How would you like to be paid based on your nursing performance? This is a question that was recently explored and was not met with positive results. Ellen Kurtzman, RN, MPH, FAAN, assistant research professor in the GW School of Nursing recently published her findings in Health Affairs magazine.
“This research has given us an unprecedented opportunity to be in the field and interview hospital leaders and unit nurses about the impact of performance-based incentives,” said Kurtzman. “While nurses are not typically considered in the design of such incentive programs, our study indicates that they influence the implementation of such policies and are impacted—in some cases negatively—by these programs. Overall, interviewees reported favorable effects of financial incentives on patients but viewed these emerging policies as burdensome to nurses and having little positive effect on improving nurse staffing or turnover.”
About ten years ago when I was teaching high school history, this issue came up as an incentive to raise state test scores for students. Much of the same results were found; I could do everything in my power to prepare my students for success, but there are so many influences that are beyond my control: parent attitudes, their home environment, and funding in low income areas deny some of the advantages that wealthier areas have. Much of the same issues plague those working with patients: those nurses working in Oakland have a different clientele and medical issues than those who are working in Walnut Creek. Medical facilities with higher funding have more access to better technology and more staffing.
Another issue I foresee would be who would evaluate the nurses’ performances? Would it be based on mortality? Would patients fill out forms? I’m sure one nurse with a patient who got well would be rated higher than a patient who is still battling illness. There are too many emotions and variants to evaluate a medical professional.
Currently, there are incentives to pursue higher levels of education such as LVNs to get their RN degrees or RN’s to get their BSN degrees. There are also opportunities to earn more for bilingual nurses or those with special skills.
I think there is a need for performance evaluations, but pay incentives are clearly not a way to improve the medical profession.
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