When nurses get support for their ideas, creativity thrives

It all starts with a problem to solve. Nurses design workarounds, rethink processes, and imagine helpful tools every day. The hard part is moving those ideas out into the world.

“What’s needed is an investment in educating nurses about innovation and entrepreneurship,” said Marguerite Rowell, MSN, MBA, MSM/HM, ONC, SCRN, NEA-BC, founder and CEO of Nurse Math LLC and former assistant vice president of nursing at the Miami Cancer Institute. “Many nurses have brilliant ideas on how to improve healthcare but lack the road map to show them how [to implement these ideas]. Simple things like where to start, where to go for support, and how to validate a concept aren’t provided in traditional nursing education.”

As part of its commitment to champion nurses and drive transformation in healthcare, American Nurses Association (ANA) programs like the Innovation Accelerator and Innovation Sandbox, and the American Nurses Foundation (ANF) Reimagining Nursing Initiative, ensure more nurses can bring their ideas to life.

“The solutions provided by nurses are nuanced and practical,” said Oriana Beaudet, DNP, RN, FAAN, vice president, ANA Innovation. “Nurses combine experiential knowledge and broader insights from across the healthcare ecosystem to crystalize meaningful, high value innovations.”

Three of the many innovations supported by the programs are garnering accolades and making an impact on healthcare.

Early intervention

Kenrick Cato, PhD, RN, CPHIMS, FAAN, FACMI, a nursing informatics expert, recalled the time in 2012 when he was working in the information technology department of a New York hospital. “We were transitioning from paper files to the electronic health record (EHR),” he said. “I remember someone handing me a paper flow sheet and saying, ‘Put this on the computer.’ We didn’t take the time to harness the power of technology. We didn’t ask how the electronic format could be used to serve our needs better.”

Since then, Cato, standing faculty clinician, educator track, at Penn Nursing at the University of Pennsylvania and professor of informatics at Children’s Hospital of Philadelphia, has worked to increase and refine the functionality of healthcare technology. He and colleague Sarah Rosetti, PhD, BSN, RN, FAAN, FAMIA, FACMI, developed CONCERN EWS (Communicating Narrative Concerns Entered by RNs Early Warning System). This predictive tool extracts nurses’ expert and knowledge-driven behaviors within EHRs and transforms them into observable data that support early prediction of organ failure or other critical conditions in hospitalized patients. CONCERN EWS has been shown to predict patient deterioration an average of 42 hours earlier than existing systems. Study findings by Cato, Rosetti, and their co-investigators showing that CONCERN EWS was associated with a 36% decrease in mortality were published recently in the scholarly journal Nature Medicine.

“Artificial intelligence gives us an opportunity to leverage the technologies that we have,” said Cato, including maximizing the capabilities of EHRs to enhance patient care.

The original CONCERN EWS pilot was one of the first projects funded by the ANF Reimagining Nursing Initiative in 2022. Cato, Rossetti, and their colleagues received a second round of funding in May 2025.

The initial $14 million grant through Reimagining Nursing funded 10 nurse-led projects that sought dramatic improvements to access, care, and outcomes. The second round of funding—$1.5 million over 2 years—has been awarded to CONCERN EWS and two other grantees to expand the reach and deepen the impact of these initiatives.

“We’re using this funding to bring CONCERN EWS to the pediatric setting,” Cato explained. “We hope to get to the emergency department at some point and eventually get to oncology. Our goal is to see CONCERN EWS used in every hospital in the country.”

Private, personalized care

In more than 2 decades as a forensic nurse, Nancy Downing, PhD, RN, SANE-A, SANE-P, FAAN, has observed that sexual assault survivors frequently don’t access follow-up care after their initial visit to an emergency department.

“As forensic nurses, we can give the most trauma-informed, patient-centered care possible during that exam,” she said, “but we’re only with those patients for a few precious hours.”

Downing wanted to fill this gap in care so that survivors would have better outcomes and more assistance dealing with post-traumatic stress disorder.

With funding from Texas A&M University and RYSE Hub at ETR, Downing and her team developed Text-SAFE (sexual assault forensic exam), an automated messaging system that sends patients 31 days of intentional messages tailored to their individual needs. Text-SAFE sends reminders about health follow-up such as sexually transmitted infection testing and repeat pregnancy tests, information about medication side effects, brief coping exercises to support mental health, and links to resources. Patients also can free-form text with a forensic nurse for additional information and support and make follow-up appointments via text.

Because of the trauma caused by sexual assault, Downing and her colleagues worked with a survivor advisory board to carefully design Text-SAFE messages to prevent triggering survivors who use the tool.

“Due to the trauma they experienced, survivors are sensitive about the messaging they receive,” explained Downing, a Texas Nurses Association member. “Negative social reactions have been shown to be associated with higher post-traumatic symptoms.” She and her team also wanted the tool to be available to as many people as possible. Research showed that most patients in the user demographic have access to free text messaging on their phones.

