title: Performance-based payment incentives increase burden and blame for hospital nurses.
abstract: We interviewed hospital leaders and unit nurses in twenty-five hospitals between June and October 2008 to explore the effect of performance-based incentives. Interviewees expressed favorable impressions of the impact that incentive policies have on quality and safety. However, they raised concerns about the policies' effects on the nurse workforce. Their concerns included the belief that performance-based incentives would increase both the burden and the blame for nurses without corresponding improvements in staffing levels, work environment, salaries, or turnover. To maximize the intended policy impact without jeopardizing the workforce that holds the key to their adoption, we recommend that policy makers invest in implementation support, redesign hospital incentives to reward teamwork, and involve nursing leaders in the design of future incentive policies.
authors.affiliation: George Washington University School of Nursing, in Washington, DC., USA. sonetk@gwumc.edu
authors.forename: Ellen T
authors.initials: ET
authors.lastname: Kurtzman
authors.forename: Dennis
authors.initials: D
authors.lastname: O'Leary
authors.forename: Brenda H
authors.initials: BH
authors.lastname: Sheingold
authors.forename: Kelly J
authors.initials: KJ
authors.lastname: Devers
authors.forename: Ellen M
authors.initials: EM
authors.lastname: Dawson
authors.forename: Jean E
authors.initials: JE
authors.lastname: Johnson
mesh_terms: D000288:Administrative Personnel / Q000523:psychology*; D001291:Attitude of Health Personnel; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D009718:Nurse Administrators / Q000523:psychology* / Q000706:statistics & numerical data; D009741:Nursing Staff, Hospital / Q000523:psychology* / Q000706:statistics & numerical data; D009936:Organizational Innovation; D016134:Organizational Policy; D010563:Personnel Turnover; D011050:Policy Making; D011787:Quality of Health Care; D012052:Reimbursement, Incentive / Q000458:organization & administration*; D017751:Safety Management / Q000592:standards; D013192:Staff Development; D013647:Task Performance and Analysis