Imagine if, at the end of a shift, every nurse wrote out a bill for the care he or she just delivered. What would be on the bill and how much would each nurse charge? It is a provocative question and gets to the heart of how to measure the added value nurses bring to the health care system. I have asked that question many times over the years. One place I recall was a hospital cardiac care unit where I was touring the unit with the nurse manager. I asked the billing question to a preceptor orienting a young nurse. She went through her own patients, one patient with routine congestive heart failure and another with complex dysrhythmia, and described the various things that would be included on her patient bills. She looked at the new nurse, smiled, and said she would charge more than her. It was a sobering reminder of the different types of experiences and expertise nurses bring to the bedside and the challenge to measure the value of each nurse

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