Nursing has long lacked the respect it deserves. As a young nurse, one of my instructors told me there is an old saying, “Nurses and prostitutes, our rates go with the room.” As a young nurse I didn’t quite understand what she was getting at. Just comparing nurses and prostitutes didn’t set well with me. I didn’t realize my morality was not the issue. It was my economic worth. 

In the past, holding hospitals accountable for quality of care left the healthcare industry struggling for solutions and nursing care out of the equation. Hospitals charged their patients based on type of room (private or semi-private), supply costs and surgical services utilized. Never were patients charged for nursing care; the “nurse came with the room.” No matter how complicated your care, nor specialized your needs, nurses were “free of charge.”  This thinking is about to change.

In October the Centers for Medicare and Medicaid Services (CMS) will stop reimbursing hospitals for eight hospital-acquired conditions. Linking hospital payments to nursing sensitive measurements is new, and the pressure placed on institutions to provide the highest quality of care at the least amount of expense places more attention and scrutiny upon nurses.

Many nurses feel the new link between quality outcomes and nursing care provides our profession with the opportunity to showcase the contributions nurses make to patients. No longer will administrators be able to take short-cuts in staffing levels, in an effort to minimize expenses; with data demonstrating links between staffing levels infection rates and pressure ulcer prevention lurking in the background.   

Some nurses are concerned the new link between outcomes and reimbursement affords hospitals the “opportunity” to “blame” nurses for poor outcomes. During a time when many hospitals are instituting “pay for performance” initiatives, many nurses feel hospitals will use the new system to punish and point fingers at nurses.

My hope is that forward-thinking organizations with enlightened leaders will use the new policies to engage nurses, improve nursing-led quality initiatives and give nursing care the respect it deserves. I would be interested in knowing what you think? How will the new rulings affect your institution?