Feb 23, 2024 NR 510 Week 3: Organizational Behavior and Business Influences and Advanced Practice Nursing Case Study- Part One
NR 510 Week 3: Organizational Behavior and Business Influences and Advanced Practice Nursing Case Study- Part One
NR 510 Week 3: Organizational Behavior and Business Influences and Advanced Practice Nursing Case Study- Part One
The first in for most important aspect to realize about this is that one is happy and satisfied with their current job which helps with optimum patient care. There are many negotiation strategies that one can use when speaking to management about elevating contract terms . The first most important negotiation strategy that a family practitioner can use for negotiating would be to have confidence in what he or she stands for and believes in. Effective negotiators must have the skills to analyze a problem to figure out the interest of both parties for a proper negotiation and fair compromise. Before going into a meeting about negotiating the contract one should be prepared and focused. Preparing effectively for this would include determining different goals, alternatives for the stated goal, and the pros and cons also. One must examine the relationship between management and themselves to find common areas for agreement and goal attainment. One should also have good, active, listening skills. Why should be able to pick up on verbal communication and also be able to read body language. One should also be able to communicate clearly, state desired outcome, and effectively so that will decrease the chances of misunderstanding and increase the chances of clear understanding of the negotiation.
One should also be able to make sure that he or she is emotions are in line during the negotiation. Negotiations on contracts or any other job upgrade can be frustrating and can open the door for emotions to take control during the meeting which can lead to unfavorable or undesired results. Decisions at the end of the meeting should be ethical and reliable and should not be based off emotions because this can hinder a proper decision. There are several different benefits for being a independent contractor. One can make their own schedule and also have more independence in how they want to complete assignments. One can also except task on a case-by-case basis and can also turn down offers depending on preference and schedule. One can also have more than one client and the family practitioner is in control of her work schedule. This benefits practice as a nurse has more advocacy in Independence rather than working under a strict organization or institution. Since the nurse practitioner is able to make her own schedule and assignments, she will probably be more satisfied and more productive with her patients and provide the best optimum patient care possible. When it comes to negotiating contract terms it is also important to bring up personal contributions that one has given to the job. For example at job rewards, certifications, patients feedback, patient turn around, and other positive contribution that one may have done for the job. (Kaman, 2014)
Reference:
Kaman, V. (2014). DIFFERENCES IN ANTICIPATED PAY NEGOTIATION STRATEGIES AND OUTCOMES. Journal Of Business & Psychology, 9(2), 142-157.
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You are a family nurse practitioner (FNP) employed as a contract (1099 independent contractor) in a busy primary care practice for 2 years. The providers in the group include one physician, who is also the owner of the practice, and two other nurse practitioners, who are staff employees (W2 employees). The owner of the practice recently made comments about the need to produce more revenue. You relate with his concerns and feel that you have several strategies that could be helpful. Your contract is up for renewal in 3 months. You are highly satisfied with your job and want to stay with the group. You see 20 patients per day on average and take call every third weekend.
Discussion Question:
What negotiation strategies should you use to propose a contract renewal? How does your role as a 1099 contractor benefit the practice over the W2 employees? What evidence will you present to the practice to reinforce your value in the practice both in terms of revenue and patient satisfaction? Consider any additional services you may be willing to provide under your contract. Use logical reasoning, and provide evidence based rationales for your decisions.
Keep in mind that your negotiation terms and conditions must be within the legal scope of practice for an ANP.
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This week we learned the importance of contracts and negotiation skills to the Advanced-Practice nurse. There is a significant financial difference to company revenue between 1099 contractors and W-2 employees. 1099 contract workers have more independence and flexibility when it comes to schedule making, and are more autonomous than their counterparts (Fitzgerald, 2016). W-2 employees have benefits of overtime, health insurance, paid leave, retirement benefits, and workers compensation (Fitzgerald, 2016). Being a contract employee saves the physician money as he does not have to provide these benefits. Studies have shown that contract nurses have lower rates of nurse and patient satisfaction (Hockenberry & Becker, 2016). Work environment and the nurse-to-patient ratio, or workload, also seem to affect patient satisfaction (Hockenberry & Becker, 2016).
