The Rounds Journal · For nurses
When revenue comes first: nurses on management and business pressure
Nurses describe targets that put income ahead of patients, policies that push unnecessary tests, and management teams that change before anything improves.
Private hospitals in the region have to balance patient care against the cost of running a business. Most nurses accept that. What they object to is when the balance tips, and they are the ones asked to carry it out.
“hospitals focus on generating revenue more than what’s best for the patient.”
“We are instructed to take all the patients, give them all IVs and blood tests even for a simple case of common cold.”
“witnessed 3 management and HR teams come and go and still at the same position.”
Why it happens
Under fee-for-service payment, every test, drip and admission generates income. That creates an incentive to do more, even when it adds little for the patient. Payers in several Gulf countries are moving toward models that reward outcomes instead, but many services are still paid per item.
When management keeps changing
Frequent changes in leadership and HR mean promises are lost, policies shift, and nurses who were told a promotion was coming start again with a new manager. Long-serving staff often see several teams pass through while their own position stays the same.
What can help
Know the clinical guidelines and your licensing body's code of conduct. They are your reference point when a policy conflicts with patient interest.
Raise concerns about unnecessary procedures in writing, through incident reporting or the quality department, rather than only verbally.
Document your clinical reasoning in the patient record.
Keep your own file of achievements, appraisals and training so a new manager can see your record quickly.
Build working relationships with the quality and patient safety team. They often have more influence over policy than ward management.
Nurses who understand how hospital finance and payment work are better placed to challenge these pressures, and to move into the management roles where these decisions are made.
Reporting procedures and whistleblowing protections differ by employer and country. Check your hospital's policy and your licensing body's guidance.