Overview and Summary: The Value of RNs: How Can We Communicate our Economic Worth?

Abstract

Any discussion of economics and economic valuing in what now is a globally connected health care delivery system is daunting talk, particularly to those among us who might prefer a focus on the art and science of care giving. Yet the nursing discipline is embedded in, and central to any discussion on the economic valuing and delivery of health care on many fronts. If this were not the case, one would have to seriously wonder, Why not? It is hard to imagine any serious health care venue consuming nursing resources in the United States or abroad - acute care, primary care, long-term care, home or public/community-based care, the military, informatics firms, pharmaceutical companies, and others - without seriously considering the value that nurses and nursing bring to bear on care or services outcomes. Chang, Price, and Pfoutz (2001) describe economics as the science that studies how consumers, business firms, government entities, and other organizations make choices to overcome the problem of scarcity. Scarcity exists because there are not enough resources to satisfy all existing human wants and desires (p. 6). As they reflect on health care, they state that most patients and families do not have the necessary means to obtain all health services. This situation is complicated through the use of third parties (insurance companies and the government, for instance) who are involved as players in what would be, in parallel business entities, a relationship restricted to that between a buyer (patient) and seller (provider). Those who embrace this edition of the OJIN: The Online Journal of Issues in Nursing will benefit in thinking about nursing's value contribution, present and future, to the health care system. The articles exemplify concepts espoused by Chang, Price, and Pfoutz (2001): (a) cost/quality valuation (what is the value of nursing interventions to patients or other aspects of the industry in the context of the outcomes produced?), (b) supply and demand (which influence salary, but also must link to career satisfaction and security), (c) awareness of markets (which asks who needs or will benefit from nursing's knowledge, skills, and abilities in the context of the discipline's social contract and emerging interests?), (d) service and product development and advancement (that link the full scope of nursing roles from basic to the highest levels of preparation with existing and new programs), and (e) pricing (where reimbursement for services and valuing of nursing contributions are in dynamic relationship). As you peruse these articles, recall that economic value is dynamic, not a static process. Value is not the purview of the supplier of services (in this case, nurses), but rather is created in tandem with users of services (the patient or health system, dependent upon the unit of analysis). Economic value is but one way, albeit a very significant one, of valuing nurses and nursing. In traditional economic models the notion of the law of demand drives prices and value beyond the reach of users, giving access to those who can demand services preferentially. Among the challenges for the nursing discipline is the creation of fair value and economic reward for a discipline that extends itself to all aspects of society to be non-scarce in light of influencing the health and well-being of society, through which healthy workers emerge to constitute the backbone that feeds all other industries. In the first article, Welton presents a robust discussion on the topic of mandatory hospital nurse staffing ratios, noting the various tensions that center on nursing's value as a commodity versus as a professional service provider. This article exemplifies the pricing concept noted above. Two articles follow that explain the relevance and use of the National Database of Nursing Quality IndicatorsTM (NDNQI)®, presented by authors Montalvo and also Dunton, Gajewski, and Klaus respectively. Using the NDNQI, both writers elucidate the importance of gathering and interpreting nurse-sensitive data when the unit of analysis is not at the institutional level, but rather at the unit level. …