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Here Are 4 Ways CNOs Can Drive Down Costs

Analysis  |  By G Hatfield  
   March 18, 2024

With rising costs in healthcare, CNOs need to brainstorm how to keep expenses down.

Cost containment is an issue throughout all of healthcare, and because of the nursing shortage, keeping costs down has become an even more difficult task.

According to Gail Vozzella, senior vice president and chief nurse executive at Houston Methodist, the nursing shortage drives up labor costs and turnover costs in nursing. Labor costs have gone down marginally with the consolidation of travel nursing, but many organizations are still requiring the use of agency nurses, which drives up costs.

“Every time we spend time training a nurse, it costs money,” Vozzella said, “[but once a nurse] feels that it’s not a good work environment… [they turn] around within those first three years and leave that organization or unit, [and] it is a significant cost.”

To combat this, CNOs need to focus on nurse retention and creating the right work environment where nurses will want to spend their entire careers.

Redesigning care

One cost containment strategy that CNOs should consider is using technological solutions to change the day-to-day workflows of nurses so that they have more time to care for patients.

At Houston Methodist, Vozzella said they meet with the deans of the surrounding nursing schools, and the number one reason why nurses go to nursing school is still to help people. Nurses want to be at the bedside, not typing into an electronic medical record, hunting supplies, or finding equipment.

“The nurse’s time is precious, and a good thing that’s come out of having a shortage is the focus on nurses doing things that only a nurse can do,” Vozzella said, “or what technology can pick up other tasks that are non-value added.”

Vozzella also recommends using ancillary support staff, such as phlebotomists, to do lab draws instead of the nurse. At Houston Methodist, Vozzella said they also partner with Rice University to help develop robotics that can screen trays to make sure the right tools are present before a tray goes into an operating room, so that the responsibility of checking the trays no longer falls on the nurse.

“[When] nurses have such a high value…and some ancillary support, we can redesign the work of that nurse in order to give that support,” Vozzella said, “so that it offloads that work and [nurses] are able to focus on caring for the patient.”

CNOs should be careful about the designation of work as well, and make sure that they support staff with communication efforts to make sure nurses understand the why of what they are doing.

“We tend to be a little controlling sometimes, or there’s factors like a very tenured ancillary person and a new graduation nurse,” Vozzella said. “It’s sometimes a challenge for that nurse to tell somebody else what to do.”

Care coordination

Additionally, efficient patient care management can help keep costs down by creating a better work environment. There are care milestones that patients must meet before they can go home, and those milestones are met with the help of care management, leadership, physicians, nurses, and advanced nurse practitioners.

According to Vozzella, improved care coordination is beneficial to both the patient and the nurse, as it improves the work environment and provides the patient with some insight into why certain processes are happening.

“It certainly helps patients with a shorter length of stay feeling like they’re a part of their care journey,” Vozzella said, “but it’s definitely helpful for the nurse too, because they feel [like a] part of something bigger than themselves and part of a team.”

Preventative care

Preventative care can also keep costs down. When primary care physicians can help patients manage diabetes or hypertension successfully, they are less likely to have an inpatient admission, Vozzella explained. Technology can help with this, so that patients can have more support at home without having to go into a doctor’s office or to the hospital.

Patient education is important to preventative care, because patients need to know about how different health factors affect their overall health, and nurses are a huge part of that.

“It is an exciting time for nurses to be part of that,” Vozzella said, “because it does offer nurses [the opportunity] to do more preventative care, but also to potentially do that virtually.”

CNOs should look at why patients are coming to the hospital in the first place and strategize ways to create support for them at home as well as in the hospital. Vozzella recommends having a case manager or social worker who can check in with patients and make sure they have transportation, food, and psychological support so that they attend their appointments and prioritize their health needs.

Leveraging technology

Over the past 15 years, according to Vozzella, health systems have moved toward rebuilding facilities to have better environments with natural light and private rooms, but it has just increased the amount of walking nurses have to do daily to see their patients.

“When [nurses] are in a room, they’re typically the only person,” Vozzella said, “and it’s so very isolating for, in particular, nurses that are newer in their career.”

However, bedside nurses are no longer alone with the addition of virtual nursing. Through virtual care, nurses can log in and come on the television screen in a patient room and act as a second set of eyes for the bedside nurse.

“I think virtual [nurses] can be a huge support, but it has to be implemented in partnership with bedside nurses,” Vozzella said. “We have to really work hard to understand where nurses tend to need support and make sure that’s our highest priority.” 

G Hatfield is the nursing editor for HealthLeaders.


The key to cost containment is retaining nurses and creating better work environments.

Redesigning care workflows can help nurses spend more time at the bedside rather than doing non-value-added tasks.

Preventative care and efficient care coordination can help shorten lengths of stay and keep patients out of the hospital entirely.

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