The Nursing Value Index: A conceptual architecture for outcome-level attribution of nursing value

Healthcare systems are evaluated at the level of patient outcomes across defined episodes of care. Although associations between nurse staffing and patient outcomes are well-established, prevailing valuation approaches primarily quantify structural and process inputs, including staffing ratios and task volume. This creates misalignment between how nursing contribution is measured and how institutional performance is judged.

The Nursing Value Index (NVI) is proposed as a conceptual framework for outcome-level attribution of nursing value.

Grounded in Donabedian's structure-process-outcome model, complex adaptive systems theory, and safety science, the NVI situates nursing contribution within the outcome domain and defines value according to influence on clinical trajectory. The framework organizes attribution across three domains: Prevention of Adverse Outcomes, Severity Attenuation, and Stability & Containment.

This article establishes the framework's conceptual structure while deferring empirical specification and validation.

Clarifying outcome-level attribution is essential for representing nursing value within performance-accountable systems.