Free phonecams chat - Mandating nurse staffing ratios

However, mandatory ratios, if imposed nationally, may result in increased overall costs of care with no guarantees for improvement in quality or positive outcomes of hospitalization.

An alternative approach would be to provide a market-based incentive to hospitals to optimize nurse staffing levels by unbundling nursing care from current room and board charges, billing for nursing care time (intensity) for individual patients, and adjusting hospital payments for optimum nursing care. Vol12No03Man01 Key words: nurse staffing; nursing minimum data set; diagnosis related group; cost of care; nursing intensity; health services research; nurse-to-patient staffing ratio; nursing workforce.

The revenue code data, used to charge for inpatient nursing care, could be used to benchmark and evaluate inpatient nursing care performance by case mix across hospitals. In the past several years, there has been a growing need for more registered nurses in hospitals due to rising acuity of patients and shorter lengths of stay.

Thompson and Diers (1991) relate: Most hospitals were charging less than their [nursing] costs for room and board.

Many theories have been advanced for this practice, the most likely one being that patients could compare the costs of a hospital ‘room’ with that of a hotel, not realizing the ‘room and board’ included many services not offered by hotels.

The method is an adaptation of the original work by Thompson and colleagues who argued for a nursing intensity adjustment for the Diagnosis Related Group (DRG)-based prospective payments to hospitals, which were implemented in 1983 (Thompson, Averill, & Fetter, 1979; Thompson & Diers, 1991).

Incorporating nursing variable costs directly into the billing and reimbursement system could align payment with costs and also provide a new source of nursing data based within the national billing system.

Proponents of mandatory, inpatient nurse-to-patient staffing ratios have lobbied state legislatures and the United States Congress to enact laws to improve overall working conditions in hospitals.

Proposed minimum, nurse-to-patient staffing ratios, such as those enacted by California, are intended to address a growing concern that patients are being harmed by inadequate staffing related to increasing severity of illness and complexity of care.

The practice of costing and defining hospital service by this misnamed ‘room and board’ eventually proved to be self-defeating, and can be interpreted as a deliberately confusing practice.

That nursing was buried along with brooms, breakfast, and the building mortgage had consequences not only for the visibility of nursing’s service, but also for the wage structures as hospitals increasingly began to compete on room and board rates, using oligoposonistic practices to artificially constrain nursing salaries. 152) A second change in nursing practice occurred just after the Second World War, as new technologies such as ventilators, cardiac monitors, and powerful intravenous drugs, were being introduced into the hospital environment.

An alternative method that has the potential to improve inpatient nurse staffing and improve payment to hospitals would be to directly link the costs and billing for inpatient nursing care with hospital reimbursement. Journal of Nursing Administration, 30(6):309-15, 2000 Jun, 37, 164-166.

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