Nursing Our Way to Better Health


David Cutler, PhD

Article Information

Nurses have always been on the front lines of health care provision. Increasingly, they are on the front lines of health care reform. Almost all of the ideas put forward for US health care reform, from reducing treatment costs to improving patient safety to moving care into the community, involve a significant role for nurses.

There are real questions, however, about whether the economics will support the needed nursing care. Done right, nursing can be the lynchpin for a better, cheaper, health system. But if we make the same mistakes with nurses as we did with physicians, we will have wasted another shot at health care improvement.

The outlook for nursing is strong. Between 2008 and 2018, nursing employment grew by 1.7% annually, well above the 0.7% annual growth rate of the economy as a whole. The US Bureau of Labor Statistics forecasts that this will continue over the next decade. In many industries, the worry is about downsizing. In contrast, nursing leaders worry that we will face a nursing shortage. Fortunately, nursing supply is now expanding rapidly, and the fact that nurses can be trained more rapidly than physicians makes any shortage is likely to be short-lived.

It is not hard to figure out why nurses are in such demand. The population is aging and developing more chronic disease. Studies show that hospitals with a higher nurse-to-patient ratio have better patient outcomes. And the alternatives to nurses are more expensive. A nurse costs just more than $1 per minute, whereas primary care physicians cost about $3 per minute and a surgeon costs about $6 per minute. Any service that can be provided by a nurse instead of a physician should be reallocated to the nurse.

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