The nurse workforce fragility hospitals are experiencing is one result of the dysfunctional incentives for the employment of nurses in the U.S., Vox contends in a policy deep dive.
Nurses' services are not considered billable under the fee-for-service payment model. "Patients end up charged for nurses' work in the same way they are for housekeeping or Jell-O, as part of the cost of a hospital room," Dylan Scott writes for Vox.
This creates an economic incentive for hospitals to keep their nursing staff – a labor cost versus revenue generator, like physicians – small. The fee-for-service payment model doesn't incentivize hospitals to consider the link between nursing and care quality in staffing decisions.
"Until nurses are not an expensive labor cost for hospitals but are seen as revenue generators and as vanguards of quality, which they are, we're going to keep having this problem," Betty Rambur, PhD, RN, professor of nursing at the University of Rhode Island, told Vox.
Mr. Scott writes that many nurses feel no more valued today than they did pre-pandemic. "Cakes to celebrate 'Nurses Week' don't make much of a difference," he writes. "They feel like their jobs are still on the line, based on metrics tied to the same reimbursement system that does not place an inherent value on their work. Pleas for more nurses and for more support continue to go unheeded."
Most experts find changes to how hospitals are paid for the care that they provide, in a way that recognizes the value of nurses' work, necessary to make progress in solving the country's nursing problem.
Mr. Scott mentions a range of solutions proposed by various industry experts, such as allowing nurses to bill for telehealth services or requiring hospitals to spend a certain amount of their revenue on nursing staff. He ultimately notes that although change is needed, change will be difficult given the success of ballot measures for nurse-to-patient staffing ratios and the slow takeoff of value-based reimbursement models in the U.S., with the majority of services still paid for on a fee-for-service basis.
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