What Nursing Must Build Now: The Infrastructure That Makes RN Work Visible and Valuable

Part of Nurse.org’s Nursing AI Watch, our ongoing investigation into how artificial intelligence is reshaping nursing practice. In her first piece, nurse leader Stephanie Witwer explained how a billing language created in 1966 left nursing out. In this piece, she lays out the fix: the taxonomy and infrastructure that would let the payment system finally see, measure, and pay for the work nurses already do.

Ambulatory care nurses deliver some of the most complex, preventive, and relationship-centered care in the U.S. health system. We stabilize chronic disease, prevent avoidable ED and hospital visits, manage transitions, coordinate care, teach, coach, and triage, intervening long before a crisis emerges. Yet the reimbursement system treats RN labor as overhead rather than value.

This is not because nursing lacks impact. It is because nursing lacks the infrastructure and reimbursement mechanisms that convert impact into visibility, measurement, and value. The valuation system built by and for physicians and uniformly adopted by CMS and all major payers was never designed to include nurses.

To elevate the value of ambulatory care nursing, we must build structures that make our work visible.

Want to see more Nurse.org articles in your Google results? Add us as a preferred source.

Nurse leaders June Clark and Norma Lang said it best more than thirty years ago: “If we cannot name it, we cannot control it, practice it, teach it, finance it, or put it into public policy.”

Right now, RN practice is buried in nonstandard documentation. We lack a unified taxonomy that describes what nurses do across settings, populations, and interventions.

Without standardized descriptors, RN work cannot be measured, compared, valued, linked to outcomes, linked to cost, or represented in national coding systems.

Taxonomy is not academic. It is the foundation of reimbursement, regulation, and national visibility. Without a way to name the work, the system cannot recognize and value it.

2. Nursing Must Capture Both Direct Services and Avoided Cost

A common misconception is that nursing value is primarily about avoided cost. Yes, RNs prevent ED visits, hospitalizations, complications, and care fragmentation. But RNs also deliver direct clinical services that fall squarely within RN scope and are essential to modern ambulatory care:

• Assessment
• Education
• Chronic disease management, including implementation of evidence-based treatment pathways
• Preventive care
• Care coordination
• Symptom management
• Transitional care
• Telephonic and virtual triage

These are not “support tasks.” They are billable services. Unfortunately, RNs who provide these services can’t bill for them though. The system simply refuses to recognize them and attributes the RN work to others. The service is only valued when a physician or other billable provider performs it, even when the RN delivers it.

Current reimbursement rules actively prevent RNs from practicing at the top of their scope.

Because RN services cannot be billed directly:

• Health systems lose money when nurses deliver care.
• RN practice is artificially constrained by billing regulations that do not match RN licenses or state scope of practice. Physicians are forced to perform services RNs could safely deliver, at far higher cost.
• Access bottlenecks worsen amid physician shortages.
• Efficiency gains cannot be realized.

No other industry forces its most expensive labor to perform work that qualified, lower-cost professionals can safely deliver.

But if RNs could bill for the services they already deliver, everything changes.

4. Reimbursing RNs Would Transform Access, Cost, and Quality

Direct RN reimbursement wouldn’t just correct an accounting problem. It would change what the health system can deliver:

• Expand access. RN-delivered visits and RN-managed protocols ease the access bottlenecks caused by physician shortages.
• Free up tens of millions of physician and APP visit slots for higher-complexity care. McKinsey Health Institute and West Health model U.S. adult demand for primary care at roughly 1.2 billion visits a year, against a workforce able to deliver just over 1 billion, a gap of 170 million visits, equivalent to 45 million people whose primary care needs are not fully met. If payment policy eventually allowed RNs to independently furnish and bill for even a fraction of appropriate primary care services, RNs could help close that gap while redirecting tens of millions of physician and APP appointment slots toward patients with more complex medical needs. That represents potential billions of dollars in savings for Medicare, other payers, and the American people.
• Improve quality. RN-delivered care is evidence-based, relationship-centered, and highly effective. When RNs manage preventive, chronic, and transitional care, physicians and others can focus on new and more complex patients, building the plan of care that RNs implement. RN reimbursement is not a cost. It is a capacity multiplier.

To fix this, nursing needs:

• A national taxonomy of RN practice
• Standardized descriptors of RN-delivered services
• Documentation that captures RN work
• Outcome linkage
• Cost linkage
• Representation in national coding and valuation systems
• A foundation for future RN billing models

This is the infrastructure that converts nursing practice into measurable, comparable, billable value.

This work has already begun. Through AAACN’s newly launched Center for Innovation and Excellence, we are building exactly this foundation: a shared national language for what ambulatory care nurses do, and, in partnership with Oculi Data, the taxonomy will be explicitly linked to the national measures and benchmarking tools that connect RN work to outcomes, cost, and value. 

Ambulatory care nurses have always been essential. What has been missing is the infrastructure that makes our work visible, measurable, and valued.

Now is the moment to build it.

Nursing must create the national taxonomy, standardized descriptors, documentation standards, outcome linkages, cost linkages, and coding structures that allow RN practice to be recognized the way every other clinical profession is recognized.

This is not about asking for permission. It is about claiming our place in the modern health system.

When nursing names its work, measures its work, and links its work to outcomes and cost, RN practice becomes visible, and it becomes valuable. And when it becomes valuable, the system can finally invest in the workforce that delivers the preventive, chronic, transitional, and relationship-centered care the nation depends on.

The timing could not be more urgent. In its proposed 2027 payment rule, CMS is formally asking the public what could replace or improve the current CPT and RUC processes. The agency that pays the bills is, right now, requesting exactly the kind of infrastructure nursing needs to build. Comments are open to anyone through September 14, 2026. Nursing should answer. 

The next era of ambulatory care will not be built by expanding physician capacity. It will be built by unleashing nursing.

More from Nurse.org’s reimbursement series:

🤔What’s one RN-delivered service on your unit or in your clinic that would be billable tomorrow if a code existed for it? Tell us in the comments below.

Nurse.org Analysis