A big thanks to everyone who joined our recent webinar discussing Nurse Reimbursement and the current nurse staffing crisis. We had several audience questions that got left on the table and our panelists were gracious enough to take some time to answer them:
Q: What is the incentive for a younger nurse to work in a hospital setting when they have so many other options and so much social and peer influence to work elsewhere–e.g. medical aesthetics?
Shawna:
RN work is stimulating, intellectually challenging and for a worthy cause
My heavens, there is great attraction to starting and building a career in a hospital/acute care setting!! The science, technology, and intellectual challenge of being part of a team, caring for the entire plethora of human illness, injury, disease, and conditions — is hard to match. There is a reverence, sanctity, respect, and adrenaline that is unmatched. Most people entering healthcare professions are smart, curious, driven problem-solvers and helpers. These settings meet the intellectual, mission-driven, and financial goals that many nurses have.
Go anywhere with a nursing degree
The greatest strengths of a nursing degree are the full range of places to start, grow, and direct your career. The incentive to work in a hospital would be the career experience, growth, opportunity, and relative financial security.
Cons: hospitals are still working to improve their working environments
The key though, for any employer in any setting and especially healthcare — is providing a safe place where you do your best work, grow your career, and be competitively compensated for the value and risk involved in doing so. Too many hospital-based employers haven’t responded to offering workplaces and careers that match what the market (and nurses) are screaming at them. Flexibility in schedules, career planning and advancement, competitive compensation, autonomy and influence in their practice, etc.
Sigi:
Hospitals are the hothouses of experience
Well for starters experience! When we enter nursing school we do so, at least I know I did, because we want to provide patient care and be involved in the medical care of patients. Although the clinical settings are not always ideal they are the only place where you can be mentored, learn, grow and thrive as an RN.
Entrepreneurship has its own challenges
Being a nurse entrepreneur and a business owner is not as generous as one may think, first of all it’s a hard, emotional rollercoaster and doesn’t always translate to success or income. I relied very heavily on my 30 years of nursing career to start my startup, without my previous clinical experience I would have failed.
Don’t lock yourself in with too narrow nursing experiences
Medical aesthetics and other such nursing jobs, require some knowledge as well and once that spa is closed, you can not become a nurse on a floor again, be careful starting your career there.
Q: Why aren’t we pushing for more men in nursing?
Shawna:
Changing social norms – like men can be nurses – is a slow process
We are!!! But we need a LOT of help from popular media to normalize, popularize, even glamorize and encourage men in nursing roles (instead of ridiculing it)
The “Name, image and likeness” (NIL) movement for student athletes needs to extend to nursing students. At an early age, introducing boys and girls to nursing in a way that doesn’t gender the role goes a long way to diversify the nursing workforce across many dimensions.
Q: Given that nurses make up a huge percentage of the workforce in healthcare, how can we approach this issue [of nurse reimbursement] by allowing nurses to bill for good outcomes, whereby the hospital (business) can increase their revenue, surpassing the revenue physicians bring on?
Sigi:
We have to negotiate with insurance and physician groups to “allow” that. Currently Nurses and RDs are credentialed “under” the physicians. In some states even advanced practice nurses and midwives require physician supervision, which means we cannot bill without a physician. We need to change credentialing, licensing and billing practices from the ground up in order for nurses to be billed by hospitals.
Q: Does anyone know who are the groups/lobbyists fighting against nurse autonomy regarding billing for their services?
Shawna:
Medical groups tend to be the ones fighting nurse independence
YES! Follow any state that is considering or has considered full practice authority for advanced practice nurses. It’s typically organized medicine groups, most frequently the American Medical Association. Take a look at the state of Wisconsin.
The evidence for giving nurses full practice authority continues to build
The best storytelling I’ve heard on this is a 2017 episode from Freakonomics “Nurses to the Rescue!” While this episode is 7 years old, the same drivers, resistance, and arguments are unchanged. What has changed is the mounting evidence in favor of full practice authority as a way to health equity, access, quality, affordable, timely care in more communities. The pandemic was an enormous proof point.
Sigi:
There are also many lobbies fighting for nurses – various nursing unions, the ANA and NP organizations. It requires much money and effort to change rules, but we are making good progress. There is MUCH more independence in nursing today than there was 50 years ago and even 10 years ago with over 24 states moving to independent practice for NPs.