As we learned in Chapter 10, an efficient Nurse Practitioner can increase productivity and numbers (Buppert, 2015). Every third-weekend call is ideal because there are three Nurse Practitioners. They can rotate through call. Although this would not be beneficial for the W-2 nurses, making everyone a 1099 contract employee would save the company money. Contracts would also ensure the nurses are treating patients extra great. Their jobs would be under contract and unlikely to be renewed if best care was not given. I could also mention paying for my own continuing education or license renewal if the company was paying for it. If the employer saved enough money by making everyone 1099, he could potentially hire another contract nurse to bring in more patients. In my opinion, my suggestions for the company and work ethic should be enough to renew the contract. The individualized care, without rushing, may make the patients more satisfied. I do not want to work myself to death and should negotiate to benefit both myself and the primary care office. I have never had to arrange terms or a job, so this was somewhat difficult for me to come up with. Only ask for what is right and earned. I am interested to see strategies for contract renewal that everyone else suggests.
Fitzgerald, C. (2016). When tech startups outgrow the 1099 model: Moving firms out of the kiddie pool. Vanderbilt Journal of Entertainment & Technology Law, 18(3), 629-652.
Hockenberry, J. M., & Becker, E. R. (2016). How do hospital nurse staffing strategies affect patient satisfaction?. ILR Review, 69(4), 890-910. doi:10.1177/0019793916642760
Buppert, C. (2015). Nurse practitioner’s business practice & legal guide (5th ed.). Retrieved from https://bookshelf.vitalsource.com
Carolyn Buppert suggests using the three P’s when preparing for a contract negotiation (Danielsen, Potenza, and Onieal, 2016). The three P’s stand for prepare, probe, and propose. When the negotiation discussion begins I would start of by stating the number of patients seen for the year and the billable hours that were paid. According to the AANP the US average of NPs see 3 or more patients per hour. A goal to increase revenue would be to start scheduling 3 patients per hour. According to Buppert’s payment model this will increase my revenues by more than $75,000 a year. As a contract employee I would be responsible to pay my own taxes, provide my own malpractice insurance, I would not receive medical benefits, and I would pay for my own continuing education, reducing my cost of employment to the practice. I would discuss patient satisfaction and new patient retention rates. An increase in these rates would show my value to the practice. I would also discuss patient outcomes and the increase or decrease in non-scheduled hospital admissions. A goal to increase revenue would be to decrease no-show rates. Initiating a telephone engagement protocol as stated by Clouse, Williams, and Harmon (2015) has to ability to decrease no-show rates and increase revenues. To take strain off the physician, comanagement of patients could be recommended. Comanagement means the NP and the physician work together to manage the health care needs of the same patients. Norful, de Jacq, Carlino, and Poghosyan (2018) state “the stronger comanagement is, the greater the potential for beneficial patient, clinician, and practice outcome” (p. 254). As the NP I could manage patient call backs of those with chronic illnesses that are being managed in extended care facilities.
Resources:
AANP. (2018). NP Fact Sheet. Retrieved from https://www.aanp.org/all-about-nps/np-fact-sheet.
Clouse, K., Williams, K., & Harmon, J. (2015). Improving the no-show rate of new patients in outpatient psychiatric practice: an advance practice nurse-initiated telephone engagement protocol quality improvement practice. Perspectives in Psychiatric Care, 53, 127-134.
Danielsen, , R., Potenza, A. & Onieal, M. Negotiating the professional contract. Clinician Reviews,28-33.
Decapua, M. (2016). How much revenue does a primary care nurse practitioner generate? Retrieved from https://www.bartonassociates.com/blog/how-much-revenue-does-a-primary-care-nurse-practitioner-generate/.
Norful, A., de Jacq, K., Carlino, R., & Poghosyan, L. (2018). Nurse practitioner-physician comanagement: a theoretical model to alleviated primary care strain. Annals of Family Medicine, 16(3), 250-256.
99213 and 99214 are billing codes that are used for patient office visits. 99214 is a higher code for providing more complex medical decision making. Jensen (2005) states that the “level of decision making in a patient encounter is based on three parameters: the problems addressed, the data reviewed, and the level of risk” (p. 53). To increase more 99214 billings there are several components that must be provided and documented during the office visit. These 99214 billing could be accomplished when seeing patients with chronic illnesses. When seeing a return patient with a chronic disease the pracitioner must do a review of systems which makes the exam extended problem-focused (Waller, 2007). During the exam if there is an additional system affected from the chronic disease process, this must be documented. The last component is the medical decision making, in which providers provide a points value to the diagnosis, data, and risk to determine if the patient visit is a 99213 or 99214 billing code. Another way to increase 99214 billings is to code using time-based billing. The practitioner must spend at least 15 minutes with the patient and half of that time must be used for counselling or coordinating care (Waller, 2007). Documentation is critical when determining the billing code for patients. Chief complaints can be similar, but the care can be completely different and that must be documented. Waller (2007) describes a scenario where the chief complaint of two patients is a cold with one patient having a sore throat, headache, no fever, and ENT WNL, while the other has a fever, sore throat, headache, enlarged tonsils with exudative materials needing a strep culture.
