Guest Column | May 22, 2020

The Nursing Experience Divide, Care, And Costs: What Hospitals Need To Know

By Anne Dabrow Woods, DNP, RN, CRNP, ANP-BC, AGACNP-BC, FAAN, Wolters Kluwer, Health Learning, Research and Practice

Smartphone Nursing Care

COVID-19 has changed the world of healthcare as we know it. One day clinicians were caring for patients with adequate resources and equipment, and then came the pandemic and within a short time, resources, equipment, and staffing were inadequate in many settings. Clinicians were forced to learn to deliver care with a supply, resource, and staffing shortage. Because this was a novel virus and we did not have experience with it, we were thrust into discovery mode, not unlike the wild west. Trying to maintain standards of care while lacking the appropriate equipment and treating many more patients than usual, make consistency of care a real challenge for nurses and healthcare workers. How that care will shake out in terms of costs to the patient varies wildly. Industry estimates indicate that the average cost to treat a hospitalized patient with the virus is $30,000, and there are a lot of factors that go into it.1 Many of the most critically ill patients who ended up on ventilators for weeks at a time certainly required the most resources and generated the highest costs. Once we get back to “normal,” care consistency and cost transparency will also go back to normal.

Or will it?

It’s with that perspective that we look at our recent independent healthcare study, Next-Generation Nurses: Empowered + Engaged. While the study was taken before the pandemic, the results give insight into consistency of care and cost transparency as it applies to both next-generation nurses (those with less than 10 years of practice) and more experienced ones. The survey conducted by Wolters Kluwer aimed to explore the mindset of today’s nurses and healthcare workers, so hospitals can respond accordingly.

Variability Of Care Presents A Challenge To Nurses Of All Groups

It goes without saying that next-generation nurses aren’t quite as aware of the cost and care differences across healthcare, most likely due to their shorter time in practice. The lack of transparency and the differences that exist in the cost of procedures and medications as well as care is much more evident to experienced nurses than next-generation nurses.

When care variation exists in hospitals, patients suffer because the lack of consistency makes optimal patient outcomes difficult to ensure. A majority of the nurses surveyed (96%) agree there are differences in the way healthcare gets delivered across departments, across hospitals, and across the country. Both next-generation and experienced nurses believe there is variability in the protocols and best practices that guide care delivery (81% and 79%, respectively). They attribute some of care variability to lack of preparedness; 73% think the training for student nurses and nurses who have graduated and are onboarding into healthcare systems lacks consistency. This finding reveals a need for schools of nursing to refine their programs to ensure the curriculum addresses the reality of practice. In addition, hospitals need to ensure the onboarding program for new nurses is comprehensive and adequately prepares the new nurses to be competent.

Lack Of Cost Transparency Affects Both Groups

And then there are costs. The cost of care, which includes procedures, hospital stays, and medications, is variable. While both groups felt strongly about most issues surrounding costs, the more experienced nurses were even more convinced. 91% of experienced nurses think there is a lack of transparency in pricing of healthcare services (compared with 84% of next-generation nurses). 90% of experienced nurses report there are pricing differences for the same treatment or procedure (73% for the other group), while 88% believe there are cost differences for medications. Next-generation nurses were not as aware of the pricing disparity for healthcare. This is important because nurses need to educate patients on how to evaluate care costs and that higher care costs are not synonymous with higher quality care.

A Wake-Up Call For Hospitals And Clinics

What do these reflections on care and costs between next-generation nurses and experienced nurses mean? In a nutshell, it’s a wake-up call. It means there are both challenges and opportunities that hospitals must recognize AND heed. In terms of challenges, care consistency and cost transparency will continue to be elusive given the evolution of healthcare. Given that, healthcare leaders must acknowledge the generational and experience gaps between the two groups. Then they must respond with plans that recognize each group’s unique needs.

Next-generation nurses are not as aware of the care and cost differences that exist across healthcare. This provides an opportunity to raise awareness of the costs of healthcare and pricing transparency among this group.

While experienced nurses can share their expertise and insights on the true costs of care and medications and where care variations exist, they present another opportunity. Healthcare leaders must approach variability from every angle by focusing on continuing nurse education for both next-generation and experienced nurses to enhance consistency and quality of care across their own departments, healthcare systems, and geographic regions and spot ways to improve pricing transparency.

Is your hospital up to the challenge?

About The Author

Anne Dabrow Woods, DNP, RN, CRNP, ANP-BC, AGACNP-BC, FAAN, is Chief Nurse at Wolters Kluwer, Health Learning, Research and Practice.


Reference: 1. America’s Health Insurance Plans. New Study: COVID-19 Health Care Costs Could Reach $556 Billion Over Two Years. Available at: Accessed May 15, 2020.