Cost of Nursing Services Part 2

Dear NursesRound readers, previously we wrote an article on the Cost of Nursing services in Nigeria/Africa Part 1, following so may reactions from many quarters of the world,  we have deduced that “the cost of nursing services is not only a problem for African Nursing, but Rather is it s global issue” see below some reactions from across the world and what they have contributed (UK,USA,UGANDA, KENYA,NIGERIA,JORDAN ETC). Some said we should have a more detailed way of costing our services while some suggests it is something that will remain with nursing as a profession for a long time, while most believed it should be reviewed internationally, some also believed it will be a hard task owing the nature of nursing work , some referred to it as a passionate discussion that requires organization to yield a very tangible out come . However we saw some positive especially in Africa and America as some of the Hospitals are already designing models on how their nursing services will be arranged, though these are only in hospital based levels of discussions,  but we believe that we can emulate to replicate these models and most importantly, scale it up to the policy makers to steer up our nursing leaders to see it as an area of immediate attention.  I strongly believe that Nursing as a profession is the only body who can take this as a course to achieve greatness for the Nursing Family owing that it could hold a large portion of the professional positive revolution and recognition strategy we suggest: 1. By instituting a stronger Leadership in the nursing starting from the most recognized body to the Hospital Directors of Nursing services. 2. By placing a Benchmark tag for employment of each categories of nurse Qualification Eg: RN $.... BSN$..... MSN$..... PHD$....... PROF$.......  this bench mark will be least of what an employer will pay to these categories but can be higher (we have bench marks but are they observed? And are these benchmarks what is worth?)Try to generate the equivalent of our salaries from services rendered (which they do already). This can also be country or Region specifics. 3. Forming a panel of experts in Auditing the Hospital Revenues from Nursing and equating it to our services and hence conducting a Sponsored Nursing based research on Cost of Nursing services within regions. 4. Is nurses’ involvement in the policy making positions and how do we get there? Involvement in the Health care politics is the only key to getting seated amongst the decision makers. Now we know and have to carry on to build nursing as an independent entity where to make decisions , implement them and hence influence the health sector without intervention of other health care groups. Over in Africa, they solely believe in using strike to achieve their objectives, however if we all have a foot print or a road map of what to at each nursing Associations level and are monitored in doing that we strongly believe that the pricing will come to a better situation. Finally is researching into How to cost Nursing services, Nursing can organize a sponsored Research into Nursing services costing in different regions of the world to generate data and hence make a point or through various channels which are there. We can raise a petition to different level such as WHO, UN, Etc. But most important question we need to ask ourselves here and as well answer them before we make this moves is who actually Leading Nursing is?  ICN? Who? and how?  Read the contributions yourself after the break and make your input

Dian Traisci Marandola wrote:

“What if we considered another angle on costing out of nursing services by starting with the role of the CNO. American Organization of Nurse Executives and American Nurse Credentialing Center for Nurse Administrator certification both require levels of financial management and expertise of the CNO. The CNO is responsible for nursing resources across the organization. So begins the journey for costing out nursing services from recruitment of nurses, retention and excellence in care delivery models. The CNO can begin to carve out what the components of nursing service cost and the cost of not doing certain quality endeavors. The CNO works across all departments to create data, operational efficiencies, & financial reports that help to define the financial impact of nursing services. At the same time the CNO is developing relationships across departments and underscoring the discrete costs around nursing services and teaching other departments to recognize these costs. At some point there is an opportunity to begin showing a nursing component to the bills being generated.”
Thank you for this important discussionn

Alice

Mulago National Referral Hospital, Uganda wrote:

“In Uganda, we have the same challenges where the physicians and anaestatists working in private wards in Mulago National Referral Hospital are paid some extra money per patient but the nurses are not paid any money. When nurses complained, they were told to give the name of the services they provide to the patients.  They gave the examples that the physicians or doctors are paid consultation fees, anaestatists are paid assessment fees. Nurses are the only healthcare providers who are with the patients 24/7, yet their services are viewed as less than that provided by the physicians and the anaestatists. This has really de-motivated the nurses working in those areas.”

Karen Plager wrote:

Nursing is still part of the general hospital charge in the USA as well, Ralueke. So we are with you in the challenge of how to cost out the nursing part of the total hospital charge. It is a big challenge when already, especially in the USA, the cost of hospitalization is astronomical. How do we recoginze the important 24/7 care giving that nurses provide to patients in the hospital while keeping healthcare costs manageable?

Lucy's iPad wrote:

“Hello Ralueke,

It is interesting that you brought of this point and this interesting article on the cost of nursing services. You are so right. Nurses are the back-bone of the healthcare industry. Nurses are the only healthcare providers who are with the patients 24/7, yet our services are viewed as less than that provided by the physicians. The hospital where is work is currently going through a series of restructuring and is in the process of transitioning into a brand new facility. This has resulted in a complete review of the services offered and costing of same as well as salary revision. This costing has now taken into consideration the cost of nursing services and have finally been added to the fee structure. Although it is not what we think it is worth, I think it is a step in the right direction”. 

