Challenges and Directions for Nursing in the Pay-for-Performance Movement

Pay-for-performance (P4P) drives improvements in the quality of care by aligning desired outcomes and care processes with reimbursement. Nursing care is central to preventing poor outcomes and ensuring optimal results in many different sectors of the health care system. This article attempts to trace the challenges and opportunities for the practice of nursing; the administration of nursing services; and the role of nursing in health policy as presented by P4P. The authors suggest four ways that health care providers can prepare for P4P. These include:

  1. Investing in information technology;
  2. Developing an effective performance management system;
  3. Creating mechanisms for practice improvement once performance and care issues have been identified;
  4. Ensuring robust research capacity that will allow data to be analyzed and considered within a broader context than just P4P indicators. (For example, researchers should also take into account an organization’s mission and long-range vision and priorities.)

To date, nurses have been relatively silent about P4P, which may be because they are nervous about its implementation. The impacts of this policy are unknown and are likely to be indirect. In the end, however, the authors suggest that P4P may help nurses to solidify their position in the health care profession.