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, that misalignment is immediately visible.

What the bedside reveals

In ambulatory oncology, care is inherently nonlinear. A single delayed lab, a missing medication, a prior-authorization issue, or an unexpected infusion reaction can change the flow of an entire day. These events are not inefficiencies; they are realities of complex care.

When schedules fall behind, productivity metrics may flag the bedside as the source of the problem. But nurses see something different. They see delays caused by upstream barriers: authorization bottlenecks, pharmacy backlogs, documentation gaps, technology failures, or supply shortages.

These are not failures of effort. They are failures of alignment.

The question we rarely ask

What nurses often wonder is not why leaders are focused on efficiency, but whether efficiency is the right lever for the problem at hand.

A more fundamental question might be:

What problem are we actually trying to solve?

If the goal is financial sustainability, the answer may not be to spend less—it may be to lose less.

Revenue delayed by authorization failures.
Revenue denied because of documentation issues.
Revenue lost when treatments are postponed or cancelled due to system breakdowns.

These are not abstract concerns. They are visible, repeatable patterns that frontline clinicians encounter every day.

From cutting costs to creating value

Hospitals cannot cut their way to long-term stability. At some point, further compression simply shifts cost elsewhere—into overtime, turnover, burnout, and reduced capacity.

Nurses see opportunities for improvement that don’t rely on cutting care: clearer workflows, better sequencing of tasks, role alignment that allows clinicians to practice at the top of their license, and earlier identification of predictable barriers.

These insights don’t emerge from spreadsheets alone. They emerge from proximity to the work.

A shared goal

This is not a critique of leadership. It is an invitation to think differently—together.

Leaders are charged with protecting institutions. Nurses are charged with protecting patients. Both are responding to the same pressures, from different vantage points.

When we shift the starting question from “How do we cut costs?” to “What problem are we trying to solve?”, the conversation changes. Solutions expand. Alignment improves. Financial stewardship and clinical care stop competing and begin reinforcing one another.

That reframing may be the most efficient move we can make.

Courtney Desy, BSN, RN, OCN, is an oncology infusion nurse UMass Memorial Health – UMass Memorial Medical Center. She cares for adults receiving chemotherapy and immunotherapy and is the author of Stronger Than Chemo, a patient education book for people navigating cancer treatment. Her writing focuses on patient communication, health care policy, and the lived experience of cancer treatment.