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NUR435 Discussion post: Step 1 Post your response to the discussion board

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NUR435 Discussion post:

Step 1 Post your response to the discussion board.

Currently, nursing services are considered an expense for which healthcare organizations cannot bill separately. Cite your references using APA 7th edition and respond to the following questions and, if appropriate, include personal experience as part of your answers:

• Why are healthcare organizations unable to bill separately for nursing services, and what is the impact on nurse leaders?
• What can the nursing profession, and specifically nursing leaders, do to change this issue?
• Why are nursing services considered an expense and not an income generator?

Step 2 Read other students’ posts and respond to at least two of them.

Ask questions of the other students that promote further thinking and discussion on the topic. Consider the changes to billing identified by the other students. Do you agree or disagree that these changes can make an impact on nursing services? Why or why not?

Use your personal experience, if it's relevant, to support or debate other students' posts. If differences of opinion occur, debate the issues professionally and provide examples to support opinions. Cite your references using APA 7th edition.

NUR435 Student Posts:

Student #1: The reason that healthcare organizations are unable to bill separately for nursing services is due to the coding process in the billing aspect of the organization. “A major concern for nurses is that the bills submitted to third-party payers and consumers from healthcare organizations bundle nursing services with the flat daily charges, such as the cost of the hospital room and housekeeping. The specific cost of nursing has neither been separated nor given a dollar value. This has hindered the ability of nurses to receive specific payment for their services from third-party payers” (Healthcare Finance, n.d., Topic 3). The impact this has on nursing leaders is how it effects the budget they work with. In trying to properly staff a unit it would go a long way to have all services rendered have a set cost, therefore the more services rendered the more the unit would gross. The problem is that health insurance is already so expensive and adding costs to a hospital stay may make it unattainable for the average American as the insurance company would surely pass the cost on to the consumer.

In nursing there has already been a move towards billing separately for services, at least in the world of nurse practitioners. “Nursing leaders have opportunities to influence policy and delivery of care initiatives. The increasing focus on nurse-sensitive indicators gives nursing leaders the opportunity to highlight the specific nursing interventions that ensure optimal patient outcomes” (Healthcare Finance, n.d., Topic 4). By advocating for this type of separate billing for services, nurse leader could boost productivity, help contain cost, and increase their budget.

The basic answer as to why nurses are considered an expense and not an income generator is that they are paid through the budget process. As such, expense is, “defined as the costs or prices of activities undertaken in the organization’s operations” (Huber, 2021, p. 388). In this way of looking at nursing in the organization it is considered a cost not a revenue source. In fact, “staffing expenses generally are the largest portion of the nursing operating budget, nurse managers and nurse executives need to have a consistent and well-defined approach to estimating staffing expenses” (Huber, 2021, p. 392). One way to change this is to have separate billing and effective cost control over supplies used on a unit. If nursing services were billed separately and the revenue gained went back to the unit it could be used to increase the budget, incentivize nurses, and improve the patient outcomes.

Student #2: Several healthcare organizations cannot bill separately for nursing services, which negatively impacts the nurse leaders. Due to the purpose of the documentation, the coding system, and other requirements related to this process, medical institutions cannot charge only for nursing services (Kennedy et al., 2017). They can calculate working hours, but they pay more attention to patients, and therefore, they cannot be registered. This effect reduces the payment process in the nursing field.

The most exciting part of looking at healthcare as a cost is the opposite of what hospitals think of other healthcare providers. Doctors and most (but not all) different therapists (respiratory, specialist, and physiotherapist) are often seen as the cost of a service that earns a hospital income. To change this problem, the nurse needs to understand the billing process. Nursing practitioners and nursing leaders can take specific actions to change this issue. They recognize the needs and conditions of their services. Care facilities must have written documentation.

Nursing services are considered an expense and not an income generator. If the patient's care costs more than the reimbursable amount, the hospital incurs a financial loss (Huber, 2018). Among the incidental costs that hospitals incur to provide medical services are appropriately licensed and trained personnel, medications, technology, food, supplies, and equipment (Huber, 2018). Hospitals must consider all these expenses when they enter into managed care contract negotiations with insurance companies to provide healthcare services for their members (Huber, 2018).

NUR445 Discussion Post: 

Step 1: Discuss the importance of advocacy as it pertains to patient care.

