Opinion: Spotlight on Nursing

by Judith G. Berg, RN, MS, FACHE

Nursing care has always been critical to hospital patients’ experiences and outcomes — and that’s about to become even more true. In October, the Centers for Medicare & Medicaid Services (CMS) will eliminate additional payment to hospitals for eight complications that are viewed as being preventable. These conditions will be “ignored” as secondary diagnoses in calculating payments and will not factor into higher payment levels, which would typically be associated with higher levels of care. That translates into the possibility of hospitals’ reimbursement levels dropping if these complications are not prevented.

The eight conditions are pressure ulcers; certain preventable inpatient injuries such as fractures, dislocations, intracranial injuries, and burns; catheter-associated urinary tract infections (UTIs); vascular catheter-associated infections (BSIs); certain surgical site infections; objects left in surgery; air embolism; and blood incompatibility. CMS says this list will expand in coming years; data are already being collected on ventilator-associated pneumonia (VAP).

Most of these complications are linked to nursing care; this should result in more recognition of the value of nursing in lessening and preventing them. I hope that is the message, and that the message is heard.

Evidence shows these inpatient adverse events can be reduced. Dramatic reductions in falls, pressure ulcers, UTIs, BSIs, and surgical site infections occur when systematic improvement strategies are employed and nurses are central to the change processes. We also know these improvements happen in environments where nurses and their colleagues receive encouragement and support as they search for better ways to serve their patients. This takes committed leadership; investment in nurse time for patient care, research, and education; appropriate environments of care, including supplies and equipment; information gathering and disseminating systems both at the individual patient level and for groups of patients; and a relentless commitment to improving the patient experience.

Of course, nurses may also be held accountable for failing to prevent these complications. This could add to their levels of job stress and dissatisfaction, which could result in them leaving their jobs. Efforts to prevent errors and improve safety will be most successful if we don’t hold the individual nurse solely responsible and instead focus on changing systems and accounting for human error.

With that thought, the upcoming changes in Medicare and Medicaid reimbursement could make nursing’s contribution to patient care and safety more visible than ever. We need to take advantage of this visibility by advocating for research and policies that reflect nursing’s core contributions to quality, and support nurses’ ability to make timely care decisions in the best interests of their patients.

Source: include.nurse.com