Hospital nursing is often measured by what does not go wrong: an infection that did not occur, a pressure injury that was avoided, or a patient safety incident that was prevented. A new commentary in JAMA Internal Medicine argues that this approach leaves much of nursing’s contribution invisible.
The authors call on health systems, payers and credentialing bodies to adopt nurse-sensitive outcome measures that reflect the full scope of acute and critical care nursing. Their proposal shifts the emphasis from a narrow tally of harms avoided toward measures that can show how nursing surveillance, symptom management and care coordination affect patients.
The commentary was led by Martha A. Q. Curley, a professor in the University of Pennsylvania School of Nursing’s Department of Family and Community Health and the Ruth M. Colket Endowed Chair in Pediatric Nursing at Children’s Hospital of Philadelphia. Her co-authors are Lori Kennedy of UC Davis Health and the Betty Irene Moore School of Nursing, and Laura Beth Kalvas of Nationwide Children’s Hospital.
What current measures miss
Traditional quality measures remain important. Hospital-acquired infections and pressure injuries can reveal serious shortcomings in care and give organizations targets for improvement. But the commentary says such measures frame nursing mainly as a defensive activity: its value is inferred when a bad outcome is absent.
That framing can miss the continuous work performed at the bedside. Nurses monitor patients for subtle changes, identify symptoms, intervene early, coordinate among clinicians and support patients and families through rapidly changing situations. Those actions may prevent deterioration, but they are not fully described by a quality system focused chiefly on adverse events.
The authors argue that this limitation also affects the economic case for nursing investment. If nursing quality is assessed principally through preventable harms, hospitals may be pushed to justify staffing, education and clinical support through a negative calculation: the cost of a service compared with the cost of a problem it may avert. The commentary calls for a measurement approach that recognizes positive clinical contributions directly.
A broader view of outcomes
The authors point to nine core practice domains established by the American Academy of Nursing’s Expert Panel on Acute and Critical Care. They use those domains as a foundation for measuring outcomes that are sensitive to nursing practice.
Rather than treating nurses simply as a final barrier against error, the proposed approach would examine the work that helps patients receive timely attention and organized care. The commentary specifically identifies surveillance, symptom management and care coordination as parts of nursing practice that should be reflected in quality evaluation.
Surveillance matters because acute and critically ill patients can change quickly. Detecting an emerging concern early can shape what happens next, including the speed with which a team responds. Symptom management can influence a patient’s experience and clinical course. Care coordination links bedside observations with decisions made by physicians and other members of the care team, while also helping patients and families navigate treatment.
These are not presented as replacements for established safety measures. Instead, the authors are arguing for a more complete picture—one that preserves attention to harm prevention while measuring what nurses actively do to support recovery and stability.
Why the proposal arrives now
The call comes amid high burnout and turnover among health care professionals, according to the commentary. Measurement choices can influence which kinds of work are visible to leaders and which are treated as background activity. A system that recognizes only failures avoided may not communicate the breadth of expertise required in acute and critical care nursing.
“Data drive accountability,” the authors write. Their central contention is that nursing quality should be evaluated with data that correspond to nursing practice, not solely with indicators of injury or failure.
That has implications beyond reporting dashboards. Measures influence institutional priorities, payment discussions, credentialing and decisions about where to direct resources. If those measures do not represent the work that nurses perform, the commentary suggests, they may offer an incomplete basis for judging quality or determining investment.
A call for collaboration
The authors invite physician colleagues to join the effort to reform how hospital nursing quality is evaluated. The appeal is notable because many outcomes in acute and critical care are produced by teams rather than by a single profession. A nursing-sensitive framework would need to account for that reality while still identifying contributions that nursing practice can meaningfully affect.
The commentary’s proposed change is therefore not simply a request for more metrics. It is a request to choose metrics that better match the clinical work being assessed. Measures should be sufficiently meaningful to show whether patients benefit from nursing surveillance, symptom management and coordination, rather than merely recording whether an easily identified harm occurred.
For hospitals, the challenge will be translating that principle into measures that are usable, credible and aligned with routine care. The commentary does not claim that this will be simple. It does make a clear case that the existing emphasis on adverse events is too limited to represent the profession’s full value.
Its conclusion is direct: nursing care should not be valued only as the sum of harms prevented. The authors contend that it should be assessed through the outcomes of the work nurses carry out every day for patients.
This article is based on reporting by Medical Xpress. Read the original article.
Originally published on medicalxpress.com
