October 2, 2018

Can Nursing be a Revenue Center?

Clinician Leadership | Leadership Development

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Nurse Executives Balancing Patient Care, Organizational Goals and Nursing Staff 

In my experience as a Chief Nursing Officer, I often found myself in a position to justify the cost of nursing. In my mind, I was thinking – what is so hard to understand about being at the bedside, providing care for patients 24/7, every day of the year, while maintaining high quality and safe practices? That is at the core of our mission and requires monetary resources! As nurses, we truly believe it’s obvious that nurses are an investment to continue to improve and achieve a highly reliable, cost-effective, high-quality healthcare organization. We have research to show how we have positively impacted hospital profitability through value-based care. Unfortunately, others often view nursing only as a cost center.
There is a fine line the Nurse Executive walks when balancing the priority of patient care with the goals of the organization and the needs of the nursing staff. It is a tightrope walk that we do. So how do we balance the three?

  1. Put the Needs of the Patient First

I don’t believe there is a doubt in anyone’s mind that putting the needs of the patient first is our moral compass. It keeps us grounded and at the same time, lifts our spirits. It is what brought us to healthcare from the beginning. Nurses tend to feel protective if they feel other priorities get in the way of patient care.

  1. Hold Staff Accountable

It is tiring and demoralizing for a leader to have to focus on absenteeism. However, the reality is we must hold staff accountable for their work or we are not being a full partner in organizational well-being. We also need to hold them accountable for efficiency, for effective change, for appropriate use of technology, and for letting go of sacred cows.  We understand this could add to our costs if we don’t hold staff to our safety and stewardship expectations.

  1. Think Like a Leader

As a nurse leader or executive, the “they” is now “us”! It’s common to hear people say “they” did this or “they” made that change.  All levels of nursing need to stop the blame game.  We can no longer blame “administration” for not understanding our practice. Nursing leaders are the ones at the table and must understand and consider finance along with all other priorities. We can think about new and innovative staffing models. We need to share examples of how we flex to workload (amounting to XX FTE saved); how we decreased falls (and saved the hospital $34,294/fall); how we decreased pressure ulcers (and saved the hospital $43,180/pressure ulcer); how we decreased staff injuries, decreased turnover, and increased staff engagement.
These are all ways we can quantify and achieve greater financial savings, become better stewards of resources and in many cases improve operating margin. We must reduce the cost of care and we can contribute in a way that allows us to reinvest in our patients.  We all could do an even better job of explaining to all levels about why we are doing what we are doing and together it impacts our success.  We must investigate, prepare the report and ultimately show the return on investment.
As much as the tightrope is a tiring exercise, it can also be exhilarating when you succeed across the rope using transformational leadership and teamwork. Your message to anyone who asks? We’ve got this!

“The superior man is distressed by the limitations of his ability; he is not distressed by the fact that men do not recognize the ability that he has.”   Confusius

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About the author

Debra Harrison, DNP, RN, NEA-BC

Debra Harrison, DNP, RN, NEA-BC was the Chief Nursing Officer for Mayo Clinic in Jacksonville, Florida from 2006–2016. She retired in May 2016 and joined MEDI as an Executive Coach early 2017.

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