How nurses can help contain health care costs

Due to ever increasing health care costs, stakeholders in the health care system rely heavily upon front-line workers to assist in containing costs to help make health care more affordable. Since nursing is the largest sector of front-line workers, the field has an opportunity to greatly impact cost containment. 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 health care costs.

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. 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 health care 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 health care costs.

September Wallingford is a registered nurse.

How nurses can help contain health care costs

This post originally appeared on the Costs of Care Blog. Costs of Care is a 501c3 nonprofit that is transforming American health care delivery by empowering patients and their caregivers to deflate medical bills. Follow us on Twitter @costsofcare.

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  • ReepRN

    Great message. We use a scanner and charge for a number of items as well; we are always encouraged to charge for the item and not just grab and run.

    • Tiredoc

      Just because you charge more doesn’t mean the hospital is paid more. Most of the hospital charges are more for accounting and inventory purposes than for actual payment purposes.

  • Tiredoc

    Sorry, your one-on-one care both cost more and was less sensitive and specific than the x-ray. In our current age of portable X-rays read by radiologists in their pajamas in Bangalore, do not presume a test is less expensive than a personal service. As long as no medication is administered or device is utilized, the test is cheaper than the person.

    The actual cost of the X-ray to the hospital was less than $10. Your time and the doctor’s time in dealing with the issue your way cost more than just doing the test. In addition, the hospital doesn’t get paid more for the test.

    In medicine, there is no such thing as a universal rule. If you don’t really know, just do the order, please.

    P.S. Only government hacks use “stakeholder.” I hope that this is a real story and not some bureaucratic twaddle sent up as a trial ballon.

    • Kelly

      It’s not just the cost of the x-ray but if you evaluate the patient you obviously can see the intervention worked. What about sticking a hard board behind their back to confirm something you already know is in place. Yes I know to us getting an x-ray doesn’t seem like a big deal but patients go through so much already being in the hospital.

  • buzzkillerjsmith

    Sorry Sept, Not buying it.

    Rounding error at most, not important in the aggregate, at least not shown to be important. Quantify, always quantify.

  • Chris Stephens

    As a RN and in management with many years of experience in ER, ICU, OB, I am curious why the physician in the article as well as “Tiredoc” would not recognize that a follow up xray was not needed to be ordered at all. Whether you are a physician or a nurse, if you follow the correct procedure for NG tube placement and you immediately get a liter of gastric fluid through the suction, it should be OBVIOUS to everyone that the NG tube was placed correctly. There are other tests that also can be performed to ensure correct placement. Air pop method for one. A followup xray was needless. I have placed literally hundreds of NG tubes without physicians ordering followup xrays to verify placement. As for a nurse suggesting that nursing would be at the patient bedside for monitoring, that is absurd! No Nurse in the field today has the time to stay at a patient’s bedside for monitoring purposes; only if you are recognizing signs of further complications.

    • militarymedical

      Not to mention the fact that since when do physicians insert NG tubes in the first place, other than during training?

    • buzzkillerjsmith

      I don’t think Tiredoc was really interested in commenting on the clinical utility or lack thereof of this particular test. He and I were commenting that doing or not doing the test has very little influence on aggregate health care costs.

      Sept would have perhaps been well-advised to give a more persuasive example of how nurses can help cut HC costs, as I am sure they can.

  • gwen rothberg

    My experience is that the only time nursing as cost containment is considered is when they up the ratio (we just went 1:6 with no acuity scale) or cut the hours, or remove the shift diff or cut the program for weekend staffing. Currently the house is in total chaos and the talent is leaving in droves…but as our Unit Director so ham-fistedly proclaimed on the floor, ‘There are 50 people lined up in HR that want your job.’ This is where we are in nursing right now.

  • Independent in NY

    Many hospitals mandate xray after NG tube placement, nurses can’t do a thing about it. CYA mentality

  • Ibatxrn

    How about we (nurses) start doing housekeeping? ;)

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