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.

The costs associated with the additional registered nurses that will be needed for the higher, mandated ratios will not be offset by additional payments to hospitals, resulting in mandates that will be unfunded.

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.

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The sicker patients who required these interventions dramatically increased the intensity of nursing care as well as the level of training and expertise needed to care for these more complex patients.

It became more difficult to know how to staff the commonly used, large wards of that era as nursing intensity began to fluctuate more significantly with each new admission.

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.

This article will explore an approach that would link cost and billing with reimbursement by separating nursing care from daily room and board charges and billing for nursing care based on the actual hours of care delivered to patients.

In response, hospitals decrease the number of other staff, such as unlicensed assistive personnel and house keepers, to compensate for the loss in revenue.

This has put additional burdens on registered nurses as they are then forced to assume non-nursing care tasks (Mitchell, 2007). Hospital billing and reimbursement: charging for inpatient nursing care.

The modern hospital was born soon after the First World War with the introduction of a myriad of new technologies, such as aseptic surgery, anesthesia, modern pharmaceuticals, x-rays, and laboratories to measure biological functions.

Within a decade, most acute patient care had moved from the home to the hospital; and the private duty nurses who had followed their patients into the hospital were eventually absorbed as employees of the hospital, losing their independence and entrepreneurial practice (Reverby, 1987). Nursing diagnoses, diagnosis related group, and hospital outcomes.

This article provides an alternative to mandatory, nurse-to-patient staffing ratios.

The main weakness of the regulatory approach is that hospitals are required to increase the number of registered nurses without receiving increased reimbursement for patient care. Nurse staffing, nursing intensity, staff mix, and direct nursing care costs across Massachusetts hospitals.

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