Towards ethical inquiry in the economic evaluation of nursing practice

Economic evaluation is a critical tool for nursing and health care. The authors claim that economic inquiry needs to be supported by expertise in ethical inquiry, that the nursing profession needs to examine values concurrently with economics. Drawing on 2 ethnographic studies of nursing practice, the authors illustrate nurses' invisible work, their invisible triaging of clients, and the invisible costs to nurses and clients. They argue that invisible work, triage, and costs are embedded in a number of values, and that if nursing is to respond to the consequences of health reform, it must examine the values inherent in economic measurement and subsequent health-policy decisions; what is invisible may go "uncounted" unless economic evaluation is informed by ethical inquiry. The authors conclude by suggesting that economic and ethical inquiry be integrated in order to foster a system that is more humane as well as more effective and efficient for all those involved in health-care delivery.