Since the owner of the practice is looking to generate more revenue, the first strategy I would use is to know how much revenue I bring into the practice (Cullen & Donahue, 2016). So far, at an average of 20 patients per day at approximately $70 per patient times 5 days a week times 4 weeks a month, I bring in a substantial amount of almost $28,000 or more per month. Of course, this must be weighed against my salary and any overhead costs (Blazek, 2014). I can use how much I currently bring into the practice as a bargaining tool (Cullen & Donahue, 2016). I help create a consistent revenue stream, which helps the practice remain stable. Another strategy that I should use is to know the type of negotiation style to use (Long, 2013). There are five primary negotiation styles: competing, collaborating, compromising, avoiding, and accommodating (Long, 2013). Each negotiation style has a different way to deal with conflict. My approach should be collaborative not combative. As a 1099, I am more of a benefit to the practice over the W2 employees since the owner does not have to pay health insurance benefits, unemployment insurance, or paid vacations for me like he does for his other two NPs. Furthermore, I must pay for my own malpractice insurance. To validate my financial evidence, I can determine the profit I bring in by tracking my own visits and noting CPT codes and dates (Blazek, 2014). According to the American Association of Nurse Practitioners (AANP), most organizations want a 15 to 20 percent profit rate (Cullen & Donahue, 2016). I can also bring my value and expertise to the table and what it does for the organization’s reputation. I should articulate my nonmonetary contributions to the practice, such as increase in patient satisfaction. I can collect patient testimonials or have patients fill out a questionnaire/survey rating my service. I must also know my market and point out the length I have been employed and the effects of leaving. Building a rapport or bond with patients is the key to building trust and maintain a loyal client base.
References:
Blazek, N. (2014). How to negotiate a fair NP contract. Retrieved from https://www.clinicaladvisor.com/aanp-2014/how-to-negotiate-a-fair-np-contract/article/356496/
Cullen, M., & Donahue, M. (2016). Partnership negotiations: Innovation for nurse contract negotiations during turbulent times. Nursing Administration Quarterly, 40(1), 33-38. doi: 10.1097/NAQ.0000000000000140
Long, J. (2013). Effective negotiation strategies and preparation. Retrieved from http://www.acc.com/legalresources/quickcounsel/ensp.cfm
After having read the lesson from this week and a few articles, it is clear that nurse practitioners can make or break their contracts when negotiating contracts for renewal. Nurse practitioners should be familiar with how to calculate the revenue they bring into a practice (Blazek, 2014). I would want to keep reports on the number of patients that I have seen. This could show how much revenue that I am bringing into the practice. I would want to also know my satisfaction scores. This will be a way that I can be prepared to make other contributions to the practice. It may not be a monetary contribution, but it will make for better patient testimonials (Blazek, 2014).
As a 1099 contractor, I am independent, so my revenue is my revenue. I will be paying the practice for my space. I have more room for play in the amount of revenue that I bring into myself, as long as I have enough to pay myself and the group for my fees. I can propose that I will obtain other credentials, such as those doing DOT physicals, or specialty trainings such as those doing Nexplanon trainings and implants. As a nurse practitioner, in many settings, getting certified to perform DOT physicals is necessary (n.a., 2014). This could bring other revenue in with having those specialty trainings. Along with the special trainings for DOT and Nexplanon, I could become certified in joint injections. This would definitely be a benefit to the practice for bringing in more revenue. I could also advocate to work in an after hours clinic one or two nights a week also. This would help bring in more revenue and satisfaction to the community.
Blazek, N. (2014). How to negotiate a fair NP contract. Clinical Advisor. Retrieved from https://www.clinicaladvisor.com (Links to an external site.)
n.a. (2014). How to get certified to perform DOT physicals. [Web log post]. Retrieved from https://www.midlevelu.com (Links to an external site.)
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