence, my salary will be the same like new grad. Plus she wanted me to work weekends too. She said in order to qualify for full time position, I have to work one weekend because everyone wants to work weekdays. (Err, I thought that's the perk of PDN, can choose their own schedules? apparently not!) Plus my friend worked there and she told me the benefits were very expensive and no PTO offered. I was not desperate enough, so I never followed up with the agency.
I also have a prn job at a PPEC. The manager sent me home earlier because another nurse, an LVN, took over. She's a great LVN, I have no doubt about that. I don't mind she's taking over, but I know the reason the manager cut my hours.. they want to cut the cost of an RN.. . The manager is always bothering me how long I will finish my charting. I can finish on time if you fix the ratio.. How can they expect me to finish on time when they only have 2 nurses and 2 techs for 8 kids with special needs? In the beginning they promised 1 nurse and 1 CNA for 3 kids. They cut the staff and they want us to clock out on time. Heck no, I'm not going to clock out until I finish my work. I used to do that in the past. Being forced to clock out when I'm not done with the work, and I and some other nurses used to work for "free."
Learnt my lesson.. if they're not happy, they can fire me, but I'm not working for free anymore.
But then from here, I learnt that they considered RN as an expense, instead of an asset. Or maybe it's just the employers that I've encountered.
most nursing hours are not billable, they are an added in expense. Usually in HH or hospice are nursing hours billable. Now if insurance allowed nurses to bill services in the hospital, ECFs and clinics, we might see a major change in staffing, but maybe not, considering that they want their profit. It really stinks
I had no idea! It makes a lot of sense, but it does stink. It's so hard to understand billing at the hospital level because the process is so nebulous. I feel like nursing hours aren't valued until nursing actions break down (i.e. someone getting a pressure injury or a CLABSI); we aren't reimbursed for good nursing care, but we are financially punished for poor nursing care (i.e. with hospital-acquired infections and pressure ulcers).
most nursing hours are not billable, they are an added in expense. Usually in HH or hospice are nursing hours billable. Now if insurance allowed nurses to bill services in the hospital, ECFs and clinics, we might see a major change in staffing, but maybe not, considering that they want their profit. It really stinks
Very true. In Community Health, we are able to bill for a 30 minute nurse visit for education (for uncontrolled diabetics) and it is a game changer. Instead of just being sent in to do whatever tasks the Dr doesn’t have time to do, I am able to see patients for these long education and support sessions. It is all about billing, unfortunately, or we wouldn’t be able to offer that.
I once interviewed with private duty agency, and when I asked for certain salary that I think is reasonable for a nurse with 18 months experience. She counter-offered me with much lower salary, saying that I don't have home health experience. Hence, my salary will be the same like new grad. Plus she wanted me to work weekends too. She said in order to qualify for full time position, I have to work one weekend because everyone wants to work weekdays. (Err, I thought that's the perk of PDN, can choose their own schedules? apparently not!) Plus my friend worked there and she told me the benefits were very expensive and no PTO offered. I was not desperate enough, so I never followed up with the agency.
I also have a prn job at a PPEC. The manager sent me home earlier because another nurse, an LVN, took over. She's a great LVN, I have no doubt about that. I don't mind she's taking over, but I know the reason the manager cut my hours.. they want to cut the cost of an RN.. . The manager is always bothering me how long I will finish my charting. I can finish on time if you fix the ratio.. How can they expect me to finish on time when they only have 2 nurses and 2 techs for 8 kids with special needs? In the beginning they promised 1 nurse and 1 CNA for 3 kids. They cut the staff and they want us to clock out on time. Heck no, I'm not going to clock out until I finish my work. I used to do that in the past. Being forced to clock out when I'm not done with the work, and I and some other nurses used to work for "free."
Learnt my lesson.. if they're not happy, they can fire me, but I'm not working for free anymore.
But then from here, I learnt that they considered RN as an expense, instead of an asset. Or maybe it's just the employers that I've encountered.
For any business, company or whatever, those who hire employees universally view them as an "expense". That is how accounting, tax laws and other things treat those hired by someone who have an associated cost, but do not usually per se generate revenue.
Ever since Florence Nightingale got the ball rolling hospitals exist in large part to provide skilled nursing care. Today you can add nursing homes, rehab and other healthcare facilities to that list.
Nursing care comes as part of bed and board for healthcare facilities. Nurses are employees of said institutions and are compensated (to various degrees) for the exchange of their labor.
In light of above it is the general tendency for all employers to manage their expenses/cost of doing business. For employees (in this case nurses) can be done in many ways including via productivity.
Late as the 1960's (IIRC) many hospitals were using student nurses (from their affiliated nursing schools), to provide a large part of patient care. Those students were not compensated and their labor was treated as part of their training/education. Hospital got free labor, students got experience/education/training, what could be wrong with that model? It turns out plenty and insurance companies began to balk. Hospitals were informed they would no longer pay for care not provided by licensed or professional nurses, and that was the end of that.
There isn't anything a LPN/LVN, aide or tech can do that a RN cannot. But the latter usually is at the top of the pay food chain so to keep expenses down places are finding all sorts of creative but legal ways to use more UAPs and or LPNs.
Via their duties a nurse does generate revenue for a facility, but often the billing does not reflect this per se. Rather the cost of administering medications, performing a procedure/treatment, etc.... includes cost of labor from the facility.
Hospitals charge $15 or more for one Tylenol. You can get a bottle of 500 in most parts of USA for same or less money.
Not satisfied with that mark-up some places charge an "oral administration" fee (around $8.00), tacked on each time a nurse (or someone else employed by facility) hands a patient an oral medication.
And so it goes; nearly everything a patient receives as part of that "room and board" including bedside kit and or a box of tissues is vastly inflated in cost. So while providing nursing care on paper is an expense, places are making their money off said care in many ways.
Nur7138
7 Posts
None of us get paid what we are worth. Managers at a fabulous and I mean a fabulous gas station makes as much as some nurses. So sad.