Courtney Desy, BSN, RN, OCN

Across the country, hospitals are under sustained financial pressure. Margins are thin, reimbursement often fails to cover the cost of care, supply chains remain fragile, and administrative demands continue to grow. Leaders are asked to stabilize organizations while navigating forces largely outside their control.

Those pressures inevitably reach the clinical floor.

In staff meetings, nurses hear familiar refrains: we need to be more efficient, we need to tighten workflows, we need to reduce waste. These requests are rarely made casually or without reason. They reflect real financial strain and genuine concern about sustainability.

But in high-acuity clinical settings—especially oncology—the question isn’t whether efficiency matters. It does.

The question is whether we are starting in the right place.

The Problem with starting at cost-cutting

Nurses are trained to define the problem before proposing solutions. In clinical care, jumping to treatment without understanding the diagnosis is unsafe. Yet in operational decision-making, the process is often reversed.

The implicit starting question becomes:

How do we cut costs?

Once that question is accepted, the solutions are predictable: tighter schedules, compressed staffing, reduced flexibility at the bedside. These approaches may lower expenses in the short term, but they rarely address the forces actually driving financial instability.

From the nursing perspective, […]