Nurse scientists are calling on hospitals, payers and credentialing bodies to overhaul how they measure nursing care, arguing that today’s metrics capture only a sliver of what nurses actually do.
In a viewpoint published Oct. 19 in JAMA Internal Medicine, three nurse researchers — led by Lori Kennedy, PhD, RN, director of the Center for Nursing Science at Sacramento, Calif.-based UC Davis Health — proposed a set of nurse-sensitive outcome measures spanning nine domains of acute and critical care nursing practice, along with a framework to develop them.
Their central critique: the nurse-sensitive metrics CMS relies on focus almost entirely on patient harm, including hospital-acquired infections, falls, pressure injuries and restraint use. Those measures matter, the authors wrote, but they “measure nursing by its absence.”
“When nursing value is expressed only as harm incurred, the economic case for nursing investment becomes purely defensive,” they wrote. Institutions tally the cost of each central line-associated bloodstream infection, they noted, but not the value of a nurse catching signs of sepsis before a patient becomes hypotensive and requires an ICU transfer.
The Hospital Consumer Assessment of Healthcare Providers and Systems survey is the closest existing proxy for nursing quality, the authors wrote, but it was not built to capture the full scope of practice. Longtime nursing priorities including surveillance, symptom management and end-of-life care have no dedicated measure.
The proposed framework builds on the 2024 “Blueprint for Change in Acute and Critical Care Nursing,” a call to action from a national panel of nursing science leaders that included Dr. Kennedy. It articulated nine practice domains:
1. Creating safe, healing environments
2. Building caring relationships
3. Assessing and managing symptoms
4. Delivering physical, therapeutic, preventive and end-of-life care
5. Providing surveillance
6. Teaching patients and families
7. Coordinating care across the interprofessional team
8. Advocating for patients
9. Navigating care transitions
Candidate outcome measures the authors floated include delirium-free days, time to physiologic stability, achievement of patient-defined goals and a length-of-stay index — each flagged as requiring further testing.
“Nurses provide the majority of direct patient care in hospitals,” Dr. Kennedy said in an Oct. 19 UC Davis Health news release, adding that decades of research link nursing care quality to length of stay, mortality and readmissions.
“This is not about elevating one profession over another,” she said. “Every member of the healthcare team contributes to patient outcomes. Measurement drives attention. Our goal is to better understand and measure the unique contributions nursing brings to that work.”
The authors urged physician colleagues to partner on the effort and to ensure bedside and advanced practice nurses have “a seat at the table” when outcome metrics are selected, whether on a hospital committee or a national measure-development panel. The push comes as clinician burnout and turnover remain elevated, and as nursing represents the largest share of inpatient labor costs.
The viewpoint was co-authored by Laura Beth Kalvas, PhD, RN, of Columbus-based Nationwide Children’s Hospital, and Martha Curley, PhD, RN, of the University of Pennsylvania School of Nursing in Philadelphia.
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