| Description |
A descriptive, case study design was used to describe specific aspects of two complex health care institutions that have charging systems for nursing care. The sample from each institution included the director of nursing services, associate/assistant directors of nursing services, 4 head nurses representing the major medical services provided by the institutions, the hospital administrator, the associate/assistant administrators, the chief financial officer and the assistant financial officer, for a total of 26 interviewees. The questions for the interviews were structured for each category of interviewees. These questions elicited responses pertaining to the organizational authority structure, span of control, financial system, patient care systems, nurse staffing methodology, patient classification system, and various belief issues about charging for nursing care. The data were analyzed and related to each research question for each group of interviewees. Additional data from written materials were used to describe the study organizations. The research questions were: (1) What are the organizational characteristics of the two complex health care institutions in which nursing care is charged for discretely? (2) What are the characteristics of the nursing department in the two complex health care institutions where the nursing budget is separated from the general hospital budget? (3) How are charges for nursing care identified so as to reflect not only nursing care expenses, but also revenue generated by the nursing department? The conclusions were that both study organizations have traditional organizational structure following the bureaucratic model. Both hospitals and the nursing departments within these hospitals utilized a system of hierarchy of authority, functional divisions of labor, formalized rules and practices with centralized major decision making and decentralized daily operational decisions. Both nursing departments utilized a patient classification system for data collection for the charging for nursing care system. The two organizations differ in their basic goals, governance structure and numbers of administrative staff of authority. The results of this study demonstrate that both hospitals were able to design and implement a system of charging for nursing care within their organizational structure, despite differences between these structures. |
