Bringing Nurses Into the Cost Containment Discussion

Why are nurses not usually integrated into the cost containment discussion? Why have we not been invited to the table? Likely, it is because we don’t have the power to order (or discontinue) tests, labs, or medications, all of which are major factors in the rising costs of care. Even so, a nursing perspective can be important and should be considered when doctors make treatment decisions.

For example, I recently treated a patient who had undergone abdominal surgery. Despite uncomplicated post-operative days 1 and 2, on day 3, he developed nausea, vomiting, and an increasingly distended abdomen. I administered intravenous anti-nausea medications, along with back rubs and cool cloths on his forehead. None of the treatments worked. While waiting for the doctor, I sat with the patient and spoke to him about the possibility of receiving a nasogastric tube to alleviate his symptoms. Given an understanding of the process, the patient agreed to this possibility and I paged the doctor once again. The doctor eventually placed the nasogastric tube, the tube was connected to suction, and out came a liter of gastric contents.

I then noticed that the doctor had put in an order for an abdominal x-ray to “check nasogastric tube placement.” Seeing this, I initiated a conversation with the doctor to discuss the patient’s symptomatic improvement as well as his current state of exhaustion. I assured the doctor that nurses would be at the patient’s bedside to monitor for signs and symptoms of tube malfunction. As a result, the doctor cancelled the x-ray, which not only eliminated an unnecessary test for the patient, but also reduced the cost associated with his care.

Situations like these are commonplace to nurses across the country. Currently, there are 2.7 million nurses in the workforce, with an expected growth rate of 26% over the next decade; however, there has been limited discussion on how nurses can help contain healthcare costs. We witness daily that more is not necessarily better, and we are in a position to help make decisions that lower costs without negatively impacting the patient’s care.

Nurses bring a unique perspective to the healthcare cost conversation, so include us in the discussions, give us a seat at the table, and utilize us as active participants in the fight against rising healthcare costs.

September Wallingford is a registered nurse at an academic medical center in Boston, Massachusetts. A previous version of this post appeared at Costs of Care.

9 replies »

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  3. Great article with a much-needed viewpoint. I particularly like that the author framed her discussion as pro-patient and doing what’s best rather than decreasing cost. We have to shift the discussion away from talk of “rationing” care to figuring out what is the best value in healthcare, and ultimately, what is the right thing to do by our patients.

  4. Well done!
    Under the how soon they forget file you’ll find that nurses and nuns ran hospitals fifty years ago and ran them cost effectively.
    Enter the dressed for success managers and trial lawyers to cash in on the high tide of the Medicare cash flow.
    And if you think testing is runaway on the post-surgical floor, check out the ER where the average cost per visit is now $1300 due to over-testing.

  5. So I think this is a two sided coin. This is very well written and puts forth a great point. Collegiality and collaboration need to exist between doctors and nurses for this to happen. Nurses CARE about their patients and have great ideas for that care, and great experience. Physicians who trust nurses, as the one above, work collaboratively with nurses. This is more than cost containment, though, its’ good , safe, quality care. The other point that is important to bring out is that nurses ( and I am one by the way, ) also need to want to be in the discussion. D’cm I agree that Case Managers are crucial, but every bedside nurse is also crucial. Nurses there are 3.1 million of us… if we just had the confidence to participate, to speak up, to join advocacy groups, to be at the table, to speak to our representatives, we could make such a difference!

  6. I’m biased, of course. I agree nurses are in a unique position to help lower health care costs and improve health care overall. But as john irvine pointed out, our system is not sensible and cover-your-a** medicine is an unfortunately reality. Nurses might help in limited circumstances, but can we expect significant change without tort reform?

  7. Nurses have been in the cost containment discussion for a long time. We are called Case Managers. Are we treated as equals in the conversation? hell no.

  8. Touches on a series of very touchy questions.

    Does anybody want to hear what the nurse has to say? Ask a lot of doctors I know and the answer is less warm and fuzzy than you’d expect. Ask a lot of nurses and you’ll get a loud grrrring…..

    We need a sensible decision-making chain, but for that we’re going to need a sensible system. Under the current system as presently constituted: liability rests with the doctor. Nobody in their right mind is going to skip ordering that x-ray if they know that they’re opening themselves up to the question “and why dr. defendant did you not order the standard x-ray that even a first resident knows is appropriate care? what were you thinking?”