Downing lauds her time in the ANA Innovation Accelerator program, particularly for its deep dive into justice and health equity. “If we’re building programs or devices that aren’t accessible, it creates more disparities,” she said.

The ANA Innovation Accelerator is a free, 9-month program that offers resources and support for nurses and nursing students interested in creating positive change in healthcare through innovative practices. The Accelerator invites participants to explore content areas focused on human-centered design, business models, entrepreneurship/intrapreneurship, intellectual property, and leadership.

Before Text-SAFE, Downing was site investigator on a National Institute of Justice funded study to systematically examine the use of alternative light sources (ALS) in post-assault forensic exams.

“It can be hard to view bruise-related injuries on individuals with dark skin,” Downing explained. “We experimented with alternate light and colored filters and discovered that the use of ALS can have clinically significant improvement in our ability to visualize bruises. Bruises aren’t always present, but when they are, they can be valuable evidence. If they are less visible on darker skin, this can contribute to disparities in justice.”

Downing is already looking at ways to increase Text-SAFE’s capabilities. She imagines a day when “it could be paired with sensor devices that could indicate when a patient is dysregulated, when their heart rate or blood pressure has gone up, and send them a text immediately to offer support.”

Adding up to excellence

As a seasoned nursing executive, Rowell was well-prepared to take on the roles of assistant vice president of nursing and then interim chief nursing officer at the Miami Cancer Institute. Even so, she felt there’d been a gap in her nursing education.

“When you become a nurse manager, you become part of the team managing a multi-million-dollar budget,” she observed. “I received about an hour and a half of healthcare finance training during orientation. Some new nurse leaders don’t receive any onboarding on this topic.”

Although she’d taken courses in healthcare finance early in her career and earned an MBA, Rowell, a Florida Nurses Association member, wanted a more efficient way to solve problems and calculate information on demand. She developed Nurse Math to provide support to nurse leaders anytime and anywhere they needed it.

Nurse Math is a mobile app that provides step-by-step instructions for performing calculations that nurse leaders need, such as nursing hours per patient day, full-time equivalents, average length of stay, productive time, and more. Additionally, Nurse Math helps streamline business calculations, which makes it easier to determine profit margins, break-even figures, occupancy rates, and other crucial computations.

Rowell was awarded funding from the ANA Innovation Sandbox and used it to create a small Google marketing campaign that increased Nurse Math’s exposure. The Innovation Sandbox provides micro-funding for very early-stage ideas, filling a gap caused by the lack of early funding from mainstream funding agencies and organizations.

She then brought Nurse Math to the 2024 Magnet & Pathway Conference™ in New Orleans.

“I was part of ANA Innovation’s first Nurse Innovator Row, which highlighted nurse-led companies, innovative
nurses, and groundbreaking initiatives,” said Rowell.

“It was amazing exposure for nurse entrepreneurs.”

Rowell has received effusive positive feedback on the app. She plans to expand its user base and keep refining and improving its features.
“My goal is to empower nurse leaders in the work that they do every day.”

Fostering innovation: What’s next

Innovators agree that what nurses need most to cultivate innovation is time, encouragement, and access.
Rowell is excited about the new MSN in nursing practice innovation at the University of North Texas Health Science Center at Fort Worth.

“It’s a first–of-its-kind program in Texas designed to develop innovation in nurse leaders,” she said. Rowell was asked to review the lessons and provide recommendations. “It offers the kind of education that you don’t get in a traditional nursing program. If I’d had these classes when I was in nursing school, I would have started my innovation journey much sooner!”

Downing, who’s a professor at the university, said that the school also is integrating an “innovation mindset” into its BSN program.

“We’ve got to give nursing students and new nurses permission to ask questions,” she said. “Instead of accepting the way things are, encourage them to think, ‘Why does it have to be done this way? How could we do it differently?’”

Cato would like to see the field of informatics better incorporate diverse perspectives, data, and thinking. He contributes to these efforts as a member of the American Medical Informatics Association Diversity, Equity, and Inclusion Committee and chair of its Nursing Informatics Working Group.

“We can produce much more impactful work when we’re considering not just race, gender, and ethnicity, but, for example, the experience of veterans and other groups that aren’t being pulled into informatics,” Cato said. “Diversity of thought can help reduce health disparities.”

— Elizabeth Moore is a content creator at ANA.

Resources

Reimagining Nursing is a groundbreaking initiative that funds bold, nurse-led solutions to transform healthcare. It aims to create a future where nurses drive change, use their skills, and are valued and compensated for the care they provide. Learn more at nursingworld.org/rninitiative.

ANA Innovation is building a culture of innovation across the nursing profession through education, events, and a vibrant community of nurses who are opening new possibilities for healthcare. Access innovation blogs, podcasts, courses, and a library of innovation guides at nursingworld.org/innovation.

American Nurse Journal. 2025; 20(7). Doi: 10.51256/ANJ072528