Cost cutting and nursing: Are we solving the unsuitable problems?

Across the country, hospitals are under constant financial pressure. Margins are thin, reimbursements often don’t cover the associated fee of care, supply chains remain unstable, and administrative demands proceed to extend. Leaders are asked to stabilize the organization while managing forces largely beyond their control.

These pressures inevitably reach the clinical ground.

At staff meetings, nurses hear familiar refrains: we must be more practical, we’d like to enhance workflow, we’d like to cut back waste. These requests are rarely made randomly or without reason. They reflect an actual financial burden and a real concern for sustainability.

However, in high-intensity clinical settings – especially in oncology – the query will not be whether performance matters. That’s true.

The query is whether or not we’re starting in the best place.

The problem with starting with cost cutting

Nurses are trained to define an issue before proposing solutions. In clinical care, it’s dangerous to start treatment without understanding the diagnosis. However, when making operational decisions, this process is commonly reversed.

The hidden opening query is:

How will we cut costs?

Once you accept this query, the solutions shall be predictable: tight schedules, compressed staff, limited flexibility on the bedside. These approaches can reduce expenses within the short term, but rarely address the aspects that really cause financial instability.

From the nurse’s perspective, this misalignment is instantly apparent.

What the bed reveals

In outpatient oncology, care is inherently non-linear. A single delayed lab, a missed medication, a previous authorization issue, or an unexpected response to an infusion can change the course of your entire day. These events don’t indicate inefficiency; it’s the truth of comprehensive care.

When schedules fall behind, productivity metrics can point to the bedside because the source of the issue. However, nurses see something different. They see delays brought on by upstream barriers: authorization bottlenecks, pharmacy backlogs, documentation gaps, technology failures or supply shortages.

These usually are not failures of effort. These are adjustment errors.

A matter we rarely ask

Nurses often wonder if this will not be the case why leaders concentrate on efficiencybut whether efficiency is the best lever to resolve a given problem.

A more fundamental query could be:

What problem are we actually trying to resolve?

If financial stability is the goal, the reply is probably not to spend less – quite the other lose less.

Revenue delayed as a result of authorization errors.
Revenue rejected as a result of documentation problems.
Income lost as a result of postponement or cancellation of treatments as a result of system failure.

These usually are not abstract concerns. These are visible, repeatable patterns that primary care physicians encounter day by day.

From cost cutting to value creation

Hospitals cannot pave their strategy to long-term sustainability. At some point, further compression simply shifts costs elsewhere – to additional time, turnover, burnout, and reduced productivity.

Nurses see opportunities for improvement beyond reducing work hours: clearer workflows, higher sequencing of tasks, role alignment that permits clinicians to perform at their best, and earlier identification of predictable barriers.

These insights don’t just come from spreadsheets. They emerge from the proximity of the work.

Common goal

This will not be a criticism of leadership. It is an invite to think otherwise – collectively.

Leaders have a responsibility to guard institutions. Nurses have an obligation to guard patients. They each reply to the identical pressure, from different points of view.

When we move the output query from “How to cut costs?” Down “What problem are we trying to solve?”the conversation changes. Solutions are expanding. Alignment improves. Financial management and clinical care aren’t any longer competing with one another and are starting to strengthen one another.

This reframing will be the only move we are able to make.

Courtney Desy, BSN, RN, OCN, is an oncology infusion nurse at UMass Memorial Health – UMass Memorial Medical Center. He cares for adults undergoing chemotherapy and immunotherapy. She is an creator Stronger than chemistry, educational book for patients starting cancer treatment. Her writing focuses on patient communication, health care policy, and lived experiences in cancer treatment.