The Hidden Cost of Care

“There is no reality, only perception”

Let’s look at how care is perceived.

When a patient visits a hospital, a doctor’s office, or even an IV clinic, they’re charged for services. These charges may go to the insurance company or be paid out-of-pocket. Either way, the bill reflects the doctor’s time, imaging, lab work, medications—even just walking through the door.

But you know what’s not itemized on that bill?

The 15 times the nurse came in.

Nurses are paid by the facility. I’ve heard—though I’ve never seen it for myself—that nursing time is billed to Medicare. About ten years ago, I was told the rate was $350 an hour. At one hospital, we were trained to push a button on the wall every time we entered or exited a patient’s room, supposedly to track billable hours.

But I’ve never worked anywhere that could reliably bill for nursing time since.

Whether one nurse or ten nurses spent most of their shift with a patient, that labor is largely invisible on any invoice. Or is it? Who really knows? It's hidden.

The Illusion of Free Care

In our current system, nursing is a hidden cost—to patients and to nurses. Because it isn’t itemized, it’s perceived as free.

We, the nurses, don’t even know what’s being billed to Medicare or the patient. That information is tightly guarded. Someone knows—but it’s not the staff providing the care.

There is no reality, only perception.

And right now, care isn’t perceived as billable. It isn’t viewed as labor—not like surgery, imaging, or diagnostics. It's seen as intangible.

But is it really?

How much is it worth to feed someone? To make them comfortable? To take away their pain? To hold their hand when they cry? To coordinate their care across disciplines?

Where is the value in that—and how do you even begin to put a number on it?

Maybe we need a new word for “nurse”—perhaps orchestrator of care, care facilitator, or something else entirely.

Maybe we need a new word for care.

Because right now, care is perceived as something that should be free.

The Invisible Load

It has been dubbed “the invisible load.” And once something has a name, it’s no longer invisible.

This is just a microcosm of a much larger idea: care should be free.

Just like a mother’s care is free. Just like a teacher’s care is free—unless, of course, they’re a private tutor.

I don’t have to point out that most of this labor is provided by women.

Nursing has a 3.5-year burnout rate. We’ve been in a nursing crisis for over a decade. Critical shortages make an already laborious job even more grueling—and burnout happens even faster. When surveyed, roughly 85% of nurses say they wish they had chosen another profession.

The “invisible load” is not invisible to them.
It’s breaking their backs.

To make matters worse, many nurses can’t even afford to buy a home in the city where they work.

The Revolution Starts With Visibility

Perhaps if the cost of care were itemized, care would be more valued.

The hidden cost of nursing is what’s fueling the nursing shortage. If nursing labor were truly accounted for, it would be very expensive. And because it’s invisible, it’s undervalued. And because it’s undervalued, fewer people want to do it.

This is why the future of nursing is freelance.

We must reclaim the right to charge for our own labor.

But first—we have to see it. We have to recognize the invisible load, and see the value in the care we provide, for ourselves.

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They are standing at the edge of a revolution.