Pay for performance in hospitals: implications for nurses and nursing care

Area of Science:

• Healthcare Management
• Nursing Practice
• Quality Improvement

Background:

• Pay-for-performance (P4P) programs are increasingly influencing healthcare quality management.
• Many P4P measures focus on chronic diseases, often managed by interdisciplinary teams including nurses.
• The impact of P4P on nursing care and labor has been under-examined compared to physician impact.

Purpose of the Study:

• To highlight the need for nursing leadership to address the implications of P4P on nursing performance.
• To examine the influence of P4P on nursing labor, processes, and patient outcomes in acute care.
• To identify strategies for nursing to effectively contribute to organizational P4P goals.

Main Methods:

• Review of current trends in pay-for-performance initiatives.
• Analysis of the structure of nursing care, including staffing and skill mix.
• Examination of nursing processes and their influence on patient outcomes within acute care settings.

Main Results:

• P4P measures are evolving to include patient outcomes, necessitating greater attention to nursing' role.
• The impact of P4P on nursing staff, processes, and patient outcomes requires further study.
• Nursing leadership must proactively address P4P's effects on nursing performance and contributions.

Conclusions:

• Nursing leadership must develop strategies to manage P4P's impact on nursing performance measures.
• Strategies should include education, documentation, team collaboration, and care patterns to support nurses.
• Adapting to P4P standards is crucial for nursing to contribute to organizational quality goals and patient outcomes.