Reports of suboptimal health care quality and rising expenditures have led payers to institute policies intended to improve outcomes and lower costs. Referred to as value-driven health care, these policies have multiplied in recent years. Despite their appeal, nursing-the nation’s single largest provider of health care-has largely been excluded from these policy directions. This article describes the nature of the evidence substantiating nursing’s contribution to quality and cost and explores the reasons-scientific, economic, societal, and political-that these contributions have been largely ignored in the formulation of federal policy. Recommendations are made to strengthen the nurse-value case and convince health care stakeholders, including policy makers, that the relationship is established, enduring, and sufficient for national action.
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