Inside a Massachusetts General Hospital intensive care unit, one bedside nurse noticed something others had overlooked.

Some mechanically ventilated patients were becoming increasingly agitated, and the default response was often more sedation. But the nurse suspected something deeper was contributing to their distress.

Rather than immediately turning to more medication, the nurse decided to test a different approach: a commercially available weighted blanket.

“That insight — grounded in empathy — shifted care from restraint to comfort,” says Hiyam Nadel, director of the Center for Innovations in Care Delivery at a hospital in Boston. “Early findings demonstrated improved sedation scores, reduced agitation, and earlier ventilator weaning, prompting a rethinking of humane, non-pharmacologic interventions in critical care.”

For Nadel, a former Johnson & Johnson Nurse Innovation Fellow, this story reflects a larger truth about health care: nurses are often the people closest to both the problems and the solutions.

Yet they are still too often viewed only through the lens of bedside care, rather than as innovators, strategists, and leaders capable of reshaping how health care is delivered.

“What’s most misunderstood is the cognitive complexity of nursing,” Nadel says. “Nurses are constantly synthesizing clinical data, anticipating risk, coordinating care, and making micro-decisions that prevent harm.”

At a time when health care systems are grappling with workforce shortages, burnout, and widening gaps in access to care, that untapped leadership capacity is more than just an opportunity for innovation — it’s essential to the future of health care itself.

The pressure points in health care

“The US and world face severe health workforce shortages, driven in part by high rates of burnout and low morale among nurses,” says Howard Reid, vice president of Global Impact and Health Equity at Johnson & Johnson.

In a survey of health workers conducted by Mental Health America with support from the Johnson & Johnson Foundation, 75 percent of respondents reported exhaustion and burnout, while 45 percent of nurse respondents said they were not getting enough emotional support.

To Reid, this issue is not simply a matter of staffing shortages; it’s also about recognizing the expertise nurses bring to the health care system.

“Nurses are leaders, innovators, and changemakers who make health care work,” Reid says. “They deliver 80 percent of hands-on care, giving them a unique perspective of the bottlenecks that keep patients from accessing care.”

That vantage point is critical. Nurses see, in real time, where systems fall short — from inefficient workflows to gaps in community-based care to inequities that make consistent treatment harder to access.

And when those same nurses are stretched too thin, the ripple effects are immediate.

“When nurses and other health professionals are overextended, patients can face long wait times, reduced one-to-one attention, and worse care outcomes,” Reid says.

Investing in nurses as leaders

For more than 125 years, Johnson & Johnson has invested in nursing as a core part of its approach to strengthening health care systems.

“We work to improve access to care for communities around the world, and to do that, we need to support the health care workers who deliver that care,” Reid says.

Today, that work is anchored in J&J CareCommunity, the company’s global social impact platform focused on strengthening the health care workforce and expanding access to quality care.

One of its flagship initiatives, the J&J Nurse Innovation Fellowship — developed in partnership with the University of Pennsylvania School of Nursing and Wharton Executive Education — equips senior nurse leaders with the tools to design and implement system-level change.

“My experience as a Johnson & Johnson Nurse Innovation Fellow was truly transformative,” says Nadel, who now guides new participants as a program coach. “Learning Design Thinking and Human-Centered Design provided a structured pathway to move from observation to solution, while ensuring both the patient and clinician remained at the center of the process.”

Just as importantly, she says, it reframed what leadership could look like.

“I used to think of leadership as operational excellence, ensuring things ran smoothly,” Nadel says. “Now, I see it as a system’s influence. Nurses are not just leaders within units — they are architects of care delivery systems.”

Turning insight into action

That shift — from observation to implementation — is where many health care systems have historically struggled.

Across Massachusetts, programs designed to close that gap are beginning to show results.

Through the Johnson & Johnson Foundation’s Nursing Workforce Solutions Program, powered by the American Association of Critical-Care Nurses, direct care nurses are gaining access to mentorship, leadership training, and tools to improve both working conditions and patient care.

At Tufts Medical Center in Boston, for example, nurses in a cardiac medical-surgical unit identified a persistent issue: patient mobility, which plays a critical role in recovery, was often deprioritized during busy shifts.

“Rather than accept this gap, the team advocated for the creation of a dedicated clinical role focused exclusively on patient ambulation and mobility progression,” Reid says.

Ten hospitals across Massachusetts are now participating in the program, reflecting a broader effort to embed nurse-led problem-solving into everyday care delivery.

At the same time, initiatives like NurseHack4Health are expanding what collaboration looks like — bringing nurses together with technologists, entrepreneurs, and industry leaders to pitch and ultimately accelerate and launch new ideas.

“Partnerships are essential to scaling innovation,” Nadel says. “Moving beyond hospital walls, these collaborations provide the resources, technical expertise, and validation needed to take ideas from local solutions to broader impact.”

Building toward a stronger system

Because nurses spend more time with patients than any other group in the health care system, they often have the clearest view of where access breaks down, especially for underserved communities.

“Nurse-led innovation is inherently aligned with equity because nurses witness disparities firsthand and design with empathy and inclusion at the core,” Nadel says.

In Massachusetts, that understanding is also shaping broader efforts to support the workforce itself. Programs like the Wellbeing First Champion Challenge are working to remove stigmatizing mental health questions from licensing and credentialing applications, helping ensure nurses can seek care without fear of professional consequences.

For Reid, these kinds of changes are necessary to unlock the full potential of the profession.

“While 60 percent of health care professionals are nurses, they make up less than 25 percent of leadership roles and just 5 percent of board seats,” he says. “We all need to rally to change these numbers because for health care to work, it takes nurses.”

For Nadel, the momentum already underway offers reason for optimism. More nurses are beginning to see themselves not only as caregivers, but as innovators capable of shaping the future of health care itself.

And as health care leaders continue searching for ways to strengthen workforce resilience, expand access to care, and improve patient outcomes, many of the solutions may already be standing at the bedside.