Nursing Practice Considerations for Medicare’s Reimbursement Model of Rural Emergency Hospitals

IF 4.2 4区 医学 Q1 NURSING
Karen L. Weis PhD, RN C-OB, FAAN, Deena Woodall PhD, RN, Teale Ryan PhD, MS, RN, Lisa Larson PhD, RN
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引用次数: 0

Abstract

Background: The Consolidated Appropriations Act of 2021 (Public Law 116-260) established a Rural Emergency Hospital (REH) designation under the Medicare program. Guidance includes provider staffing requirements, but the nurse staffing recommendations conflict with state boards of nursing scope of practice requirements.
Purpose: To gain a perspective regarding the nurse staffing needed to provide 24/7 emergent care and patient observation for the REH reimbursement model.
Methods: A mixed methods design of ethnography and cross-sectional descriptive data were collected through unstructured field observations, face-to-face interviews, and focus groups to evaluate descriptive data on nurse education, skill mix, and competencies.
Results: Data were collected from nursing personnel and leadership (N = 45) at four critical access hospitals (CAHs) in Kansas. The nursing workforce sample was predominantly registered nurses (87.8%) with associate degrees in nursing (51.3%). Findings reflect the need for a highly skilled, flexible staff with strong critical thinking skills and the ability to function within their full scope of practice.
Conclusions: The REH reimbursement model and associated policies do not address appropriate nurse staffing within the required scope of nursing practice and services. Initial assessment and patient transports are key factors in the REH designation, both of which require the support of registered nurses. The nurse staffing recommended for REHs does not adequately meet the needs of the service model.
农村急诊医院医疗保险报销模式的护理实践思考
背景:2021年综合拨款法案(公法116-260)在医疗保险计划下建立了农村急诊医院(REH)指定。指导包括提供者人员配置要求,但护士人员配置建议与国家护理委员会的执业范围要求相冲突。目的:了解REH报销模式中提供24/7急诊护理和患者观察所需的护士人员配置情况。方法:采用民族志和横断面描述性数据的混合方法设计,通过非结构化的实地观察、面对面访谈和焦点小组来评估护士教育、技能组合和能力的描述性数据。结果:收集了堪萨斯州四家危重医院(CAHs)护理人员和领导(N = 45)的数据。护理人员样本主要是注册护士(87.8%),具有护理副学士学位(51.3%)。调查结果表明,需要高技能、灵活的工作人员,具有很强的批判性思维能力和在其全部业务范围内发挥作用的能力。结论:REH报销模式和相关政策没有在护理实践和服务的要求范围内解决适当的护士配备问题。初步评估和病人转运是REH指定的关键因素,两者都需要注册护士的支持。REHs推荐的护士配置不能充分满足服务模式的需要。
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来源期刊
CiteScore
4.60
自引率
12.50%
发文量
50
审稿时长
54 days
期刊介绍: Journal of Nursing Regulation (JNR), the official journal of the National Council of State Boards of Nursing (NCSBN®), is a quarterly, peer-reviewed, academic and professional journal. It publishes scholarly articles that advance the science of nursing regulation, promote the mission and vision of NCSBN, and enhance communication and collaboration among nurse regulators, educators, practitioners, and the scientific community. The journal supports evidence-based regulation, addresses issues related to patient safety, and highlights current nursing regulatory issues, programs, and projects in both the United States and the international community. In publishing JNR, NCSBN''s goal is to develop and share knowledge related to nursing and other healthcare regulation across continents and to promote a greater awareness of regulatory issues among all nurses.
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