What Can We Learn from the Existing Evidence of the Business Case for Investments in Nursing Care

Importance of Content, Context, and Policy Environment

Lack of evidence and difficulty replicating results make it hard—for now—to make the business case for investing in nursing care.

New research funded by Robert Wood Johnson Foundation's Interdisciplinary Nursing Quality Research Initiative (INQRI) explores the business case for financial returns on investment in nursing care.

These authors reviewed all peer-review-published INQRI-funded studies for mention of an economic evaluation component (searching the terms business case, cost, cost-saving, resources, cost-benefit analysis, economic evaluation, return on investment, cost effectiveness, and financial return). They define an investment in nursing care as “an organizational commitment of financial resources to any type of a change in structure or process of care related to nursing, with the expectation of improving the quality of patient care or reducing the cost.” By business case they mean the cost of an intervention (such as additional nursing staff or training) was supported by the benefits that resulted from implementing it.

They found limited literature on the business case for nursing investment. They cite a number of reasons:

  1. The inability of most studies to fully capture long-term financial impacts in support of nursing investment.
  2. The design of most studies with findings supporting a business case for nursing are intervention- or organization-specific and not easily replicated or generalizable.
  3. Fragmentation of care delivery and payment models tend to create disincentives to investments.

As provisions of the Patient Protection and Affordable Care Act are rolled out, financial penalties (such as Medicaid nonpayment for specific hospital-acquired infections) and other payment reforms, they believe, will strengthen the business case for nursing investment.