RWJF-Funded Study Raises Concerns About Effectiveness of Performance-Based Incentives for Nurses
A new study led by Ellen Kurtzman, R.N., M.P.H., F.A.A.N., assistant research professor at the George Washington University School of Nursing, reveals that hospital leaders and unit nurses are concerned that financial incentives for nurses who meet quality care goals may weaken the nursing workforce. The study is part of a larger, two-year research project to examine the impact on nurses of performance measurement, public reporting and performance-based financial payment policies.
Kurtzman and colleagues interviewed hospital leaders and unit nurses at 25 hospitals in mid-2008, to explore their views on the effect of performance-based incentives. Interviewees expressed favorable impressions of such policies’ impact on quality and safety. But they said they worry about whether incentives would increase both the burden and the blame for nurses without corresponding improvements in staffing levels, work environment, salaries or turnover.
Study authors recommended that policy-makers redesign hospital incentives to reward teamwork, that they involve nursing leaders in the design of future incentive policies and that they invest in implementation support.
The study was funded by the Robert Wood Johnson Foundation (RWJF) and published in the February issue of Health Affairs.
Nursing Employment Trends: The View from Cincinnati
A nursing supply-and-demand study conducted in Cincinnati, Ohio, finds that area hospitals are placing greater emphasis on hiring nurses with advanced degrees, and that new nursing school graduates are increasingly finding jobs outside of hospitals.
The study by the Greater Cincinnati Health Council found that the number of nurses with bachelor's degrees increased to 41 percent in 2010, up from 33 percent in 2008, while the number of nurses with master's degrees rose to 12 percent in 2010, up from 3 percent in 2008. "Hospitals in our region are beginning to demand more specific degree requirements in order to adapt to changing health care trends and meet changing patient care needs," said Mary Duffey, executive director of the Council's Health Care Workforce Center.
Another finding from the research: The percentage of new graduates from area nursing schools who took jobs outside of hospitals increased dramatically. In 2008, data from nursing schools in the area showed that nearly all new graduates (99 percent) who took jobs in the Cincinnati area were hired by hospitals. In 2010, that percentage dipped to 80 percent, with non-hospital health care settings gaining ground.
Long Shifts for Nurses Linked to Increased Patient Mortality
Patient deaths from pneumonia and acute myocardial infarction are significantly more likely in hospitals where nurses work long hours, according to a study by a team of University of Maryland School of Nursing researchers, funded by the National Council of State Nursing Boards.
University of Maryland Professor Alison Trinkoff, Sc.D., M.P.H., R.N., F.A.A.N., and co-authors correlated patient outcome and staffing information from 71 acute care hospitals in Illinois and North Carolina, with survey responses from 633 randomly selected nurses who worked in the same hospitals. In an article in the January/February issue of Nursing Research, they report that pneumonia deaths “were significantly more likely in hospitals where nurses reported schedules with long work hours,” as measured by the number of hours in a work day. Similarly, deaths from acute myocardial infarction were more likely in hospitals where nurses had a high “weekly burden”—as measured either by the number of hours worked consecutively or the total number of hours worked per week.
"Alertness and vigilance required for providing good nursing care depend upon having an adequate duration of quality sleep and rest," said Trinkoff, "and long work hours can impact the quality of nursing care and can increase the potential for error.”
The authors conclude that hospital “policies should be refocused on the work schedule as a means of improving patient care and nursing working conditions.”