RWJF Nursing and Health Policy Fellow Nicole Adams has been selected to present a poster at the American Academy of Nursing’s Transforming Health, Driving Policy Conference in October. Ms. Adams’s poster is based on the 2-Midnight Rule and its impact on nursing care. The 2-Midnight Rule demonstrates the interface of law, federal rule, hospital policy, and nursing practice concerning inpatient, outpatient, and observation status. One of the roles of nurses is to be advocates for their patients and help ensure that care is provided in the most affordable manner possible. Nurses may not be aware that when patients are under observation, their hospital stay does not qualify for Medicare coverage of post-acute care, and patients are required to pay a portion of all procedures and tests conducted. In addition, any over-the-counter or previously prescribed home medications are billed directly to patients at retail hospital prices.

The 2-Midnight Rule is the result of a series of policy and practice adaptations in which hospitals have attempted to protect their income and Congress has attempted to control health care spending. These guidelines protect the financial interests of hospitals and Medicare beneficiaries. This rule needs to be communicated to hospital nurse leaders so they can advocate for electronic medical record changes that help guide physicians and nurses to decisions that protect patients and their financial health. The research for this poster was completed under the guidance of Dr. Barbara Damron, Associate Professor, Office of Community Partnerships & Cancer Health Disparities, UNM Cancer Center and RWJF Nursing and Health Policy Collaborative at UNM.