Performance-Based Payment Incentives May Harm Nursing Conditions

Highly touted as a way in which to improve patient outcomes, pay-for-performance incentives have been gaining steam in hospitals nationwide. However, as reported on endnurse.com, a recent study published in Health Affairs suggests that linking reimbursement to quality of care goals could undermine the nursing workforce and shake up the nursing practice environment. The study, conducted by Ellen Kurtzman, RN, MPH, FAAN, assistant research professor in the GW School of Nursing, suggests that while payment incentives do have favorable effects on patient outcomes, they have little to no positive effect on nurse staffing and turnover rates.

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RWJF Study Suggests Strategies for Reducing Nurse Turnover

A new study by the Robert Wood Johnson Foundation (RWJF) proposes a series of strategies aimed at improving nurse retention, the Wichita Eagle reports. Coordinated by The Lewin Group, the Wisdom at Work study is based on seven case studies of health care and nonhealth care employers that have been recognized for their efforts to retain experienced workers, as well as on findings from 13 research projects conducted between January 2007 and December 2008 that evaluated various retention efforts in hospitals. Although the researchers were unable to identify a common strategy that improved retention at all of the evaluated institutions, they were able to identify several successful initiatives implemented at individual institutions. For example, Tucson, Ariz.-based Carondelet Health Network implemented a "snow bird" program, which allows R.N.s to work for three, six or nine months at a time, which presents an appealing option to R.N.s who reside in Tucson only during particular months of the year. The report also highlights a mentoring program at Virginia-based Bon Secours Richmond Health System that taps experienced R.N.s to provide clinical and leadership mentoring to new nurses. According to an RWJF release, the program has helped to reduce turnover among new nurses. In addition, the report profiles a continuing education opportunity offered by Pitt County Memorial Hospital in North Carolina that allows tenured nurses to participate in three-day off-site training sessions to learn how they can practice more effectively in the hospital environment. Another practice that seemingly bolstered nurse retention was providing nurses with a voice. For example, Scripps Health in San Diego created a "leadership cabinet" under which nurse leaders were invited to advise hospital administrators on important decisions and serve as a liaison to voice employee concerns. Meanwhile, the research projects revealed that nurse turnover rates improved in cases where employers took innovative approaches to staffing; offered employee health and wellness programs; and provided training and development opportunities for senior nurses. In addition, although ergonomic initiatives, such as safe patient handling programs, did not directly contribute to an overall decline in turnover rates, it did improve employee morale. Commenting on the report, RWJF Senior Adviser for Nursing Susan B. Hassmiller notes that "at a time when organizations everywhere are looking hard at their bottom lines, the 'Wisdom at Work' evaluations demonstrate the economic benefits of retaining experienced workers, which can improve productivity and workplace morale." (Shideler, Wichita Eagle, 7/29/09; RWJF release, 7/29/09; RWJF report, 7/29/09)

(c) RWJF, 2009

Study finds that work environment dissatisfaction causes nurse turnover

A study published in the July issue of Nursing Outlook suggests that dissatisfaction regarding work environment is a key driver of turnover among newly licensed R.N.s (NLRNs), Modern Healthcare reports. The study, which was funded by the Robert Wood Johnson Foundation, was based on survey responses gathered from 612 R.N.s practicing in 34 states and Washington, D.C., who had first passed the National Council Licensing Exam between six months and 18 months prior to completing the survey.

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INQRI Grantees Patti Hamilton and Gretchen Gemeinhardt are concerned about the impact of working environment on the quality of patient care and the effect on nurses. In their study, "The Effect of Off-peak Hospital Environments on Nurses' Work," the team is using an Institutional Ethnography (IE) to situate nursing in the center of an interdisciplinary approach to learn how and why off-peak work environments are different, and how they affect nurses' work and patient care. This project will provide researchers with insight into how to account for temporal variations in nurses' work environment when specifying causal models linking nursing care to patient outcomes. The project also will provide stakeholders with materials that help them identify, evaluate, and anticipate effects of initiatives to improve efficiency, effectiveness, quality and cost on nursing care provided during off-peak periods.

For more information, please check out their blog.