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. However, mandatory ratios, if imposed nationally, may result in increased overall costs of care with no guarantees for improvement in quality or positive outcomes of hospitalization. The costs associated with the additional registered nurses that will be needed for the higher, mandated ratios will not be offset by additional payments to hospitals, resulting in mandates that will be unfunded. 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. The revenue code data, used to charge for inpatient nursing care, could be used to benchmark and evaluate inpatient nursing care performance by case mix across hospitals. A nursing intensity adjustment to hospital payment, such as that described above, has already been endorsed by national nursing organizations. Efforts to implement this model nationwide within the next few years have already been initiated. This article will argue for the benefits of implementing a nursing intensity adjustment for nursing care by briefly reviewing the process by which nurses lost their economic independence; describing the gap between the supply and demand for registered nurses; presenting the arguments for and against mandatory, nurse-to-patient staffing ratios; offering a different approach for increasing the number of registered nurses at the bedside, namely nursing intensity billing; proposing sources of funding to pay for nursing intensity billing; and identifying limitations of nursing intensity billing.

nurse staffing --- nursing minimum data set --- diagnosis related group --- cost of care --- nursing intensity --- health services research --- nurse-to-patient staffing ratio --- nursing workforce

Nurse turnover is a recurring problem for health care organizations. Nurse retention focuses on preventing nurse turnover and keeping nurses in an organization’s employment. However, decisions about nurse turnover and retention are often made without the support of full and complete knowledge of their associated costs and benefits. This article identifies common nurse turnover and retention costs and benefits, discusses the use of benefit-cost and cost-effectiveness analysis relevant to nurse turnover and retention, and calls for the construction of a business case for nurse retention. It also provides a foundation for including the costs and benefits of nurse turnover and retention in estimating the economic value of nursing.

benefits --- business case --- costs --- nurse turnover --- nurse retention

Cost-utility analysis is one method of determining the cost effectiveness of nursing interventions. It is heralded by the World Health Organization as the measure to determine allocation of resources. This method of measurement includes calculation of both the cost of quality-adjusted life years (QALY) and the cost of disability-adjusted life years (DALY). The purpose of this article is to present cost-utility analysis as a relevant measure for describing the value of registered nurses. First the article will present a short overview of cost effectiveness, along with a discussion of two cost-effectiveness measures, cost-effective analysis and cost-utility analysis. Then the measurement of quality-adjusted life years and disability-adjusted life years will be presented. The article will conclude by challenging nurses to develop cost-utility analyses into a meaningful and useful methodology that can provide nursing with a process to measure the economic outcomes of our nursing interventions.

professional nursing --- cost-utility analysis --- quality-adjusted life years --- QALY --- disability-adjusted life years --- DALY