December 2009

Grant Results


As noted in Policy, Politics, & Nursing Practice (Vol. 9, No. 2), historically, the economic value that nursing brings to the patient care process has not been recognized or quantified. Improving the quality of nursing care through work environment changes or increases in staffing is viewed by many as an added cost, but the benefits in terms of money saved through improved nursing satisfaction and patient outcomes are not considered.

In 2007, the Robert Wood Johnson Foundation (RWJF) and the Rutgers Center for State Health Policy at Rutgers, The State University, co-sponsored a conference that brought together a diverse, multidisciplinary group of health care leaders to explore the issues surrounding reimbursement for quality nursing care. The conference was the first formal national policy meeting on the topic of nurses' role in the evolving pay-for-performance environment.

Key Results

  • The "Economics of Nursing Invitational Conference: Paying for Quality Nursing Care" was held at RWJF headquarters in Princeton, N.J., on June 13–14, 2007. The conference addressed the following key issues:
    • How can a "business case" be made for improving and maintaining high-quality nursing care?
    • Should public and private reimbursement systems specifically account for the intensity of nursing care, and if so how?
    • What are the challenges and directions for nurses in a pay-for-performance environment?
    Approximately 70 people attended. Conference speakers, facilitators and attendees were leaders in nursing; economics; health care administration and funding; and provider, payer and consumer organizations.

    Conference participants made a number of recommendations for future research and work, including:
    • Research should be conducted on the impact of policy and payment changes on the nursing workforce and quality of care, and health care leaders should be educated and motivated to act on the basis of evidence in their management decisions.
    • Evidence regarding the value of nursing should be translated and disseminated, and the 15 National Quality Forum nursing-sensitive measures should be added to existing pay-for-performance measures. (A report on the consensus standards, which were established in 2004, is available online at the National Quality Forum's Web site.)
    • The health care system should be redesigned in order to rationalize payment systems so that:
      • Nurses have more direct time with patients.
      • Human/caring factors are increased.
      • The skills, knowledge and scope of practice of nurses are maximized.
      • Providers have incentives to make lasting quality improvements.
    Participants made individual pledges to continue work in the area. Some examples include:
    • Designing projects to develop evidence of how nursing care is associated with better outcomes for specific patient groups.
    • Beginning to address the economic value of nursing care by:
      • Revisiting the Cromwell study (Cromwell J and Price K. "The Sensitivity of DRG Weights to Variation in Nursing Intensity." Nursing Economics, 6[1], 18–26, 1988) to estimate the percentage of change in reimbursement by billing for nursing care, compared to reimbursement based on per diem room and board.
      • Defining nursing in the terms of costing, billing and reimbursement systems, rather than merely associating it with room and board.
      • Working with the American Organization of Nurse Executives and the American Nurses Association to incorporate the recommendations.
      • Writing one to two articles within one year.


  • An entire issue of the journal Policy, Politics, & Nursing Practice (9[2]: 2008, abstracts available online) is dedicated to the conference.
  • The Online Journal of Issues in Nursing published an article on the conference—"Legislative: Economics of Nursing Invitational Conference Addresses Quality and Payment Issues in Nursing Care"—by Lynn Unruh, professor in health services administration at the University of Central Florida, and Susan Hassmiller, an RWJF program officer (available online).

RWJF supported the conference through a solicited grant of $150,000.

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Conference on the economics of nursing care, quality and reimbursement


Rutgers, The State University, The Center for State Health Policy (New Brunswick,  NJ)

  • Amount: $ 150,000
    Dates: December 2006 to December 2007
    ID#:  059289


Lynn Y. Unruh, Ph.D., R.N., L.H.R.M.
(407) 823-4237

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Report prepared by: Robert Crum
Reviewed by: Marian Bass
Program Officer: Susan B. Hassmiller

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