Abstract
Background: High-quality nursing care is crucial for healthcare quality and safety, yet there’s limited understanding of the business case for investing in nursing from an organizational perspective. This study seeks to address this evidence gap by identifying and synthesizing data on the organizational return on investment in nursing human capital, considering initial investment costs and the resulting impact on production costs and revenue.
Method: We conducted a systematic review using four databases (PubMed, CINAHL, EconLit, Web of Science) to find nursing human capital studies from January 1990 to June 2024. Studies were eligible for inclusion if they examined nurses providing care within healthcare delivery organizations or systems and reported financial outcomes, were written in English, and used inferential statistics. The systematic review was registered in Prospero (CRD 42023462385).
Results: From 37,132 search results, the final analysis included 59 studies from North America, Europe, Asia, and Australia/New Zealand. Thirty-two studies focused on nurse staffing, 14 on skill mix, and 8 on nurse education and experience. Most studies reported improved patient and nurse outcomes, reduced turnover, and lower production costs. However, few studies fully accounted for initial investment costs and their subsequent impact on production and revenue, complicating inferences about organizational return on investment. Only 12 studies conducted complete return on investment evaluations, covering 19 nursing variables: 11 evaluated nurse staffing (2 positive, 4 negative, 5 neutral), 3 examined skill mix (1 positive, 1 negative, 1 neutral), and 1 focused on increased education (neutral). Two studies examined the work environment (1 positive, 1 negative) and two evaluated programmatic interventions (1 positive, 1 neutral).
Conclusion: Based on the findings, we conclude that the existing evidence of organizational financial return on investment in nursing is limited in scope and contradictory. Although nurses improve patient outcomes and are valued by consumers, the lack of a strong organizational business case restricts organizational investments in their nurse employees’ growth and development. Future research should evaluate organizational return on investment in nursing to better inform decisions on nurse employment and utilization.
Sigma Membership
Non-member
Type
Article
Format Type
Text-based Document
Study Design/Type
Systematic Review
Research Approach
N/A
Keywords:
Nursing, Human Capital, Investment, Revenue, Cost, Profit, Return on Investment, ROI, Value Economics, Workforce, Health Care, Organizations
Recommended Citation
Yakusheva, Olga; Lee, Kathryn; Fial, Alissa V.; and Weiss, Marianne E., "Organizational Return on Investment in Nursing: A Systematic Review" (2025). Individual Articles. 38.
https://www.sigmarepository.org/individual_articles/38
Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-No Derivative Works 4.0 International License.
Publisher
Elsevier
Version
Publisher's Version
Rights Holder
All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record. All permission requests should be directed accordingly and not to the Sigma Repository. All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.
Review Type
External Review: Previously Published Material
Acquisition
Indexed Previously Published Material (Per Creative Commons License)
Date of Issue
2025-12-19
Full Text of Presentation
wf_yes
Description
Open Access Details:
This is an open access article originally published under the terms of a Creative Commons License, which permits the Sigma Repository to post a copy in its collections. The license is attached to this item record; please click on the license for further details.
Original Article Citation:
Yakusheva, Olga, et al. “Organizational return on investment in nursing: A systematic review.” International Journal of Nursing Studies, vol. 170, Oct. 2025, p. 105146, https://doi.org/10.1016/j.ijnurstu.2025.105146.
No changes have been made to this article.