Nurses frequently hear about how important they are; key, central, and vital to the work of health care. Some say the system simply could not do without the important work they do. Others state how critical nurses are to the work of health care and that the system would simply fall apart if it weren't for the work and impact of nurses. While these statements may certainly be true, these and more all are statements about people's sentiments of value but have little to do with the reality of value (Porter-O'Grady et al., 2022). The term value is a “hard” word; definitive, clear, and precise. The demonstration of value has decisive elements grounded in metrics that deliver a cold and rational, often numeric, indication of value. This definite and often numeric metric can be seen, analyzed, evaluated, compared, and used as a point of reference for other measures of worth to which it relates or intersects (Porter-O'Grady, Weston, et al., 2022). Today the term “value of nurses” is a conundrum in that no one knows exactly what that is. The value of nursing or nurses has never really been objectified sufficiently to have either content or meaning. In contemporary history, nursing has always appeared on the left side of the operating ledger in health care and has therefore been primarily determined as a cost. There has never been a successful broad-based national/international effort to treat the nursing resource in any other way. As a cost, nursing has always been a negative item on the balance sheet along with the other institutional costs such as laundry, physical plant, supplies, and other overhead expenses. And because nursing is like all costs, it is to be well managed, minimized, reduced, controlled, tightly allocated, even eliminated wherever possible (Yakusheva, Rambur, et al., 2022). Imagine how nurses are dealt with when they are treated operationally as a deficit line item in the financial ledger. Consider how the human behaviors of leaders and nurses are informed and influenced by the operational circumstances they represent in the cost metrics continuously negatively challenging the viability and success of the organization. How does this cost-mental model affect the ownership of professional practice by nurses, the engagement of nurses in decision-making, the support of nurses by the organization, the management approach to individual nurses and to the community of nursing? Imagine the operating paradigm of leadership required to manage the nursing cost “on the margin”; closely control staffing, carefully allocate time for renewal, limit patient care expenses, and tightly budget education, development, and evaluation time. And since there is no counterbalance generated by carefully calibrated work products, benefit, or benefaction denoting contribution, impact, or outcome, there exists in the workplace a never-ending negative psychodrama between nurses and their leaders that creates a culture of unrelenting accommodation to limitation and endless work-arounds that eat up at least a third of a nurse's work activities. Of course, it is no wonder this circumstance is nonsustainable and infinitely nonproductive for both nurses and health organizations (Yakusheva, Munro-Kramer, Love, et al., 2022). Value determination is central to any measure of contribution and impact. If cost is offset by some value metric that validates its worth or legitimacy as a reflection of that merit, then its legitimacy fits into a contextual framework that provides a useful link between the processes of work (cause) and its product (effect). For nurses, there is generally only the discourse around process, the doing of nursing, with little reference to the impact of that “doing” and its relevance and consequence. In practice environments around the world, nurses are caught up in the constancy of action, process, task, check-offs, and timelines. For most nurses, it is the capacity to do, to complete, to finish activity that has become the enumerator of value. The activity of practice is its own end. This dynamic stands in place of determination of relevance, impact, and the difference the action of the nurse made on the outcome, goal, or a health result of some definitive kind. For nurses, there is lots of cause but not much effect, which together are essential to the determination of value (Yakusheva & Buerhaus, 2022). And value is a “hard” measure. There are rules to value that are generally understood by everyone in the marketplace of human interaction. Value generally has a unit of measure that acts as an objective indicator of its significance and its power to reflect worth. In the marketplace, we all reflect on work products and their price to decide on their worth to us. The price is a “hard” (clear, precise, definitive) indicator of stated value but worth is attached to the decision we make about that valuation. Here there are input and output realities to contend with in making decisions about what choices we might make with regard to price and worth. While there are a host of other personal and economic factors that affect our decision-making about the products of work, the parameters informing us are specific and precise (Fong et al., 2022). As nurses, half the elements in this equation are missing. We often can tell others what we do and how much of it we do; we less frequently can demonstrate or define what difference we make or what impact we have in terms that reflect an enumerated value that is definitive and clear. For good or for ill, if we cannot do that, we can never expect to ever be more than a cost, an expense, a deficit, an outlay for which there is no countervailing