Though it sounds like fiction, today’s nurses are compensated using a system established nearly a century ago.
Fortunately, there’s a committed group of nurses and other key stakeholders at the Commission for Nurse Reimbursement who are dedicated to the long-overdue reformation of antiquated nurse reimbursement models.
And though the commission recognizes that raising awareness about the challenges of current compensation practices is demanding, it remains steadfast.
Among the commission’s members is Rebecca Love, MSN, RN, FIEL, a staunch advocate for this cause.
Love is the commission’s cochair and cofounder. She's also the coauthor of two books, The Rebel Nurse Handbook and The Nurses Guide to Innovation, and pioneered the Nurse Hackathon initiative as the first Director of Nurse Innovation and Entrepreneurship in the U.S. at Northeastern School of Nursing in Boston, Massachusetts.
Love’s work with the commission focuses on fundamentally changing how nurses are compensated for their contributions to health care. To that end, the commission is scheduled to attend a legislative summit this June in Washington, D.C., to meet with chief nursing officers, policymakers, and other interested parties to “shape the future of nursing services reimbursement,” according to the commission’s website.
During a recent interview with Nurse.com, Love discussed the commission’s efforts to ensure fair compensation for nurses and why this is critical for the well-being of nurses and patients alike.
Q: When was the Commission for Nurse Reimbursement established and why?
Rebecca Love: It was established in April 2023 after years of conversations. We started to realize that nurses were rolled into room rates back in the 1930s with the development of national insurance when hospitals were run by men. Before that, nurses could bill for their services.
At the time of the women's rights movement, nursing became the largest economic vehicle for women's financial independence in the history of the world. But men became threatened by women's financial independence in nursing and looked to a model that would capture nursing reimbursement, but not give them a financial identity about how much value they bring to health care.
Hotel maids had been rolled into room rates. And nurses were also rolled nursing into room rates and into the models for national insurance, hiding the true value of nursing.
And to this day, 100 years later, nurses are the only healthcare professionals that cannot bill for their services.
Q: How do you and the commission plan to go about changing the way nurses are paid?
Rebecca Love: We’ve come up with seven different models based on models for other healthcare professionals that currently have billing structures in the United States, as well as in Belgium.
Belgium was the first country to unbundle nurses from room rates and have found that not only is access to care better, but patient outcomes are better because they’re now able to pay for the nursing workforce. We're setting up meetings with organizations like the Senate HELP (Health, Education, Labor, & Pensions) Committee, state treasurers, and Health and Human Services offices at state levels to educate them on how nurses are considered part of cost.
What we're surprised to hear is the vast majority of our elected officials responsible for driving health care had no idea that there was no reimbursement mechanism for nursing in our healthcare system today.
Q: Have you ever been part of an initiative that shows promise for effectively addressing various nursing issues?
Rebecca Love: Back in 2015, I went to my first Hackathon around innovation, and there were no nurses in the room. These events brought people together who wanted to create solutions and drive change. Nurses were absent from the conversation.
By the time we launched a nurse innovation movement in 2016 with our first Hackathon at Northeastern, every single major hospital in Boston was sending teams of nurses to attend. By 2017, so much excitement had happened around nurses being innovators and problem solvers that Johnson & Johnson met with us. Soon, Johnson & Johnson began recognizing the brilliance of nurse innovation.
Nurses can drive change. And we can make nurses visible in places that they have been largely invisible.
Two years ago, when I attended Vive, which was one of the major healthcare conferences in the world, there were only six U.S. nurses in attendance. Everyone on stage was talking about the workforce crisis and nursing, yet there were no nurses there to talk about it. Nor were there nurses in the audience.
But this year, Vive made it a key initiative for nurses to attend, and nurses were on stage, in the audience and everywhere having these conversations with those driving health care forward.
Q: What is the impact of an inadequate nurse reimbursement system on the quality of patient care?
Rebecca Love: A hospital is paid equally whether a nurse cares for four patients or eight patients. So from a financial perspective, since you're not getting paid more to have any more nurses, hospitals that are dealing with financial challenges, which all of them are, assign more patients per nurse to meet their economic viability.
It has nothing to do with outcomes for patients because if it did, we would be following the models that have long been researched and studied by the National Institutes of Health that show that for every additional patient a nurse carries, there is a 7% increase in mortality of patients within 30 days of admission.
That is the one denominator we know is certain — more patients per nurse leads to increased death in patients. And the reason that we don't staff safely is because nurses equal cost and hospitals say they cannot afford more nurses, even if it means better outcomes for patients.
Q: What are the potential long-term consequences if nurse reimbursement is not adequately addressed?
Rebecca Love: If nurse reimbursement is not adequately addressed, nursing in this country is going to fail as a profession. Prior to the pandemic, as many as 57% of new grads already have left the bedside within two years of practice.
We don't have a shortage of nurses in this country — we have a shortage of nurses who are willing to work in healthcare environments as they exist today because there is no investment in it.
What I’m concerned about is that no future Americans are going to choose nursing. And I wonder to myself what happens to the fabric of our society if we don't have nurses?
We should be doing everything, investing every single dollar we can into that workforce.
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