Nurse leaders, who are charged with increasing retention, patient satisfaction, and patient safety, often view innovation initiatives as another competing priority. Yet, nurses already innovate daily through the workarounds and adaptations they develop to address clinical challenges.1 Thus, the leadership opportunity is not in creating innovation from scratch but in building systems that recognize, support, and scale it. Moreover, focusing on innovation and innovativeness may spill over to positively impact other core patient care and financial outcomes through improved nurse communication, responsiveness of hospital staff, communication about medicines, and care coordination.2
The Nurse Innovators Program, launched in fall 2022 with support from the Ewing Marion Kauffman Foundation, was built on the core premise that….
Those closest to the problems are often closest to the solutions. — Jon Darsee, Chief Innovation Officer, University of Iowa
By positioning nurses as primary agents of innovation, the program challenges traditional top-down models of health care improvement. It further reframes innovativeness as a new way of thinking about and capturing the problem-solving that nurses engage in every day. Research supports the reality that nurses solve problems every day. It suggests that nurses spend at least 10% of each shift dealing with operational failures that require workarounds (i.e., situations in which the information, supplies, or equipment needed for patient care are insufficient).1,3 Given the pervasiveness of nurse problem solving, the Nurse Innovators Program challenges nurse leaders to adopt the language of “innovativeness” to emphasize clinicians’ capacity to identify problems, generate solutions, and improve practice in response to everyday challenges, not just the creation of new technologies.2
Next, Allison Hurt, MSN, RN, Associate Director, Iowa Nurse Innovators, provides actionable insights to turn the abstract concept of innovativeness into concrete steps that help nurse leaders put innovativeness into practice. Hurt stresses that the central question for nurse leaders is not whether frontline nurses are innovating or not. The question is whether institutional structures exist to recognize, support, and scale that innovation. After initially working with nurses unit-by-unit, the program introduced a Rapid Prototyping Workshop, a 90-minute facilitated session modeled, in part, on the work of partner organization Maker Health. Sponsoring a prototyping workshop not only signals institutional support for nursing and the importance of dedicated time for innovation but also generates momentum. Within a single session that includes iterative experimentation, nurses move systematically from problem identification through physical prototyping. Hurt stresses 3 key takeaways for nurse leaders seeking to unlock a nurse-led culture of innovation.
Reframing Clinical Workarounds as Innovativeness
A central function of the program is conceptual: shifting how nurses understand their own adaptive behaviors. Hurt, who previously worked on both a burn unit and a COVID-19 ICU, describes a recurrent dynamic in her outreach work, one that she initially experienced herself— nurses who have modified dressings, extended IV tubing, or improvised supply solutions consistently decline to identify themselves as innovators. Realigning this perception requires more than language — it requires relational engagement. Hurt's approach is direct: she sits with nurses, asks what frustrates them, explores what they have already tried, and then surfaces the innovation that is already occurring.
The goal is to give nurses the satisfaction and recognition to want to stay staff nurses, because they now have a means to solve the challenges they identify during their daily work.
— Allison Hurt, MSN, RN
Provide Protected Time to Capture Innovativeness
Hurt stresses the need for protected time for prototyping and testing. Innovation cannot occur in the margins of a clinical shift; it requires dedicated, non–patient-care time for experimentation.4 Hurt draws a direct parallel to evidence-based practice projects, which routinely receive 2- to 4-hour blocks of NPC (nonpatient care) time allocated formally within nursing calendars and are eligible for clinical excellence recognition. Innovation work merits equivalent institutional standing. Hurt emphasizes that this is among the most significant commitments that chief executives and nurse leaders at all levels can make.
Measure and Track Innovativeness Impact
Tracking nursing impact is critical in most health care settings and for the nursing profession. For evaluating the program's impact with pre- and postintervention scores, the Nurse Innovator Program partnered with the National Consortium for Innovativeness in Health Care to adapt the 2 impact scales of the Innovativeness Across Academia and Practice for Healthcare Progress Scale.5 Additionally, nurse leaders seeking to implement change efforts to strengthen their Culture for Innovativeness can assess it by adding the Innovativeness Across Academia and Practice for Healthcare Progress Scale culture sub-scale to their existing efforts (also see the discussion by Joseph and Williams, 2026 on the importance of using reflective survey measures for change).2
Conclusion
The history of nursing is, in part, a history of invention under constraint. From the systematic hand-hygiene protocol to the crash cart, health care systems have embraced nurses' clinical observations and worked with them to institutionalize structural changes. The University of Iowa's Nurse Innovators Program does not create innovation; rather, it creates the infrastructure necessary to identify, support, and scale the innovation nurses already generate.
When even one idea is taken seriously — resourced, developed, and credited — the culture begins to shift toward innovativeness. Once established, a culture of innovativeness may not only systematically address specific organizational disruptions, it is likely to also support nurses’ satisfaction and retention.
Declaration of Competing Interest
Michele Williams has no competing interests to disclose.
References
- Designed for workarounds: a qualitative study of the causes of operational failures in hospitalsPerm J, 18 (3) (2014), pp. 33-41
- Leading change: a systematic review of formative versus reflective culture scales of innovation and innovativenessJ Nurs Adm, 56 (5) (2026), pp. 237-239
- Operational failures and interruptions in hospital nursingHealth Serv Res, 41 (3 Pt 1) (2006), pp. 643-662
- Health care innovations across practice and academia: a theoretical frameworkNurs Outlook, 67 (5) (2019), pp. 596-604
- Development and testing of the relational and structural components of innovativeness across academia and practice for healthcare progress scaleJ Nurs Adm, 54 (5) (2024), pp. 260-269