Frequently Asked Questions

A nurse’s experience of CareEffects is a supportive conversation with their unit leader, opened earlier and better informed. The report goes to a unit’s leaders and its CNO. It is not designed as an evaluation and rates nothing about a nurse’s work. It describes the strain a nurse has carried relative to peers on the same unit and shift, and whether that load is easing or building.

The same report shows leaders which nurses have been lifting the team, so recognition is specific and timely. This is the practice the AACN Healthy Work Environment standards describe under Appropriate Staffing and Meaningful Recognition, and the ANCC Pathway to Excellence framework describes under Support. Before any finding reaches a leader, a credentialed nursing professional development expert has reviewed it, written the conversation guide, and sorted out what matters for that unit, so the leader's thirty minutes go to preparing a supportive conversation with the nurse.

About thirty minutes a month of review time, plus the conversations themselves. Each month a credentialed nursing professional development expert sits down with a unit’s leaders, in person or virtually, and walks through the report: which nurses would benefit from a conversation, what the numbers show about each, and how to open it. The report and the conversation guide arrive complete; there is nothing for leaders to pull, compile, or check between sessions. The conversations that follow are typically about fifteen minutes with each nurse on the list, time leaders would spend with those nurses anyway, now earlier and with something objective in hand.

Between sessions, the expert is a call away. The CNO receives a unit-level summary each month and a conversation each quarter on what is working, what may be structural, and how to help nursing leaders grow.

CareEffects begins with a historical extract of one or two years, two where it is readily available, then a scheduled monthly refresh. Both draw on three data feeds the hospital already has: ADT, eMAR, and basic workforce records for direct care nurses (role, unit, hire date, seniority, separation date if applicable). Indicator Sciences provides the specification and works with the hospital's IT team on the historical reports, the monthly update, and an automated, encrypted SFTP transfer. IT effort is concentrated in the first weeks and is small once the transfer is running.

The first report follows about thirty days after the data arrives in the specified form. Nothing is installed at the hospital and nothing is integrated with its systems; the analysis runs in Indicator Sciences' environment, and reports are delivered as documents accessed through a secure portal.

Identified data, under a Business Associate Agreement executed before any transfer. The three feeds contain protected health information, so Indicator Sciences operates as a HIPAA business associate with a written Security and Privacy program and a designated security officer. Encrypted feeds are held only in Indicator Sciences' own cloud environment, itself covered by a BAA, and do not leave it.

Analysis runs on de-identified extracts: patient identifiers are removed and nurse identifiers are coded before any data reaches the modeling environment. Delivered reports contain no PHI. They name nurses to their own unit leaders, which is the purpose of the service, and nothing else about a patient. Retention and return of data at the end of an agreement are set in the agreement itself.

Yes, but never on protected health information and not to generate findings. The findings in every CareEffects report come from specified statistical models run by the Indicator Sciences science team; no generative AI produces a finding or makes a decision about a nurse. A commercial enterprise AI service, under contract terms that prohibit training on client data, manages the software process that assembles the monthly report documents under operator supervision. It works only with the statistical model outputs and limited workforce information, such as nurse names, for formatting. It has no access to patient data of any kind. Every report is then reviewed by a physician scientist and a doctorally prepared nurse before it reaches a nurse leader.

EMR analytics describe the work: census, throughput, documentation, medication timing. CareEffects uses those same records to describe the nurse's month: how heavy their assignments have been, how much help they have given and received when it was needed, how much work they have handed forward, and how that compares with peers on the same unit and shift with a comparable patient mix, over months rather than days. An EMR dashboard is built to be read by whoever opens it. A CareEffects report is read first by a credentialed nursing professional development expert, who then sits down with the unit leader. 

The CareEffects difference is in the methodology that recovers the indicators of strain from patterns no EHR field records directly, in how those indicators are context-adjusted for the conditions each nurse actually worked in, and in the nurse expert whose peer-to-peer review lets nurse leaders move directly from the analysis to helpful action.

By comparing each nurse with peers who worked under the same conditions, adjusted for the clinical context each of them was in, every four hours on every shift. A nurse on a short-staffed ICU night shift and a nurse on a fully staffed med-surg day shift are doing different work, and a comparison that ignores that would be wrong about both. Every Strain Score is therefore adjusted for unit, shift, and patient mix, so that a high score means more strain than peers in the same circumstances, not a harder unit.

The method is fixed-effects panel modeling, a standard approach in econometrics and health services research for separating a person's pattern from the setting they work in. It is fully specified and reviewable; no machine learning or generative AI produces a finding. The score also responds to sustained patterns rather than single weeks. A hard stretch does not move it; months of carrying more than peers do. That is what lets a leader act on it without second-guessing.

In hospitals from under 100 to more than 500 beds. The longest-running is Troy Regional Medical Center, a 97-bed Chartis Top 100 Community Hospital in Troy, Alabama, where CareEffects has been part of nursing leadership practice for three years and is renewed for three more. Over that time Troy's CNO credits the service with experienced nurses remaining on staff and smoother transitions for newer nurses, and Troy's HCAHPS Overall Safety score climbed 20 points in the three quarters after Strain Score reporting to leaders began.

Forrest General Hospital, the 547-bed flagship of the Forrest Health system in Hattiesburg, Mississippi, is launching CareEffects facility-wide in September 2026 following a successful 90-day pilot on multiple inpatient units. "Our leaders immediately recognized their teams in the analysis," said Heather Keys, MSN, RN, Executive Director of Nursing Services at Forrest General Hospital. "It helped them proactively identify nurses who quietly needed support and nurses whose work deserved recognition."

Nurse leaders using CareEffects say it strengthens their work with their teams and gives them confidence in how they lead. Leaders describe the first reports as confirming much of what they had sensed about their team, and that confirmation is what gives them confidence to act. From there the change is in the conversations: leaders ask more open questions, listen longer before offering a fix, and find that nurses often name what they need when given the room. Because the reports show strengths as well as strain, development is planned around what a nurse does well, not only what is hard. Each conversation is one nurse and one leader, and the benefit runs both ways: the nurse is supported before strain becomes a decision to leave, the leader learns something about the unit no report alone could show, and months of those well-chosen conversations are what improve a unit's working environment.

Indicator Sciences does not yet publish a turnover reduction figure; the retention record at each hospital is reviewed with its CNO. For scale, NSI's 2026 report puts the cost of each RN turnover at $60,090 and the annual cost or saving of a one-point change in RN turnover at about $295,000 for the average hospital.