Nurses should bill separately from hospitals and physicians [Letter]

The dean of the Johns Hopkins School of Nursing recently claimed that "today, nurses are full partners and leaders in the heath care process" ("This is not crazy; this is nursing," Aug. 18).

But if that's so, why are nurses (primarily a female workforce) still being paid at a flat per diem rate out of their hospital's room and board line item?


According to a 2007 article in the Journal of Nursing Administration, during the 1920s nurses presented a separate bill to the patient at discharge that directly competed with the hospital and physician bills. This was short-lived, as hospitals gained increasing power in the marketplace and absorbed the private duty nurses as employees.

Nurses lost their economic independence and their expenses were placed in the room and board rates. There was no separate line item in the hospital bill. This arrangement significantly understates the actual direct costs of nursing care.


There are no universal data for capturing the actual number of hours of care nurses deliver to individual patients that can be used to produce a nursing bill for a hospital stay. Nor are there nursing costs or total hours of care necessary to affect changes in DRG reimbursement.

The separation of nursing from room and board would provide real time data to show the actual value of nursing, very much like the profession operated in the early 1900s when nurses were hired directly by patients and billed separately from the physicians and hospitals.

I'm surprised this opportunity was missed during the creation of the Affordable Care Act. It certainly would have added to the spirit of this legislation, which encourages quality of care and measurable outcomes that provide value.

Patricia Bayly Miedusiewski, Monkton

The writer is a registered nurse.


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