What do you think of when you consider the value of nursing? How would you describe nursing’s value to a colleague or a neighbor? Merriam Webster (n.d.) defines value as “the regard that something is held to deserve; the importance, worth, or usefulness of something”. This article will first focus on professional identity and values, and then will look more closely at the economic value of nursing.

One way to reframe and reclaim the purpose and value of nursing is to address and elevate the intellectual, clinical, ethical, and relationship aspects of our discipline (Wolf, 2022). This will mitigate burnout, improve retention, and create a culture where nursing knowledge and leadership is encouraged and valued. Nurse leaders can support and participate in organizational structures to improve nursing and patient outcomes.

Our professional values influence our perception of the value of nursing. Professional values affect both patient care and organizational outcomes. Gassas and Salem (2022) conducted a comprehensive integrative review to identify factors affecting the development of professional values. Thirty-five qualitative and quantitative articles published between the years of 2015 and 2021 were included in the review. Five major themes emerged from the review. These were:

• Individual determinants
• Education
• Experience
• Nurses’ value
• Impact of role models

Factors influencing individual determinants were age, gender, religion, satisfaction with the nursing major, personal values, and use of coping strategies. Education included the role of nursing education, learning activities, ethics courses, academic level, and grade point average. There were no subthemes for experience and impact of role models. Nurses’ value perceptions included caring as the highest priority among values, justice, and activism as the lowest priority among values. They concluded that this reflects the truth that values are the heart of nursing practice (Gassas & Salem, 2022).

The Professional Values Model (PVM) was developed by Kaya and Boz (2019) to improve nursing practices based on values. The aims of the PVM are to:

• Describe features, values, experiences of individuals to offer a whole person approach to care.
• Describe individual and professional values of nurses, and to help get to know themselves.
• Raise the professional values of nurses to increase job satisfaction and to offer high-quality care to increase patients’ satisfaction with care.

Value is related to human behavior and is a series of principles that form personal acts. Each person has individual, social, and cultural values. These values by interaction with each other shape the lives of individuals, make their lives meaningful, and influence their moral decisions. The three concepts included in the PVM are individual values, professional values of the nurse, and nursing care quality.

Individuals have been studying the economic value of nursing for years. A landmark study by Dall et al. (2009) examined the economic value of nursing by identifying the relationship between registered nurse staffing levels and nursing-sensitive patient outcomes in acute care hospitals. Data from 5.4 million discharges from 610 hospitals in the 2005 American Hospital Survey were used to estimate the risk for nosocomial infections. Estimates from this study suggested that adding 133,000 full time equivalents (FTEs) to the acute care hospital workforce would save 5,900 lives per year. The productivity value of total death averted was equivalent to more than $1.3 billion per year, or about $9,900 per additional registered nurse (RN) per year. They found each additional patient care RN employed would generate over $60,000 annually in reduced medical costs and improved productivity.

Value-based health care (VBHC) is a term used to describe the framework for restructuring healthcare systems with the overarching goal of value for patients, with value defined as health outcomes per unit of cost. Improving health outcomes relative to the cost of care has been embraced by interested parties across the healthcare system, including patients, providers, health plans, employers, and government organizations. The concept of value, which was introduced in 2006, aligns care with how patients experience their health (Teisberg et al., 2020). The strategic framework described in the article included:

• Understanding shared health needs of patients,
• Designing solutions to improve health outcomes,
• Integrating learning teams,
• Measuring health outcomes and costs, and
• Expanding partnerships

Kerfoot and Buerhaus (2023) emphasized the importance of nurses having some knowledge of healthcare payment systems to appreciate why value-based payment systems make sense. Nurses also need to understand the specific clinical outcomes within the value-based payment system, how nursing services contribute to attaining those outcomes, and the cost of resources used to produce patient and organizational outcomes. “Until more nurses gain such knowledge, nursing’s clinical workforce will continue to miss opportunities that enable nurses to reach their full potential to improve the delivery of health and nursing care, increase access, decrease costs, and address critical social problems affecting the nation’s health” (p. 120).

