The Silent Value of Nursing Professional Development

Return on investment (ROI), economic impact, and cost analysis are words that often make nursing professional development (NPD) practitioners and other non-revenue generating healthcare departments hesitate. Yet, at their core, these terms illuminate the profound impact educational projects and programming have on an organization. In today's demanding healthcare climate, where efficiency and resource optimization are paramount, it is imperative for NPDs to actively showcase their value. This need is amplified when departments face restructuring due to "reductions in force." This can occur for a variety of reasons. For our 13-hospital system, this has been a challenge that we navigated multiple times over the last several years. Though our team did not emerge unscathed, we learned invaluable lessons in advocacy and the power of a compelling, data-driven pitch to top executives.

From Challenge to Cutting-Edge Advocacy

Inputs: The Genesis of a Powerful Tool

Prompted by initiatives such as the Economic Value of Nursing Project (ANA, 2025), and education activities from ANPD, our NPD team began efforts to quantify and communicate their value. We hosted three ROI classes for approximately 50 total NPDs, teaching them how to calculate the impact of their initiatives and provided a tool to help them accomplish that task.  This tool—a spreadsheet calculator—utilizes historical and organizational data to automatically input costs associated with the problem, interventions, and the outcomes being evaluated and calculate ROI.  When key leaders such as chief nurse executives, nursing directors, and clinical managers shared concerns about soft numbers and confounding variables, we incorporated their feedback to transform the calculator into a more sophisticated and highly functional advocacy tool. 

The Calculator: From Simple Inputs to Powerful Insights

The result is a tool designed for the frontline clinician, leaving the heavy lifting to Excel. For example, a nurse proposing a skills day to reduce Catheter-Associated Urinary Tract Infections (CAUTIs) does not need to be a data analyst. They simply input basic project variables: the baseline CAUTI rate, the number of staff and hours required for the intervention including planning, and any supply costs, and CAUTI rates after the intervention implementation.

The calculator then instantly performs the complex financial analysis and populates a summary dashboard that visualizes the problem's total expense, intervention costs, and the resulting ROI. Beyond these core calculations, the tool boasts advanced functionality:

• Annualization and Scaling: The ability to annualize or scale initiatives allows for projections across our multi-hospital network
• Comprehensive Benefits Integration: It accounts for benefits beyond direct costs, such as hourly rate benefits.
• Statistical Rigor: Chi-square statistics calculate the statistical significance of initiatives.
• User-Centric Design: A plain language interface and summary dashboard provides high-level overviews, while detailed reports and customizable charts support deeper insights.
• Extensive Citation Library: Over 300 citations link known expenses from peer-reviewed sources to a user-friendly drop-down menu.

Methodological Rigor: Ensuring a Defensible Engine

To ensure these outputs are robust and defensible, the calculator’s architecture is grounded in the Institute for Healthcare Improvement's Plan-Do-Study-Act (PDSA) model. It was specifically designed to address key limitations in healthcare data analysis, such as inconsistent internal cost data and lag times in reporting clinical outcomes. We deliberately draw financial data from externally vetted, peer-reviewed sources, such as the Healthcare Quality Report and the Agency for Healthcare Research and Quality (AHRQ). This addresses common concerns that internal data can be inconsistent or lack the comprehensive contributing variables considered by large research bodies like AHRQ. For instance, AHRQ transparently details the complex costs of a single CAUTI, accounting for factors like increased length of stay, pharmacy labor and follow-up tests- a level of detail internal resources often cannot provide. To further bolster accuracy, we collaborated with our internal financial analyst teams and incorporated precise wage data from human resources partners, with a process to update all data sources annually.

Throughputs: Validation through Pilot Testing and User Feedback

Pilot testing across a 12-hospital network demonstrated the calculator's feasibility, efficacy, and user-friendliness.  To formally assess this, post-implementation surveys were distributed to the initial 50 NPDs trained on the tool. Results were overwhelmingly positive, with 95% of respondents agreeing or strongly agreeing that the calculator simplified the process of demonstrating value.  One nurse leader noted, “For the first time, I could confidently walk into a board room with data that spoke the language of our executives.”