Nicola from  McHugh,Global Research Nurses’ Network,

 “Good nursing is invisible – often only noticed when things go wrong. People who have experienced good nursing value it, but it is not perceived as a high value skill as it should be by society as a whole. I don’t know how society can be encouraged to value care and carers more – by people before they need to use it! “  Nicola

“From experience in our settings,  in my country Uganda and in many countries on the continent, nurses' devaluation is historical and mainly related to the education of nurses and who manages the services both at ministerial and lower service delivery levels.
For example, todate in most countries we still have nurses educated at certificate level after completing their high school, and most of these may not have not perfomed well. Even entry into the diploma program is not as rigrous. Majority of managers of hospital nursing services are products of these programs. Their medical counterparts have got higher levels of education with a bachelors at minimum. The hospital executives and ministerial officials are physcians with specialized training including management. Their nurse counterparts are in few cases holding bachelors degrees with majority holding posts through accumulated experience. The challenge here is that none of the nurse managers has not only the capacity to cost nurses work but also to advocate for its costing. The nurses are also less involved in decision making and not well prepared for the challenge.
In the USA it is not uncommon to find nurses heading hospitals with a lot of influence.
We need to find how best we can have our nurses' education improve to make sure that we work with our counterpart as collegues and be able to influence others to recognize our contribution. Nurses work is not priceless.”

Rachel Breman, MSN, MPH, RN
Johns Hopkins University School of Nursing- said:

“Dear Members,
Thank you for this great discussion.  It is leading me to wonder how you document your work.  Are nurses where you practice keeping clear patient charts?  Documenting vital signs, fluid intake and output, daily care, patient’s mobility?  What about nursing interventions, how are those documented?  How is patient education provided, individually or in a group? 
Do you have any innovations that you can share in how your practice has improved patient care effectively and reduced the work burden?
I will be happy to provide a summary of our discussion as requested by one of our members.  You can always log into the Knowledge Gateway to see the discussion threads from all our discussions https://knowledge-gateway.org/ganm. If you have problems logging in, please let me know.”

Lucia Buyanza  said:
“Costing will and remains a phenomenon to be explored. What I have learnt from costing particular in the private sector is that the nursing/midwifery services takes the least cost being put in the category of other costs.
We have tended always to have the fear of costing ourselves highly, reasons just known to ourselves, and sometimes it takes a matriarchal role, hence the public viewing our services as cheap and secondary to our counterpart.
All in all I concur with my Director of Nursing Services. We were asked one time to cost our services but took a lot of time debating what was right and convenient.”

Chris Rakuom, OGW
Director of Nursing Services Kenya wrote:

“This is a great debate. I have captured two issues - "costing nursing services" and "gender issues in Nursing".
“It is long since I last contributed to debates on this page. Costing of nursing services is essential if nurses are to have their rightful value in healthcare. But where do we start? Nursing services are defined differently in different countries. Each country must therefore have a standard way of defining nursing services. The confusion is among nurses themselves - they hardly agree on this. In this confusion our counterparts ran away with our ideas and implement them for themselves. I have observed this for years on end, yet nurses themselves have not learned a lesson form it. This brings me to the gender issue - to succeed does one need to be male or female nurse? A very controversial issue to which I have no answer yet. Last year I was invited to make a presentation on the Role of Chief Nursing Officer in Kenya at the University of Wits in SA. At the end of my presentation a question was put to me - allow me to be gender specific here - by a female
nurse professor: "Have you succeeded in doing some of these things because you are a man". I had never thought of thinking that way but after that I have been taking stalk. Perhaps my response to this question is for another day. As for now we have since managed to change the title of Chief Nursing Officer to Director of Nursing Services with one grade elevation among other things in our Scheme of Service for Nurses, amid series of protests from senior doctors at policy level.”

Mellon Manyonga-jordan wrote:
“Unless we can put a dollar figure as in a "Nursing Fee", the same way
doctors do, or how we cost cannulas, IV fluids, bandages, needles (as done
in private hospitals on their Charge Sheets) nursing care and nursing in
general will remain largely undervalued. This research should raise
excitement in the nursing fraternity so that nursing - the backbone of the
health industry - can be rewarded appropriately.”
Nsingu

Karen wrote:
“The Institutes of Medicine (IOM) report in USA encourages interprofessional collaboration in health professions educational programs and at health care work places as well as in health care research. While this seems like a no brainer, one challenge for nursing is recognition and valuing of what nurses contribute to patient care. Emphasis on interprofessional collaboration gets everyone talking and working together for the common good of the health and well-being of the patient while helping the team see the important contributions of each player. That is one way to work at educational and practice levels to raise visibility of what nurses do on a day-to-day basis as part of the health care team... as well as each other member of the team.
Kind regards,”

Theresa wrote:

“The Dr. Charges high fee and is generally acceptable. Nurses’ charges are

unclear/ unknown. Nursing is described as the backbone of health services

in any country. Where and how can this be discussed. I feel very

revolutionary about this. What can I say? Please discuss this in a more

organized way without any emotions

Theresa.”