From: David R. Stoolworthy, M.H.A., M.B.A. <dstoolworthy@saintrectory.org>
Sent: Monday, 7:15 AM
To: All Nursing Staff, Charge Nurses, Nurse Managers
Cc: Nursing Administration, Revenue Cycle Management
Priority: High All Nursing Staff
MEMO VIII: Nursing Duties — The Things We Cannot Unsee

VIII. Nursing Duties — The Things We Cannot Unsee

Saint Rectory Memorial Hospital System is proud of its nursing staff. We are prouder still of the fact that, unlike our competitors, we have begun properly documenting and billing for the full scope of nursing labor — including the portions of that labor that are, to put it clinically, gross as hell.

This memo is a mandatory orientation supplement for all nursing staff, new hires, and nursing students. It exists for two reasons: (1) to prepare you for the realities of the job, and (2) to ensure that no billable task goes unrecorded.

A. The Official "Gross Duty" Registry (GDR)

Effective immediately, the following duties shall be logged in the G.D.R. — Gross Duty Registry module of our EHR. Each is separately codeable. Each is real. Each has happened to someone on this unit, possibly today.

Code Duty What It Actually Means Billing Note
GDR-1 Oral suction of unexpected projectile vomit Patient announced they were "fine" and then was not. You were within range. You are now wearing it. Billable. Trauma-adjacent.
GDR-2 Manual disimpaction, polite edition You have said "this is normal, lots of nurses do this" more times than you care to count, mostly to reassure yourself. Billable. Do not code as "routine."
GDR-3 Foley catheter, surprise splash No further detail will be provided. You know. We know. Billable. Eye protection logged separately.
GDR-4 Ostomy bag change, active leak The bag failed at the exact moment you touched it. It is now a narrative, not a task. Billable. Add "complex" modifier.
GDR-5 Removal of unknown substance from call light You will never learn what it was. You have stopped asking. You wipe in silence. Billable under "patient environment maintenance."
GDR-6 Wound care, olfactory event You smiled and said "that's actually a good sign" while your soul left your body. Billable. Mask change documented.

B. The Unwritten Hierarchy of "Can You Grab Me A..."

Patients will ask you for items. The request reveals the patient's self-awareness. A reference chart follows.

THE ASK INDEX
LEVEL 1 — "Can you grab me a water?" (Normal. Billable as hydration assist.)
LEVEL 2 — "Can you grab me a warm blanket?" (Normal. Billable as comfort care.)
LEVEL 3 — "Can you grab me a... wait, where's the nurse call button?" (Concerning.)
LEVEL 4 — "Can you grab me a... why is the floor moving?" (Call the team. Bill the team.)

C. The "Code Brown" Protocol

A Code Brown is not in the emergency manual, yet every nurse knows it. It is declared when a patient has exceeded the structural limits of the bed, the linens, and the nurse's composure. Protocol:

  • Step 1: Announce "We've got a Code Brown in Room 4" on the unit channel. Do not elaborate. Everyone understands.
  • Step 2: Assemble the pod. Minimum two nurses, one willing CNA, one person to hold the door and mentally prepare.
  • Step 3: Execute the turnover with military precision and zero discussion of the details afterward.
  • Step 4: Document as "Complete bed bath and linen change, soiled." Code it. Bill it. Move on. We are professionals.
Billing Note A Code Brown generates, on average, $180–$420 in billable nursing and environmental services. The mess is free. The cleanup is revenue. We did not write the rules of insurance; we simply read them, and we are very good at reading them.

D. Things You Will Say With A Straight Face

As part of your professional development, you will deliver the following statements without inflection. Practice at home.

  • "No, that color is actually reassuring."
  • "We see this all the time, it's totally normal." (It is not normal. You are lying for comfort. This is billable as "patient reassurance, complex.")
  • "Just relax and let it happen, we've all been here." (You have, in fact, been here.)
  • "That's a great question for the doctor." (Translation: I know the answer and it is worse than you think.)

E. The Unspeakable But Documented

Some duties resist categorization. They are logged under GDR-99: "Other — Do Not Describe In Detail." If you find yourself writing GDR-99, you are doing the job correctly. You are also, statistically, owed a snack, a debrief, and a raise. The snack and debrief are approved. The raise is pending the next budget cycle, which is never.

Nurses at Saint Rectory do the work no one else will.
We document it. We code it. We bill it.
And then we go home and we do not talk about it.

That is not just nursing. That is revenue with a pulse.

Questions regarding this policy may be directed to:

David R. Stoolworthy, M.H.A., M.B.A.
Chief Operating Officer — Saint Rectory Memorial Hospital System
Email: dstoolworthy@saintrectory.org
Phone: Ext. 2800 (ask for "the poop guy" — they'll know who you mean)
Saint Rectory Memorial Hospital System
"We Save Lives. We Document Everything. We Bill Accordingly."