Article
What the study found
On March 26 the American Nurses Enterprise released initial findings from its INVEST study, conducted by Olga Yakusheva of Johns Hopkins University and Marianne Weiss of Marquette University. Chief nurse executives at 45 hospitals, most of them large, system-affiliated organizations with more than 400 beds, reported on workforce characteristics, nursing investment spending and operating margin. Together they oversee more than 80,000 nurses.
Wage adjustments for competitive pay made up more than half of reported nursing workforce investment. Recruitment and retention programs accounted for 30%, continuing professional development for about 11%, and safety and well-being programs for about 8%. Investments in safety and well-being, recruitment and retention, and minimum wage adjustments showed the strongest positive association with operating margin. The researchers have not yet published effect sizes, and the full peer-reviewed paper is expected in the coming months, so these are associations, not proof of cause.
The most practical finding is about measurement. Every hospital tracked what it spent, but only 13 of the 45 tracked return on investment in any category.
Why it matters for budget season
Nursing is the largest single part of most hospital personnel budgets, and finance teams usually see it as a cost to control. Without return data, nursing leaders enter budget discussions with requests, while finance arrives with variance reports. That imbalance makes it easy to cut programs whose benefits show up later or in other departments, such as lower turnover, fewer agency hours, shorter stays and fewer safety events.
The study’s emphasis on safety and well-being is notable because it is the smallest slice of spending. If those programs are among the most closely tied to margin, they may be underfunded relative to their value.
Steps for CNOs and CFOs
- Pick three programs: Choose a retention bonus, a residency program and a safety initiative, and define the outcomes each should move.
- Agree on the math: Have finance and nursing jointly set how avoided turnover, agency use and harm events are valued.
- Report quarterly: Put nursing investment results on the same dashboard as labor productivity so leaders see both sides.
- Protect what works: Use the evidence to shield effective programs when expense targets tighten.
Archive entry for Mar 28, 2026, added Nov. 11, 2026.