Q: How do we change nursing to a reimbursement model without increasing costs to patients? (i.e. When you have a doctors appointment, you get charged for the visit AND separately for the doctor)
Sigi:
By creating models of care that are complementary to the doctor practice and that are still “billable”. Such as education, support, advice and other complementary services that are not in the current service system due to staffing but that can be easily done using health innovation and technology without increasing cost of care.
*Note: You can also check out Part 1 of this series. Panelist Rebecca Love refers to several pilots which found that nurse reimbursement models were able to keep care costs the same or less while improving outcomes.
Q: Have you seen the Telenursing model used in a mixed in-hospital shift and Telenursing shift per week? How does it work?
Shawna:
YES — many health systems are using this model. PBS NewsHour recently ran a series/story that does a good job describing the trend and how it plays out in practice. Care.ai is a company providing these services. Bonnie Clipper is a nurse leading a lot of this virtual nursing work.
Sigi:
Yes! and they are not NEW. Telenursing over the phone has been accepted since the 1970s, but the COVID-19 pandemic caused a large increase in telehealth visits. The New York University Langone Health System saw a 683% increase in telehealth visits between March 2, 2020 and April 14, 2020.
A quick review of the origins of telehealth
Telehealth services started in the 1800s when the telephone was invented. By the 1950s, the National Aeronautics and Space Administration used remote patient monitoring to evaluate the health of astronauts in space. Twenty years later, nurses providing nursing care over the phone became a widely accepted practice. As new technology, such as video conferencing, remote monitoring, and electronic health records, were invented, the types of technology used in telehealth expanded.
Mercy hospital which now have a full virtual hospital. We see this model in nursing homes as well and in other places where nurses are centralized to observe patients remotely.
This increase in telehealth visits made nursing programs start to consider how to add telehealth to their curriculum and better prepare nursing students to provide telenursing.
What Is Telenursing?
Telenursing, telehealth, and telemedicine are sometimes used interchangeably. All three terms refer to the use of information technology and telecommunications to provide healthcare, medical care, and health education services virtually. Yet, the definitions of each term hold slight differences.
– Telehealth provides medical care, healthcare, and health education services using information technology and telecommunications. Telehealth includes services provided by nurses, doctors, pharmacists, and other healthcare professionals.
– Telenursing, a subset of telehealth, is the use of information technology and telecommunications to provide remote nursing care. The responsibilities for telehealth nurses include remote patient monitoring, collaborating with the healthcare team, and communicating with patients and their families.
– Telemedicine refers specifically to diagnostic and treatment services provided by advanced practice nurses or doctors.
Q: Have you seen or heard of Temi autonomous service robots by Advanced Telemedicine Group? What are your thoughts about robot tech for assisting nurses or even providing direct care one day?
Sigi:
Yes I have seen this model before and it is “cool” and extremely useful for remote communities, nursing homes, cancer centers, and more. However, it is actually a very expensive modality of care and these days we do not need a Robot model. We can do all of this more affordably on an iPad or phone.
Explore more Telenursing resources:
- Bend Staffing Costs and Reduce Attrition: Telenursing, AI, and Nurse Reimbursement [On-Demand Webinar]
- Telenursing Webinar with Oracle Health & Children’s National Hospital [On-Demand Webinar]
- VSee AI-Assisted Telenursing [Whitepaper Solution]
About our Panelists:
Shawna Butler, RN, MBA
Nurse Economist | Host of SEE YOU NOW podcast
Shawna is a nurse economist and the creator and host of the SEE YOU NOW podcast produced in partnership with Johnson & Johnson and the American Nurses Association. The podcast features nurse-driven solutions addressing the most challenging health care problems. Shawna is passionate about raising the visibility of nurses, empowering them as system-level change agents, and recognizing how they create and drive clinical and economic value. She initiated a global conversation highlighting the rarity of nurses in boardrooms, product design, innovation teams, policy development, tech conferences, and health media. In 2021, Butler was honored by Rock Health as a Top 50 in Digital Health. LinkedIn
Sigi Marmorstein, RN,MSN,PHN,FNP-BC
Nurse Innovator | CEO and Founder, BabyLiveAdvice
Sigi is a telehealth consultant and a Top 50 Health Technology CEO with over 20 years experience. She has held clinical, operational, and executive roles with providers like Kaiser Permanente, DaVita, and Adventist Health and has led over 60 successful telehealth implementations. As a serial entrepreneur, her latest company BabyLiveAdvice is a J&J Innovate winner and leverages virtual care to improve black maternal health outcomes. Sigi is a recognized industry speaker and nursing advisor, blending her passion for healthcare equity and broad experiences to provide valuable telehealth insights.
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