Many academic nursing programs do not include education related to healthcare economics and finance. Jenkins and Armstrong (2022) made the case that including competencies related to the financial elements of care delivery would improve the quality and safety of care. In the 2021 The Essentials: Core Competencies for Professional Nursing Education, the American Association of Colleges of Nursing (AACN) recognized the critical importance of nurses understanding cost and value. One of the competencies, incorporate consideration of cost-effectiveness of care, has six entry-level and six advanced-level competencies. Some of the competencies address the financial and payment models of health, the importance of health disparities and social determinants of health on care outcomes, and the impact of healthcare cost and payment models on the delivery, access, and quality of care.

The American Nurses Association (ANA) has done a lot of work to achieve equitable reimbursement of nursing care (McClendon, 2023). “The ANA Enterprise – which includes the American Nurses Association (ANA), American Nurses Foundation (the Foundation) and the American Nurses Credentialing Center (ANCC) – has worked for decades to improve reimbursement of nursing care, foster the ongoing conversation about the nursing professional in the healthcare financing system, and elevate the indisputable value of nursing care” (p. 14). One strategy to achieve this goal is the National Provider Number (NPI) as a unique nurse identifier. Use of NPIs allows advanced practice nurses to bill Medicare and Medicaid for services provided to patients. Any nurse can obtain an NPI and ANA is conducting a rigorous assessment of the utility of NPIs for valuing RN care.

The Foundation’s Reimagining Nursing Initiative is funding the expansion of nursing through direct reimbursement. The Foundation granted $5.5 million to support four projects led by nurses that document nurses’ value to health care and create a road to reimbursement for nursing care. This includes a clear accounting of nursing’s impact on outcomes. The ANA Enterprise Research Council is conducting research to understand new ways of quantifying nursing reimbursement and offering recommendations to fully leverage and recognize the contribution of the largest and most trusted profession for consumer benefit (McClendon, 2023; Nickitas & Nanof, 2023).

This article summarized numerous ways we can show the value of nursing. Please take some time to consider how you communicate your value and the value of your colleagues to the patients you serve, the individuals with whom you work, and the community in which you live. Remember that it is our professional responsibility to communicate effectively, on behalf of our profession, the value and impact of nursing (Wyatt, 2020).

References

American Association of Colleges of Nursing. (2021). The essentials: Core competencies for professional nursing education. https://www.aacnnursing.org/Portals/42/AcademicNursing/pdf/Essentials-2021.pdf

Dall, T. M., Chen, Y. J, Seifert, R. F., Maddox, P. J., & Hogan, P. F. (2009). The economic value of professional nursing. Medical Care, 47(1), 97-104. https://doi.org/10.1097/mlr.0b013e3181844da8

Gassas, R., & Salem, O. (2022). Factors affecting nurses’ professional values: A comprehensive integrative view. Nurse Education Today, 118, 10555. https://doi.org/10.1016/j.nedt.2022.105515

Jenkins, P. & Armstrong, G. (2022). Teaching nursing economics competencies. Nursing Economics$, 40(4) 200-203. https://doi.org/10.1016/j.outlook.2018.11.007

Kaya, A. & Boz, I. (2019). The development of the Professional Values Model in nursing. Nursing Ethics, 26(3), 914-923. https://doi.org/10.1177/0969733017730685

Kerfoot, K. & Buerhaus, P. (2023). The ‘not so hidden costs’ associated with failing to educate nurses and researchers about health care economics, financing, and payment policies. Nursing Economics$, 41(3), 113-120.

McClendon, S. (2023, July, August, September) ANA Enterprise leads national efforts to achieve equitable reimbursement of nursing care. Arizona Nurse, 14.

Merriam-Webster. (n.d.). Value. In Merriam-Webster.com dictionary. Retrieved on February, 2024, from https://www.merriam-webster.com/dictionary/value

Nickitas, D. M. & Nanof, T. (2023) Driving the economic value in nursing through equity in nursing care reimbursement. Nursing Economics$, 41(4), 161-163.

Teisberg, E., Wallace, S., & O-Hara, S. (2020). Defining and implementing value-based health care: a strategic framework. Academic Medicine, 95(5), 682-685. https://doi.org/10.1097%2FACM.0000000000003122