Learning Objective #1: Describe and discuss risk-induced professional caregiver despair

Learning Objective #2: Give two examples of how the transfer of insurance risk to health care providers affects the quality and quantity of care provided

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Professional Caregiver Insurance Risk (PCIR) describes the impact on nurses and other healthcare professionals of capitation contracts, prospective payment plans, and other insurance risk transfers to healthcare providers. This researcher used Cowling's Unitary Appreciative Inquiry (UAI) in collaboration with registered nurses, enabling them to draw from their experiences in dealing with risk induced professional caregiver despair. Using unstructured interviews, imposing no time limits, facilitated this collaboration and allowed participants to share their experiences, perceptions, and expressions until they felt the experience was complete. Several participants engaged in intense collaborations to shape their stories into aesthetically pleasing narratives, which will be presented. Cowling suggests that UAI, a Rogerian praxis method counters the tendency toward diagnosis, behavioral objectification, time-limited, and inappropriately directed nursing care by renewing our focus on wholeness. This research demonstrated the utility of UAI as a research, practice, and theory generative nursing method, by generating rich detail on the experiences of registered nurses who stand, often alone, at the crossroads of insurance claims management and clinical care, as insurance risk transfers impact the nursing unit. Nurses are increasingly facing situations where insurance claims management functions have shifted to the bedside with doctors, practitioners, and bedside caregivers making combinations of clinical and financial decisions when their employers are financial interessees in the outcomes. These stories of the experiences of registered nurses facing caregiving situations with inadequate resources, staff, and equipment, are visions of an avoidable future, if registered nurses and other healthcare professionals press back against the tide of the intrusion of financial eligibility for services. This researcher, a psychiatric nurse, is developing new strategies and tools for detecting, quantifying, and correcting inadequate 'nursing capacity' resulting from cost-cutting and failures to adequately staff and supply nursing units in order to manage the insurance risks tht healthcare providers are increasingly assuming.