How do we aid APNs serving in this role to benefit from the cost savings provided by utilizing nurses as hospitalists?

In the 1990s, hospitals, like all other organizations that bill Medicare, experienced declining reimbursement for residency training programs (13). Combined with the guidelines that limit medical residents to 80 hours per week implemented by the Accreditation Council for Graduate Medical Education five years ago, a need emerged which highlighted the unique skills and expertise of nurse practitioners. More importantly, when nurse practitioners or clinical nurse specialists are utilized in this role, hospital and nursing staffs have documented hospital savings and improved patient outcomes. During the collective bargaining process unions should request financial information to ascertain benefits and hospital savings accrued from the utilization of APN nurses as hospitalists and negotiate bonuses which are calculated based on the savings benefit accrued from expansion of the role. Places to look for nurse hospitalists through the information request process include the following:

• NPs who have been given the authority to do preoperative workups are usually working as hospitalists thereby decreasing laboratory costs and surgical delays. Request position descriptions of NPs to ascertain if the hospital clearly delineates between the role of the hospitalists and the NP as the primary care providers. Also discuss this issue with bargaining unit NPs who can tell you other areas where their work has been documented;
• NPs and CNSs are tasked with the authority to develop guidelines and education for individualized patient care. Additional cost savings result from the development of guidelines to individualize patient care. Again, ask for the position descriptions of the NP and CNS who function in these roles to ascertain whether this function has been incorporated into their role; also request quality information on the benefits of the guidelines and individualized patient care plans;
• NPs and CNS who discusss or who can s how they work with physicians to decrease lengths of stay for seriously injured patients, decrease lengths of stay for seriously injured patients, improve documentation in medical records, decrease waiting time in the outpatient clinics and reduce complaints from patients obviously have been given quality indicators or other research methodology for documenting the benefits of the service. Ask the APN to review the information request to ensure you are able to properly request all documentation of quality care;
• Critical care coordinators who tend to be registered nurses working on the multidisciplinary hospitalist team or with MD hospitalists should obtain additional compensation for this role. Ask the RNs if there is a hospitalist team with RNs working with the team. Often the hospital will avoid the coordinator title, but find out if RNs are filling this role; and
• Units with staffing of nurse practitioners to address acute care needs such as stroke, MI in emergency rooms, typically are utilizing NPs as hospitalists.