How Nurses Can Sustain Hospitals amid Reimbursement Challenges

As hospitals across the United States brace for the financial impact of new legislation and shifting reimbursement models, the sustainability of many health systems, particularly vulnerable populations, hangs in the balance. With the growing emphasis on value-based care and cost containment, hospitals are expected to deliver higher-quality outcomes at lower costs. Amid this complex environment, one resource stands out as both essential and underleveraged: nurses.

Nurses are frontline providers, but they are also leaders, innovators, and system influencers. Their role extends far beyond bedside care. In today’s healthcare landscape, nurses are in a unique position to help hospitals remain both clinically effective and financially sustainable. Here’s how.

1. Driving Quality to Avoid Financial Penalties

One of the most direct ways nurses’ impact hospital sustainability is by influencing quality metrics tied to reimbursement. Programs such as Medicare’s Hospital Value-Based Purchasing (VBP) and Hospital-Acquired Condition Reduction Program link hospital payments to outcomes like infection rates, patient safety, and readmission rates. In many of these domains, nurses have the greatest contact and influence.

For example, prevention of hospital-acquired infections (HAIs) like catheter-associated urinary tract infections (CAUTIs), central line-associated bloodstream infections (CLABSIs), and surgical site infections (SSIs) are largely dependent on consistent and evidence-based nursing practice. When nurses adhere to protocols and escalate concerns early, they help reduce complications that cost hospitals hundreds of thousands of dollars annually in lost reimbursement.

Similarly, effective patient education at discharge, a nurse-led intervention, can significantly reduce 30-day readmission rates, another metric tied to payment penalties under the Hospital Readmissions Reduction Program (HRRP). A single avoided readmission not only improves patient outcomes but can also save hospitals thousands of dollars.

2. Leading Process Improvement and Lean Initiatives

Nurses are uniquely positioned to identify inefficiencies in clinical workflows, care coordination, and operational routines. They know where bottlenecks happen, where supplies are wasted, and where communication breaks down. When nurses are empowered to participate in Lean, Six Sigma, or other quality improvement initiatives, they become catalysts for meaningful change.

Nurse-led quality improvement teams have reduced unnecessary blood draws, shortened average length of stay, and streamlined medication administration processes, all of which lead to measurable cost savings without sacrificing patient care.

By contributing to these initiatives, nurses don’t just improve efficiency of hospital operations, they shift the culture toward continuous improvement, where frontline input is valued, and waste reduction becomes a shared goal.

3. Promoting Resource Stewardship at the Bedside

Though often overlooked, nurses play a key role in the day-to-day financial stewardship of hospital resources. Every decision about supply use, medication timing, or test ordering has a cost implication.

Nurses help manage these decisions responsibly by:

• Avoiding unnecessary labs and procedures by working with providers to question redundant or nonessential testing.

• Managing inventory wisely: Awareness of what supplies are available (and what’s being wasted) helps reduce overstocking and prevent spoilage or loss.

• Reducing medication waste by collaborating with the pharmacy can help ensure medications are administered efficiently and safely, avoiding costly errors or discards.

When frontline teams are educated on the financial impact of care choices, small changes can add up to substantial savings.

4. Elevating the Patient Experience

In the era of patient-centered care, experience matters, not just for satisfaction, but for reimbursement. Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores are tied to Medicare payments. These scores reflect a patient’s perception of care, including communication, teamwork, and responsiveness.

Nurses are often the face of care—answering call lights, explaining treatments, and listen to concerns. Consistent behaviors, timely update and compassionate touch elevates the patient’s perception of care and, by extension, the hospital’s bottom line. Moreover, improving patient experience builds community trust, which supports a hospital’s long-term reputation and sustainability, especially in competitive markets.

5. Supporting Preventive and Population Health Approaches

As hospitals increasingly shift from episodic care to population health management, nurses are instrumental in bridging the gap between acute care and preventive services. Whether in primary care clinics, transitional care roles, or community outreach programs, nurses help keep patients healthy and out of the hospital.

Examples include:

• Chronic disease management: Nurses educate patients on managing conditions like diabetes, heart failure, and COPD, reducing the likelihood of complications and hospitalizations.

• Care coordination and follow-up: Ensuring patients attend follow-up appointments, take medications appropriately, and understand their treatment plans.

• Community outreach: Vaccination drives, health screenings, and health education initiatives led by nurses can prevent illnesses before they require costly interventions.

By focusing on keeping people well rather than treating them only when sick, nurses align their efforts with evolving payment models that reward prevention and outcomes over volume.

6. Engaging in Advocacy and Health Policy

Finally, nurses play a critical role in influencing policy and advocating for the sustainability of healthcare systems. With more than 4 million nurses in the United States, the profession represents the largest segment of the healthcare workforce and one of the most trusted.

Nurses can advocate for:

• Legislation that protects hospital funding, especially for rural and safety-net institutions

• Fair reimbursement structures that reflect the complexity and time intensity of nursing care

• Policy reforms that remove administrative burdens and allow nurses to practice at the top of their license

By sharing their firsthand experiences with legislators and participating in health policy discussions, nurses help shape a healthcare system that supports both patient needs and hospital viability.

Invest in Nurses, Invest in Sustainability

As hospitals confront reimbursement cuts and legislative shifts, the path to sustainability isn’t just about cutting costs—it’s about making smart, strategic investments in what drives value. Nurses are not just caregivers; they are change agents, stewards, educators, and advocates.

Healthcare leaders should engage nurses not just in clinical roles but in system-wide strategies. When empowered and equipped, nurses can help keep hospitals financially viable, operationally efficient, and above all, open and accessible to the communities they serve.