contribution, merit, gain, or benefit that serves as a real reflection of value. With the onset of new technology tools, it is becoming easier for us to construct methods for building the underpinnings of data generated indicators of value (Yu et al., 2019). The substantial and accelerating development of augmented reality provide tools for drilling down into the huge repository of macro and micro clinical data and the interfaces and intersections that demonstrate definitive relationships and interdependences in data sets that inform our decision-making and the objective determination of impact and value. Furthermore, through these emerging mechanisms, we can clarify the recurring, replicating evidence that more powerfully establishes the veracity and usefulness of that data and its potential for rigorous evidence utility and application. Newer capacity to link structural, decisional, actionable, and impact trajectories or interfaces in real-time establishes not only evidentiary mechanisms of responsive practice but also the elements of quality and financial relationships and clinical value related to both resource use and how its configuration influences impact and outcome. Productivity relationships can more specifically measure the established relationship between practice intensity measures with regard to clinical demands and resource use. This can be more tightly aligned with clinical action and outcome leading to a more accurate reporting of the relationship between clinical demand and more specifically related resource demand. This whole approach is contribution based and takes the mental model related to the cost ideation of nursing work and transforms it into a consistent contribution operating model whose goal is to determine the margin/price of effectiveness of nursing practice, and making the financial and quality case for clarifying and structuring the operational milieu for sustaining it. What nurses do in such an environment of nursing practice value determination would bring a new and relevant conceptual and contextual framework for thinking about their practice and how they would understand and apply nursing work. Instead of the focus on the completion of a multitude of nonaligned tasks and functions which inherently terminate their notion of impact and generates compartmentalized (just-in-time) completion of those work activities, value-grounded nurses can focus more completely on assessing and applying validated protocols and approaches that more clearly lead to sustainable determination of impact and value. These new algorithms for the reflection and action of professional practice builds for nurses and nursing, for the first time in its history, an operating algorithm that potentiates and yields the products of value. Out of this effort is created a budgeting, operational, and relational configuration in their practice setting that for the first time enumerates and delineates the discernible impact of the real-time value of nurse's individual and collective efforts. This is accomplished through use of recognizable financial tools and quality metrics of contribution that are quantifiable, specific, and useful. The creation of these contribution approaches for nursing practice value determination are not difficult to accomplish nor are they operationally revolutionary. This approach is undertaken every day in physician's offices and in other professional practice settings worldwide. The barriers that remains are the prevailing cost construct for nurses, structural and operational impediments to applying contribution-based financial and service models to nurse's work, and the lack of enumeration of the broad financial, clinical, and social impact determinations of nursing practice. It will take innovation, determination, and perseverance (Love et al., 2020). If health care management were truly interested in ending these incessant cycles of feast or famine of nursing resource use they would eagerly end the exceptionally costly mechanics of “margin management” for the use of the nursing resource. This long addiction to cost management always fans nurses' negative reaction to “tight” cost control of numbers, too little time, work disfunction, poor utility, and turnover. Wise managers would by now readily embrace creation and use of nursing value-based approaches (Pattison & Corser, 2023). Using contribution algorithms for nurses, leadership going forward could ground nursing management methods in data that informs the relationship between cost and benefit and advises the resource strategy based on the benefit, outcome, and impact on both the bottom line and health impact. For nurses, value-based approaches to practice would finally connect their work to relevance, using metrics that tie effort to impact, relate effort to both the financial impact of resource use and the financial and service impact data resulting from measurement of intensity service demands, clinical practice choices, and benchmarks extrapolating the difference nursing efforts make to care and health outcomes. Nurses could finally connect meaning and value in terms that are objective, specific, and precise. Its' past time for both nurses and health systems to construct value norms of the work of the profession and the cost–benefit interface that finally establishes factually what we know intuitively; nurses have real and sustainable value. We would all finally know, in real terms, exactly what that value truly is. The author declares no conflict of interest. Data are sharing not applicable to this article as no data sets were generated or analysed during the current study.