Outputs: Quantifiable Value and Empowered Advocacy

The calculator has proven remarkably effective in quantifying the ROI of diverse educational interventions, revealing significant financial and non-monetary benefits. Our analysis of over 20 quality improvement and evidence-based practice projects from 2023-2024 fiscal year yielded a positive ROI, with the majority exceeding 22%. Tangible examples from our system include: 

• Nurse Residency Program: A 39.82% ROI with approximately $8.7 million in annual savings, partly due to improved nurse retention and a 22.8% reduction in turnover. The nurse residency program alone had a ROI of 41.11% with $12.09 million in annualized savings.

• Pressure Injury Reduction: A project reducing average pressure injuries from 2.5 in 2023 to 1.428 per 1000 patient days in 2024 surpassed a 30% reduction target, translating to $1.5 million in cost avoidance. Projected annual savings are estimated at $2.9 million, with a 44.9% ROI.
• Vascular Access CLABSI Reduction: A single two-hour intervention yielded $435,612 in savings and a 63% ROI, indicating potential network-wide savings of $5.2 million, going from 15 CLABSI to 2 CLABSI in one year.
• Blood Culture Contamination Reduction: This initiative showed a 79.50% ROI and $2.857 million in annualized savings. The pre-intervention average was a 4.51% blood culture contamination reduced to 1.8% in 7 months.
• Nurse Resilience and Retention: This four-year initiative evaluated a 16-hour overnight nurse renewal retreat. Of the 336 nurses who attended, 23 nurses left the organization which is a 7% turnover rate in a four-year period. Compared to the comparison group of 269 nurses who left the organization and did not attend the retreat, an 80% turnover rate. Over 4 years, this resulted in $3.32 million in annualized savings and an 1,155.08% ROI. Simply put, for every $1 spent on the nurse renewal retreat, the organization saved $11.55. 

These compelling numbers underscore that investing in nursing education can generate substantial returns. Beyond our system, the calculator's impact is evident in its integration into process improvement software and its widespread adoption. It has been downloaded over 400 times through national and international scientific symposiums since 2024.

The Art of Advocacy

Despite the calculator's advanced functionality and robust outputs, we realized it could not replace the critical skill of advocacy- the art of telling the “why” behind the numbers. This led us to develop a standardized framework for presenting ROI data, helping our teams craft a compelling narrative for continued investment. The framework is a concise 5-10 slide presentation that includes:  

1. A hook- an opening with a patient story or frontline testimonial to create an emotional connection.
2. The problem- a clear SBAR-formatted overview of the issue, supported by baseline data.
3. The solution and investment- a description of the education intervention and its associated costs.
4. The impact- engaging graphs and visuals displaying the clinical improvements and the calculated ROI.
5. The ask- a clear, persuasive request for resources, continued support, or expansion of the program.

Driving a Culture of Value

This combination of a powerful tool and structured storytelling has catalyzed a cultural shift. The ROI calculator has been formally vetted and approved through our system’s shared governance council and is now an accessible resource in our Ovid Synthesis evidence-based practice repository. This success has created a new standard; there is now an organizational push for every improvement project to be analyzed through this framework. This initiative empowers our teams by transitioning them from simply identifying problems to building data-driven business cases for impactful solutions. We believe this calculator is a pivotal resource, empowering nurses and NPD practitioners to effectively quantify their initiatives, advocate for their crucial role, and contribute to a culture of sustained excellence in healthcare delivery while maintaining financial stewardship.

Our open-source calculator is available for download here.

References

American Nurses Association. (2025, January 8). Economic value of nursing. https://www.nursingworld.org/ancc/nursing-research/economic-value-of-nursing/#evntop

Bicket, A., Lemke, C. & Ittickathra, P. (2023). Return on investment: Changing the game. [Webinar] Association of Nursing Professional Development. https://www.anpd.org/core-curriculum/2023-anpd-recorded-webinar-return-on-investment-changing-the-game