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This International Nurses Day, nurses are being asked not to leave health system finances just to the bean-counters in the back room. Instead, the International Council of Nurses (ICN) says nurses should be actively engaged in thinking about how each dollar can be best spent to improve health care. Nursing Review reports.

The global financial crisis (GFC) that began in 2008 had a “devastating impact on the nursing workforce and access to care”, says the International Council of Nurses.

The council says the crisis acted as a brake on recruitment and staffing levels, despite a global shortage of nurses and a growing demand for health care.

“In many countries around the world, governments have cut back on expenditure on healthcare and, in particular, on nursing.”

What is the role of nurses in health system finances?

“Nurses have an important contribution to make in health services planning and decisionmaking,

and in development of appropriate and effective health policy,” reports ICN in a 2008 position statement on the issue.

“They can and should contribute to public policy related to preparation of health workers, care delivery systems, health care financing, ethics in health care and determinants of health.”

Nurses also have a role in improving health systems on the floor level and wider, so that health services are more effective and efficient, with fewer errors and less wasting of resources.

• The World Health Organisation estimates that over half of all medicines are prescribed, dispensed or sold inappropriately. 
• The problem of medical errors is huge, with a 2003 study finding a quarter of adults with health problems in Australia, Canada, New Zealand, and the USA reported experiencing a medication error or medical error in the previous two years.
• Nurse-sensitive care indicators, like health care acquired infections (HCAIs) andpressure injuries, are not only negative for the individuals involved but also expensive for health systems, with HCAIs estimated to cost the United States US$6.5 billion in 2004 and pressure injuries more than US$10 billion a year.
  
  

Nurses’ roles can include:

• Improving prescribing guidance
• Developing evidence-based best practice guidelines
• Adhering to and championing infection control procedures
• Undertaking more clinical audits.
  
  

Nurses can have a major impact

ICN president Judith Shamian and chief executive David Benton, in the foreword to the International Nurses Day kit, point out that the cost of health care is rising worldwide, placing a heavy financial burden on health systems and populations globally.

“Nurses, as the single largest profession in the health workforce, are well positioned to drive efficiency and effectiveness improvements while providing quality care and attaining optimal patient and population outcomes,” they say.

“The decisions that every nurse makes multiple times a day in everyday practice can make a vital difference in the efficiency and effectiveness of the entire system.

The nursing role in cost-effective care is described as follows:

• Primary health care nurses who have a unique opportunity to put people at the centre of care, making services more effective, efficient and equitable.
• Evaluations show advanced nursing practice roles (like nurse practitioners) can improve access to services and reduce waiting times.
• Nurse prescribing has the potential to save costs for the patient and the health system by freeing up a doctor’s time for more complex patient issues.
• Nurses must use supplies and equipment effectively and be aware of how much supplies cost and how waste occurs.
• Nurses have a role in reducing polypharmacy and promoting rational use of medicines.