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A nursing intensity adjustment to hospital payment, such as that described above, has already been endorsed by national nursing organizations. The safety and quality of patient care is directly related to the size and experience of the nursing workforce.

Efforts to implement this model nationwide within the next few years have already been initiated. Inpatient working conditions have deteriorated in some facilities because hospitals have not kept up with the rising demand for nurses. Adjustment of inpatient care reimbursement for nursing intensity.

HISTORY: IN 1999, California passed Assembly Bill 394, which was the first comprehensive legislation in the United States to establish minimum staffing ratios for registered nurses (RNs) and licensed vocational nurses (LVNs) working in hospitals.

AB 394 directs the California Department of Health Services (DHS) to establish "minimum, specific, and numerical licensed nurse-to-patient ratios by licensed nurse classification and by hospital unit." The legislative regulation has had a major impact on hospital reimbursement.

Although this preparation took place in hospitals, Nightingale was really preparing these early nurses for independent practice in the home.

Until the 1920’s, nearly all hospital functions were carried out by unpaid, student nurses under the watchful eye of the nursing superintendent while graduate (private duty) nurses provided care in the home.

In response, hospitals decrease the number of other staff, such as unlicensed assistive personnel and house keepers, to compensate for the loss in revenue.

Mandatory staffing ratios also ignore other necessary criteria for adequate staffing decisions, including patient acuity and required treatments, length of stay, team dynamics of staff, physician preferences, environ- mental limitations, variations in technology, and avail- ability of ancillary staff.In 2008, the medicare-medicaid established new regulations linking Medicare hospital payment to patient outcomes.Eight conditions such as falls with injury and catheter-associated urinary tract infections and other nosocomial infections were cited as conditions that will no longer be reimbursed.Nurses need assistance from elected officials on state as well as federal levels to have adequate nurse staffing ratios through legislative or regulatory means.Safe staffing ratios is the setting of minimum ratios of staff-patient for each type of care unit, requiring use of patient classification /patient acuity system before adjusting the legislated minimum ratios.

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An alternative method that has the potential to improve inpatient nurse staffing and improve payment to hospitals would be to directly link the costs and billing for inpatient nursing care with hospital reimbursement. Journal of Nursing Administration, 30(6):309-15, 2000 Jun, 37, 164-166.