Nursing and labor cost reduction.

The coming of healthcare reform requires healthcare providers and hospitals to rethink the goals and objectives of the healthcare delivery system of the United States. To lower increasing costs while preserving the ultimate quality of care is a tremendous challenge. Labor costs in health care are primary targets for cost-cutting. Professional nurses, the group of healthcare providers who take up most of the hospital budget, are being targeted in many settings as an expendable budget item. Critical care physicians and patients depend on professional nurses to meet the care needs in the ICU. Creative, innovative, cost-effective methods of delivering critical care services must be developed in order to meet the demands of an increasing patient population. Some trial models with the explicit goal of managing cost and delivering high-quality critical care are discussed.