In the News: Are Hospitals Conspiring to Fix Nurses' Wages?

[JanRNICU]

An article in the November 2007 American Jouranl of Nursing Vol. 107, No 11 discusses Class action lawsuits allege anticompetive activity. The article is written by News Director Maureen Shawn Kennedy, MA, RN.
From the article:
"In May the U.S. Department of Justice and the State of Arizona sued the Arizona Hospital and Healthcare Association ( AzHHA), charging that it conspired to set mandatory billing rates for temporary and travel nurse staffing agencies doing business with member hospitals. On the day the charges were filed, the AzHHA agreed to stop setting uniform bill rates."
"In four nearly identical cases filed in June of 2006 on behalf of nurses in Albany, NY; San Antonio, TX; Chicago, and Memphis, TN, plaintiffs alleged that human resources staff at many hospitals in those cities exchanged detailed, non-public compensation information, agreed not to compete when recruiting or setting compensation rates for nurses, and paid nurses at the same or nearly the same rate. In fact, the Chicago suit says: "Human resources employees have been evaluated by their superiors on their ability to accomplish this RN compensation coordination." The defendants, are seeking to have the cases dismissed. Anthony David Balto, who represents one of the nurses in the AZ case, said that such conduct is likely in response to rising costs, with hospitals and hospital associations seeing nurses' wages as an easy target for budget cuts. These are among the first cases of their kind, he said."

Take the time to read the article. I believe most nurses know this is happening these articles bring the isuues to the forefront.
Wondering why even in a national nursing shortage we are still unable to move forward and take control of our professional practice environment!
The author can be reached at shawn.kennedy@ wolterskluwer.com

[copperrose]

Well I'm not surprised about the AZ nurse. When I worked in AZ in the 80's the wages were very low. You got paid in "sunshine" to quote a recruiter. Because AZ was a destination for some nurses the hospitals knew that if you didn't like their low wages some poor nurse from a northern state would tolerate the low wages just to ..get out of the cold/away from her ex/start a better life etc. If you look on the Salary Wizard that Nursing Spectrum has you are automatically supposed to subtract money if you want to know the wages in AZ. Not only do they need to watch the travel co's but they need to look at the hospitals in general.

[PWhite]

I have always found this subject to be confounding!
You also can be paid "in sunshine" to work in Florida institutions.
However, these same institutions have to pay "beaucoup bucks" for Per Diems, Agency, and Travel Nurses to cover their staffing shortfall.
Not "Kitchen Cupboard" economics for me.
;- o

[JanRNICU]

I don't believe that many nurses are buying the "paid in sunshine" pitch anymore. As professionals we have to act like other professionals in the business world ,and not sell ourselves out so easily. We need to play on the same playing field as the boys/girls/CEO's do. We are in demand...hello there is a national shortage of nurses. We must seperate our passion and advocacy for our patients from the business of healthcare because it has obviously become about profit margins for the people who run healthcare from the business end. Kind of like a split personality. The business nurse and the taking care of others nurse. When seeking work advocate as hard for ourselves as we do when we are caring for others. If we settle for less they will not offer us more out the the kindness of their hearts. In the healthcare environment we have to seperate the roles of personal financial security and patient advocacy! It is a very difficult thing to do. We hear it all the time, " In order to take care of others you must take care of yourself first". Nurses in general, have a really hard time puting themselves first on the list of things to do. It is our sense of good will that becomes the employers weapon of choice. That is why choosing to not give raises because of budget shortfalls is sooooooooooo easy a decision for employers. WE are the line of least resistance. Another issue I see over-and-over again is lack of support for each other, in that a nurse that stands along, usually loses his/her job. The assertive ONE is labled a problem and or has a negative attitude. The labels I hear most is burnt-out or disgruntled. I love what I do but that does not mean that I like the extraneous nonsense that interferes with "doing good work". I do the best that I can, short of sacrifising my livelyhood to advocate for change. That gets me in some very uncomfortable situations.

[bryan]

All hospital administration knows that nurses can't just walk out and off the job. If they did/do they could lose their license. Even nurses in unions can't just walk out. Through out the years nursing salaries have remained stagnant as has the educational requirements. Salary fixing is nothing new.

[PWhite]

I do not mean to imply that I am really familiar with "fee for service" issues with my following comments, but here goes.....
It is my understanding that only Nurse Practitioners may/are able to "bill for service" in certain arenas or situations.
The inability of Nursing Professionals, in general, to "bill for service" is what is at the bottom of this economic problem.
In an institution, the Nursing budget is competitive with the maintenance, pharmacy, housekeeping, food service, supply department, etc. budget needs/demands.
Nursing compensation and benefits could change if Nursing was able to be billed as a "fee for Professional Service" component of the reimbursement process.
Until this happens........we are all "spitting in the wind" regardless of our educational, Degree, or experience status.

[Dental_Hygienist]

Hope you don't mind an interested dental hygienist chiming in on your board.
I am here because I am wondering if our 2 professions might face some of the same issues and struggles, and this thread piqued my interest.
For comparison's sake, a RDH (registered dental hygienist) CAN bill for services directly provided by that RDH; but in 48 states this must be done under the supervision of a dentist. Ex. If I do a cleaning and x-rays I can bill $85 for the cleaning and $60 for the x-rays under my own provider code; this production is considered "MY" prodution and tracked accordingly and then when I go to ask for a raise I can say "I produced X amount of dollars last year so I'm worth this much"
I'm sure that dental ins. and medical ins. operate very differently; but do you mean than a RN cannot bill for services actually performed by the RN? How is the RN's time compensated then? By "room and board" fees in the hospital? By inflating the doctor's fees?
Thanks for any insight, I am very curious how this all works.

[bryan]

Hospitals bill for the nursing services. The nurse receives a salary from the hospital for the services provided. (APN) Avance Practice Nurses' have a masters in nursing and a different licensure and may bill for services independent of other healthcare entities but not in all states. APN's in some states have to have a collaborative agreement with a MD to practice and bill.

[JanRNICU]

The majority of RN's work for an hourly wage. Wages vary by state. Last time I looked at the numbers; the East and West coast paid the highest (not high) as you move to the middle of the country the wages get lower and lower. For comparison. A teacher with 5 years in the profession would make more then the majority of RN working 182 days, about 1,040 hours annually. While an RN would be working about 2080 which inlcudes, weekends, nights, and holidays. I am not beating up teachers this is for comparision. Both are considered full-time jobs. RN works double the hours in a one year period.