May is a recognition month for nurses, but nurses deserve more than a moment in time to celebrate who we are and what we contribute to the health and well-being of the world's population. The International Council of Nurses (ICN) has chosen the International Nurses Day (IND) 2024 theme of “Our Nurses. Our Future. The economic power of care.” ICN President Dr. Pamela Cipriano states, “Despite being the backbone of health care, nursing often faces financial constraints and societal undervaluation. ...ICN has chosen to focus IND 2024 on the economic power of care...to reshape perceptions and demonstrate how strategic investment in nursing can bring considerable economic and societal benefits.”1 Nurses have tended to shy away from taking accountability for provided services and demanding commensurate compensation, not only in terms of salary but also bottom-line contributions to the business of healthcare. How have nurses become so undervalued?

Nurse = cost ≠ revenue

Nurses are employees, and nursing care is invisible within the healthcare finance system in the US and elsewhere. It has historically been embedded in the patient room charge or facility stay and not viewed as the means by which that system is able to bill for reimbursement. Advocates for a value-based nursing care model wrote: “We need to view nursing as a practice and nurses as individual providers of essential services that have both a clinical and financial impact. Metrics that measure nursing value should be based on what nurses accomplish, the ultimate results of nursing care in collaboration with all members of the healthcare team and not solely the actual process of care.”2 However, the culture of healthcare is stagnant. “In 2019, hospitals spent a median of 4.7% of their total nurse labor expenses for contract travel nurses, which skyrocketed to...38.6% in January 2022.”3 During the pandemic, a critical need for nurses to supplement existing low numbers amid an exponentially increasing census of critically ill patients necessitated a change in how hospitals staffed nursing positions. Nurses were viewed as an expense, not as the healthcare professionals who made all care possible. The same reality persists today: “Since nurses represent the largest labor expense in healthcare facilities, nursing positions are budgeted as a cost as opposed to a revenue generator.”4 It is dangerous to compare nursing to cost departments that may be expendable or reduced; safety and quality suffer.

Value of nurses

This year's theme for National Nurses Week is “Nurses Make the Difference.” To make a difference means to have a significant effect. Many APRNs generate revenue in their workplaces but are often referred to as being cost-effective, which carries the undertone of a cost center. It is time to reframe services provided by nurses within the context of a business model, shifting nursing from a cost to a revenue center.

Value = mental health

Feeling valued by others and receiving demonstrations of that value contribute to nurses' well-being. Nurse stress and burnout are well documented, and organizations are paying more attention to employee wellness. In recognition of Mental Health Awareness Month, Dr. Cameron Duncan discusses transcranial magnetic stimulation, a noninvasive therapy used in mental health conditions, on The Nurse Practitioner Podcast. APRNs, he says, can generate revenue for a practice by providing this service: an example of economic power.

“Use your ‘nurseness’ and influence wisely, and fully internalize and embody the power of your nursing identity.”5 Happy Nurses Week!

Jamesetta A. Newland, PhD, FNP-BC, FAANP, DPNAP, FAAN

Editor-in-Chief [email protected]

REFERENCES 2. Pappas S, Welton JM. Nursing: essential to healthcare value. Nurse Lead. 2015;13(3):26–29,38. 3. American Hospital Association. Massive growth in expenses and rising inflation fuel continued financial challenges for America's hospital and health systems. 2022. www.aha.org/guidesreports/2023-04-20-2022-costs-caring. 4. Laskowski-Jones L. Classifying nursing as a cost comes at a high price. Nursing. 2023;53(1):6.