ng force, in fact providers operate under the incentive to provide the smallest quality of services necessary. Managed care operations not only reduce hospital stays and numbers of nurses, but they also increase demands for nurse practitioners and take over many tasks at a lower cost. Nurses are overworked and their morale is decreasing due to mandatory overtime and scheduling practices that are unsafe and demeaning. Nurses float, moving from one unit to another where they may be unfamiliar with the tasks. Heavy caseloads erode quality of patient care as well as the nurses' life (Gordon, 2000).
The nurse views the rationing of care and is in a position to protect the patient, however, this presents a conflict of interest since nurses jobs are at risk in many instances. Rationing of care has further impacted the elderly, with beliefs such as, since their usefulness is diminishing, focus should be on the young. This denial of care is in conflict with the nurses' professional ethics. It is concluded that nurses need to be involved in the decision-making for healthcare delivery (Jones, Jennings, Moritz, Moss, 1997). Advanced practice nurses have many interest groups that can serve as their advocates and have been successful in many instances such as with approved legislation for direct Medicare reimbursement (Wong, 1999).
With organizational changes, billing is changing and nurses now attempt to identify tasks for direct reimbursement. However, nurses roles are constantly being redefined and the difficulty of measuring intangible functions such as caring, support, coping, nonmedicinal pain control, decision making, and care planning, make billing a challenge. A shift toward NP decision making is resulting in the removal of power from physicians and hospitals. The nurse is now able to provide autonomous care with the ability to bill directly and be reimbursed (Girard, 1993).
The traditional role of the nurse was to be ...