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Executive Summary
Creating more sophisticated models that describe and value nursing care will enable more sophisticated management of nursing resources. The authors used the Nursing Interventions Classification (NIC) as the basis for describing actions performed by nurses.
Nursing experts evaluated each intervention in order to assign the time required for each task and the minimum level of education required to perform each task.
Fifty-four percent of the interventions were determined to require fewer than 30 minutes. Over 70% of the interventions in the NIC were deemed to require basic RN education to perform them safely and appropriately.
With the time and skill level required to complete each intervention, a cost per intervention can be determined. Assigning overhead cost per intervention and a corresponding charge will enable more effective contracting for nursing services in the health care marketplace.
DETERMINING THE COSTS Of nursing service has been of interest to nurses for several decades (Elliott, 1997; Hendricks & Baume, 1997; "IRS challenges," 1990; Mittlestadt, 1992; Mundinger, 1985; Palcini, 1984; Scherubel, 1994; Vanderbilt, 1990, 1992). Nursing cost determination is important to demonstrate the cost effectiveness of nursing practice, improve service delivery, and decrease health care costs (Curtin, 1984; Davis, 1983; Fagin, 1986; Olsen, 1984; Scherubel, 1994; Shaffer, 1984; Thompson & Diers, 1985). Knowledge of costs is also necessary for establishing fee schedules for nursing reimbursement (Peters & Hays, 1995).
In the 1980s, multiple efforts to "cost out" nursing services were reported in the literature. Most of the studies had small sample sizes, were conducted in one institution, and used patient classification systems without much regard to their validity and reliability (McCloskey, 1989; McCloskey, Gardner, & Johnson, 1987). The wide variety of nonstandardized patient classification systems was a key reason for the difficulty of obtaining large data sets for comparing nursing costs. Determining nursing costs based on interventions performed was advoGated but required a standardized comprehensive list of interventions. It was not until the development and use of the Nursing Interventions Classification (NIC) (McCloskey & Bulechek, 1992, 1996, 2000) that this was possible. NIC, described in a following section, is a comprehensive standardized list of all interventions performed by all nurses no matter their practice setting or area of specialty. With a standardized language now available...