Friday, February 20, 2009

Is nursing like economics?

A student in an online class I am directing was trying to relate her nursing skills to the economics that I am trying to teach. She indicated that the proverbial "light bulb" went on when she reached the conclusion that nursing really may be a lot like economics.

Here is her logic. Nurses' roles in patient care can involve making assessments of the benefits and "costs" of treatment options and making decisions about when the benefits do and do not outweigh the costs. An example--a patient in the hospital who needs to get up and out of bed for some amount of time each day in preparation for discharge. The exercise that comes from getting out of bed has the benefit of making the person more ready for discharge. But the exercise is an effort. The patient will eventually tire. There may be risks of falling. At some point the risks and increase in tiredness of more time out of bed and more exercise outweigh the benefits of the exercise. The nurse may be asked to make a judgment as to when the costs become higher than the benefit.

Similarly, one thing that health economists do is measure the costs and benefits (or effectiveness) of different treatment options and suggest whether the treatment option is worth using at all and how much might be worth doing.

While the decisions are similar it is important to note that nurses perform their job tasks on a patient-by-patient basis. And, an individual patient's health (and life) depend on the nurse's action. Economists work with averages in a population. Will the average benefit be enough to merit spending the average cost? Some patients will have higher costs and some will have lower costs. Some patients will have more benefit while others have less. The average health of patients is affected by economists' recommendations but not the health of individual patients at the time the economist makes his or her decision.

In conclusion, if nurses were as imprecise as economists, we'd have a lot more patients in ill health. However, the analogy is worth considering. Many jobs involve assessing tradeoffs between different actions, so others may also be able to use this analogy to help them understand how economists think about the world.

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