What is the nurse's role in patient advocacy? Describe a situation in which you were involved with patient advocacy. Explain what the advocacy accomplished for the patient, and what the repercussions would have been if the patient would not have had an advocate. Cite your references using APA 7th edition.

Step 2 Read other students' posts and respond to at least two of them. Cite your references using APA 7th edition.

NUR445 Student Posts:

Student#1: What is the nurse's role in patient advocacy?

Patient advocacy in nursing refers to the act of making sure that the patient’s rights are always protected, ensuring that the medical care administered to the patient is correct and making sure that all the benefits entitled to the patients are provided, for example financial support. It is an important aspect in patient care as it ensures that there is patient equality in provision of health care facilities to all patients despite their race, socioeconomic status, and their religion. It also helps to reduce patient suffering, not only the disease-caused suffering that is the pain management and the physical suffering but also other types such as depression and emotional suffering by identification of patients in such situations and helping them overcome the suffering. Nurses have the role of preserving a patient’s dignity at all costs by respecting cultural and ethical beliefs and accepting them especially in situations where they have great influence on the patient’s physical and emotional well-being. In addition to that, they must ensure that all the information relating to the patients’ illness remain private and confidential. Equality in the service of healthcare offered to the patients must be practiced by serving every patient with the same degree of professionalism and compassion. A nurse has the obligation of serving as the communicator, interpreter and as the caregiver to the patients.

Describe a situation in which you were involved with patient advocacy. Explain what the advocacy accomplished for the patient, and what the repercussions would have been if the patient would not have had an advocate.

I was once involved in a patient advocacy situation where I spotted one of the patients who seemed not contented with the information he was given about his illness. I approached him and initiated an open dialogue where I asked him several questions and gave relevant feedback concerning his state of health to help him arrive at a final answer on the method fit for his treatment. Having educated the patient on his rights and our obligation as nurses and doctors he had to select the best treatment method for his condition from the possibilities he had prior been informed about.

It’s mostly likely that the patient would have ended up choosing a treatment method that would have severe effects on his lifestyle or even one that will not solve his health issues, considering the fact that he had no information on the different methods offered to him.

Student #2: The role of patient advocacy in nursing is many faceted, we are the last line of defense for many of our patients. I like the way it is summed up in an article from Sage Nursing Journals;

"The attributes of patient advocacy are safeguarding (track medical errors, and protecting patients from incompetency or misconduct of co-workers and other members of healthcare team), apprising (providing information about the patient’s diagnosis, treatment, and prognosis, suggesting alternatives of healthcare, and providing information about discharge program), valuing (maintaining self-control, enabling patients to make decisions freely, maintaining individualization and humanity, maintaining patient privacy, and acting in the patients’ values, culture, beliefs, and preferences), mediating (liaison between patients, families, and healthcare professionals, being patients’ voice, and communicate patient preferences and cultural values to members of the healthcare team), and championing social justice in the provision of healthcare (confronting inappropriate policies or rules in the healthcare system, identifying and correcting inequalities in delivery of health services, and facilitating access to community health services and health resources)”  (Ahmadi, 2019, para. 3).

The situation that comes to mind that I was deeply involved in patient advocacy was when I was in the role of charge nurse, a patient had fired her nurse and I had to go talk to the patient to help sooth the situation. As I entered the room, I realized right away that the patient was extremely angry. She is a deaf woman who cares for her disabled brother who was also in the hospital just down the hall. The reason she was so upset was she was best at reading lips, and we all had to wear masks with COVID-19. She also refused the use of MARTTI as she considered it demeaning. The woman was also quite concerned about her brother as he is also deaf and really only able to communicate with his sister. The way I advocated for her was by taking the time to write out my end of our conversation (practically a book!) and show her each of her medications in the package before opening them. I also got her attending physician to come discuss what would happen when she was discharged. She was refusing discharge because she wanted to be near her brother. The next step in advocating for her was to contact my manger to see if she could stay with her brother for the duration of his stay. I was able to secure this exception and made her much more comfortable and she even smiled. If I had not advocated for in these and many other ways, she may have refused discharge indefinitely, been confused about the medications she was taking, and not understood what was next for her and her brother upon discharge. Ironically, the next time she was hospitalized I was her primary nurse and we got along quite well!