Nursing Knowledge and Theory: Where Is the Economic Value?

By Nickitas, Donna M.; Frederickson, Keville | Nursing Economics, July/August 2015 | Go to article overview

Nursing Knowledge and Theory: Where Is the Economic Value?


Nickitas, Donna M., Frederickson, Keville, Nursing Economics


DEFINING ECONOMIC VALUE within the U.S. health care system is currently driven by the Triple Aims of value-based purchasing (VBP) including, higher quality, lower costs, and consumer demands. The Centers for Medicare & Medicaid Services (CMS) focuses on value-centric reimbursement to incentivize nurses and other health care providers to demonstrate their achievement or failure to meet quality outcomes and performance benchmarks. As the convergence of reimbursement and valuebased care challenge all providers, nurse leaders are called to lead with the goal to advance nursing's full scope of practice, innovate service delivery, and address emergent nursing science. The Triple Aim (Institute for Healthcare Improvement, 2013) provides significant opportunity to showcase the performance benchmarks to improve the patient care experience, advance the health of populations, and reduce the cost of health care by quantifying nursing's value in economic terms. Can nursing knowledge and theory help uncover nursing's economic value? The value-based care and performance benchmarks present a real quandary for nurse leaders, researchers, educators, and clinicians who have used nursing theory to guide their work and derive value. The question is finding the value in nursing knowledge and theory to develop and advance nursing science through research, education, and practice.

Nursing Knowledge and Theory: Finding the Value

It is time to ask what is the impact of nursing knowledge and theory as external motivators to improve quality? Value-based purchasing and reimDONNA bursement changes have profound implications for the nursing profession to demonstrate economic value. Defining value in nursing knowledge and theory within the health care system requires a renewed understanding and appreciation of nursing science. Value in nursing must be defined relative to nursing's unique theoretical knowledge and not just as a result of the Affordable Care Act and a shift towards a value-based reimbursement model. This demand towards value, especially economic value, warrants a redefined approach for nursing that goes beyond achieving value from CMS's key quality outcomes and performance benchmarks.

For nursing care to be valuable in today's value-based environment, nursing theory must be fully realized. It requires the rich and continued development of the discipline where there is a body of knowledge that is uniquely recognized as nursing. This means going beyond evidence-based practice guidelines and protocols to theory-driven capability and reliability where nursing knowledge development drives and determines nursing practice. Parse (2015) suggests nurse leaders use discipline-specific nursing theory to guide practice, policy development, and documentation.

In today's performance-driven health care system, there are new expectations to measure, report, and reward excellence. And yet, much of that performance is linked to nursing care. Linking nursing knowledge and theory-guided practice to a health care system's performance may help heighten the recognition of what is unique to nursing and awareness of nursing's value to cost. To drive value-based care to the bedside, nurse leaders must redesign the practice environment to fully integrate nursing knowledge and theory into philosophical and operational structures of the health care organization. This means translating nursing theories that are congruent and synergistic with the VBP principles of the organization.

Historically, when the National League of Nursing required the use of a conceptual model as the basis for a curriculum, nursing models flourished. Specifically, there was an emphasis on Orem, as concept of self-care was appealing not only to educators but to clinicians as did Roy and the Roy Adaptation Model. …

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