Supporting the value of nursing

FigureLAST MONTH'S EDITORIAL SOUGHT to remind us that focusing on the “basic” metrics underlying our responsibility to patients and the workforce can be fun, full of purpose, and meaningful. Curley and colleagues have powerfully expanded these fundamentals in an insightful call to action for change in acute and critical care nursing.1 The authors make the case for more balanced measurement that emphasizes what nurses do and what patients need, up to the national policy level. This position may seem like a “duh” from an ethical perspective, yet support of the practice and value of acute care nursing is currently inadequate. Relatedly, the economic value of nursing is a hot topic. As Olga Yakusheva, economist and professor of nursing at Johns Hopkins, has stated, “If nursing disappeared, the healthcare system would collapse, that is value.” There would be more infections, less access, an increased risk of medical error, and many other morbidities—all costly to patients and organizations. Underinvesting in nursing has negative effects on society as outcomes suffer in a downward spiral; conversely, investing in nursing creates value.2 The framework supporting value includes our unique competencies, processes, and impact on outcomes. Are our outcomes visible and framed more than the CMS (Centers for Medicare & Medicaid Services) measures of not causing harm? Nursing Management's editorial board member Tim Porter-O'Grady sums up nursing's value in a recent Leadership Q&A, concluding that technology advancements, evidence, and new metrics that support nurses' contributions will finally validate nurses' impact on healthcare, perhaps even changing the reimbursement system.3 So now we're full circle on a direction forward with these three viewpoints. As leaders, you are probably wondering what nursing “value” means in practical terms. The policy and conceptual ideas may seem high level, yet change can and must happen at the local level too. Curley's measurement-related recommendations include elements that are important to patients and have nursing impact, such as symptom relief, improved levels of frailty and self-care, and length of stay, as well as measures related to providing excellent care, such as nurse engagement, turnover, health of the practice environment, and culture of safety. Most of these measures and nursing actions can be converted to dollars—the language of our chief financial officers. Imagine the incentive if these were CMS core measures with penalties for hospitals with results below the national median! We can advocate for metrics that support what we do and what patients need besides hospital-acquired conditions. We can propose investments that maximize impact, for example, in staffing models, innovation, cost avoidance, or producing revenue. Of course, we'd have to be accountable and responsible for expanded outcomes at all levels—no excuses. Non-value-added work should be eliminated; don't get me started on electronic health record documentation and some regulatory expectations. This is all part of defining value. There has been some effort to change billing and reimbursement systems so that nursing's contribution is defined and not part of “room and board.” This change makes sense conceptually, although pragmatically it's complicated and has the potential to be a financial burden on patients. This level of defining value may not be in our immediate future; however, work to improve data capture and measure nursing impact and working conditions will be foundational for future change. We've been valued by society for ages; it's time to be valued in national policy and within healthcare systems. This is cutting-edge thought leadershipFigure[email protected]