An Open Letter

AN OPEN LETTER
Thanks to Olga Yakushev, Betty Rambur, and Peter Buerhaus.

ABSTRACT. Nurses make decisions about the use of costly resources in countless care delivery settings 24 hours a day. Consequently, nurses are inseparably connected to not only the quality and safety of care, but to the cost of care as well. This article is Part 1 of a 5-part series on ‘value-informed nursing practice’. It describes the concept of value-informed nursing practice as ’practice that focuses not only on outcomes, but also on the cost of care’ - a new way to envision nursing practice*1 1

Dear Peter et al,

I read your article in Nursing Outlook with deep interest and strong enthusiasm. In my opinion, ‘value-informed nursing practice’ is exactly the right direction for nursing to be taking post-COVID. It is an exciting example of implementing disruptive change in order to destroy dysfunctional staffing systems.

During my life-long experience of practice innovation and leadership development, the staffing/workload issue has always been front and center of every practice model, innovation, or development, driving either staff resistance or acceptance.

I have thought hard and deeply about the mind-sets that control so much of the experience of nursing practice in hospitals. Ever since reading about mental models in Peter Senge’s work, I saw how mental models re: staffing negatively impacted the experience of hospital nursing 2. In my decades of experience with practice innovations that have staffing implications, the power of the collective mind-set has been stunning. Equally stunning, however, is the disruptive impact COVID has had in breaking down and destroying these mindsets.

A key to ‘value-informed nursing practice’ is nurses’ ownership of resource distribution for the care provided on a shift-to-shift basis. What value-informed practice provides is consideration of choices about care activity priorities having efficacious outcomes. COVID handed us a destructive force powerful enough to shatter mental mindsets and create a process for assuring high quality care within a framework of cultures that lean into advances in humanization.

1. “Valued-informed nursing practice”: What it is and how to make it a reality. Nursing Outlook Vol.70 Number 2 March/April 2022 pg., 2011
2. ?A Brief Compendium of Curious and Peculiar Aspects of Nursing Resource Management. CREATIVE NURSING., Vol 15 Number 2. pg 61