Voice of the President | July 2021
How do you measure the value of nursing? Over the course of a nurse’s career, how can we quantify the impact he/she has had on unit, organizational, and patient outcomes? Should inpatient nursing care con-tinue to be bundled into the standard room-and-board charge? These are the questions that our profession has wrestled with for decades and require answers as our workforce evolves and the health care system becomes more value-based.
Throughout the recently published National Academy of Medicine’s The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity, the committee recognized the critical value of nursing. The report recommends the development of a research agenda to determine the impact of nursing intervention, as well as payment mechanisms to enable nurses to fully address social determinants of health and ensure health equity. It goes on to say that “promoting health and well-being has always been nurses’ business.
Nurses are bridge builders and collaborators who engage and connect with people, communities, and organizations to promote health and well-being.” In our current environment, it is difficult to quantify the value of what we do and how we do it, but a growing body of research provides a solid foundation from which to start.
Reimbursement models define value as a product of quality and cost. Given that quality is subjective in nature and knowing that we have not yet consistently mapped the practice of nursing to the actual cost of services delivered, it is difficult to appraise nursing’s total value. This will be important in the value-based reimbursement environment that health systems will be governed by in the coming years. A 2017 concept analysis completed by Tracey Dick and her co-authors found three dimensions that contribute to the value of nursing care. One is an economic dimension defined by payers and is measured as labor costs, productivity and outcomes. A second societal dimension is determined by the overall health of the populations we serve. Patients and their families determine a third relational dimension.
As nurse leaders, we know that articulating the value of nursing in every setting of care is critical to advancing the workforce, delivering care that best meets patients’ needs and helping us move society away from sick care toward one that is more equitable and focused on a culture of health.
Articulating the value of nursing in every setting of care is critical . . . to move society [toward] a culture of health.
This issue of the Voice of Nursing Leadership contains articles examining the value of nursing from several different perspectives, including the evolution of nurse-sensitive quality indicators, the creation of agile staffing models and financial management as a core leadership competency.
Authors Nancy May and Rachel Start focus on leveraging the role of the ambulatory care nurse to address the social determinants of health and achieve better health outcomes. They discuss the importance of broad participation in and support for national benchmarking of ambulatory nurse-sensitive indicators. These indicators can serve as a vehicle to demonstrate the value of this specialty and the impact it has on health promotion and disease prevention across a patient’s lifespan.
Nicole Gruebling and Anna Kiger discuss the results of a system chief nurse executive (SCNE) survey to identify effective staffing strategies applied during the COVID-19 pandemic. The article discusses five successful approaches to staffing and seven key recommendations SCNEs can apply to enhance the value nursing brings to all settings of care.
K.T. Waxman and Anna Kiger remind us of the importance of financial competence for nurse leaders including inpatient charge nurses, who are not often thought of as part of the core leadership team. Research has shown that they are collectively responsible for making clinical and operational decisions that have a direct impact on patients and staff for more hours per week than any other leader. Given that quality and productivity metrics are key drivers of how health care is measured, it is imperative nurse leaders are capable of articulating the value front-line staff provide.
Changing the way nursing care is conceptualized and operationalized—away from a bundled room-and-board charge toward providers of discrete services—is just one item of focus. We need to continue to foster methods to measure the value of nursing, not just through episodes of care, but across settings and as new models of care delivery are developed. This is what the Future of Nursing committee challenges us to do and will require the efforts of all nurse leaders. Let’s get to work.
Finally, I invite you to join me and your colleagues from across the nation on July 13-14 for the AONL 2021 Virtual Conference. It is a wonderful opportunity to engage, network and share best practices with those at the forefront of care delivery transformation.