Mandating additional

Furthermore, nurses leave the professional because they believe quality of care suffers when they are forced to care for critically ill patients when they are fatigued.As hospitals lose revenue, they may respond by reducing RN's and healthcare staff, and increase the use of mandatory overtime.This article provides an alternative to mandatory, nurse-to-patient staffing ratios.

Since the mid-1990's, hospitals have used mandatory overtime as standard practice in an attempt to cut costs by not hiring additional nurses.

Nurses and other direct care staff are being required to work double shifts, often without any advance notice, which can also put a severe strain on their family obligations.

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.

Mark Honoski, owner of Premier Medical Staffing Services, a service that provides nurses and healthcare staff to hospitals and other healthcare facilities on a day-to-day basis, predicts an increase in mandatory overtime.

"With the pinch of economic times, many facilities have decided to do more with who they have and have even been forced to mandate overtime." stated Honoski.There are limits on the work hours of truckers, airline pilots, flight attendants and rail workers becaue it is assumed that alertness is critical to the safe performance of their jobs, and many other lives are at risk.Since 2000, 15 states have either banned mandatory overtime or have passed laws restricting its use in healthcare facilities.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. 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.