When we say the healthcare industry is always changing, at National Healthcare Institute we know we’re preaching to the choir.  One of today’s biggest challenges is the dichotomy of the need for more nurses, and yet the desire of top notch institutions to cut costs every which way they can – including nurses salaries.

One up and coming idea is the pay-for performance (also called “variable pay” or “profit-sharing” among other monikers) concept that is becoming more than just a trend.  The general idea is that nurses receive bonuses or pay increases if they can produce more effectively and increase patient satisfaction; in short your first have to do more for less.  The big question:  should nurses be subjected to compensatory salaries based on achievement?  Nursing is about healthcare first; the patient isn’t always going to be satisfied and as we know – the patient isn’t always going to get well.

What is clear – there are legal ramifications; nurses are obligated to follow the professional obligations of their healthcare institutions and what’s written in their state licensure requirements.  Pay for performance can also have a practical and ethical impact on your adherence to your code of ethics.  For example, an incentive to make more money should not imply you cut corners in patient care or try to “force” wellness on someone through possibly illegal practices (i.e., additional administration of undiagnosed medications).

If you work for an institution that is starting a pay for performance program, you may need to know your rights – contact a representative of your state labor board or speak with a legal employment professional about how such changes in your job would square with the NLRA (National Labor Relations Act).  At NHI we’d like to hear from you if you’ve been having concerns about such programs or even participate in one – give us your pros and cons.


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