Challenges and Directions for Nursing in the Pay-for-Performance Movement

Sean P. Clarke, Carol Raphael, Joanne Disch

Research output: Contribution to journalArticlepeer-review


Pay-for-performance (P4P) initiatives attempt to drive quality of care by aligning desired care processes and outcomes with reimbursement. P4P schemes have emerged at a time of great concern about safety and quality in health care and in the face of a growing nurse shortage. This article discusses the state of the literature linking structures for providing nursing care, measures of process heavily favored in P4P initiatives, and patient outcomes and outlines how P4P is expected to affect nursing practice. It also presents directions for managing practice settings to cope with P4P and for steering nursing's involvement in this area of health policy. As implementation broadens, it remains to be seen whether unintended consequences emerge or whether nurses are successful in using the programs and the data sets that result from them to justify investments in nursing services and solidify the profession's position.

Original languageEnglish (US)
Pages (from-to)127-134
Number of pages8
JournalPolicy, Politics, & Nursing Practice
Issue number2
StatePublished - May 2008


  • P4P
  • nurse practice environments
  • nurse staffing
  • pay for performance
  • quality improvement

ASJC Scopus subject areas

  • Leadership and Management
  • Issues, ethics and legal aspects


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