Moving healthcare quality forward with nursing-sensitive value-based purchasing

J Nurs Scholarsh. 2012 Dec;44(4):385-95. doi: 10.1111/j.1547-5069.2012.01469.x. Epub 2012 Oct 15.


Purpose: To underscore the need for health system reform and emphasize nursing measures as a key component in our healthcare reimbursement system.

Design and methods: Nursing-sensitive value-based purchasing (NSVBP) has been proposed as an initiative that would help to promote optimal staffing and practice environment through financial rewards and transparency of structure, process, and patient outcome measures. This article reviews the medical, governmental, institutional, and lay literature regarding the necessity for, method of implementation of, and potential impact of NSVBP.

Findings: Research has shown that adverse events and mortality are highly dependent on nurse staffing levels and skill mix. The National Database of Nursing Quality Indicators (NDNQI), along with other well-developed indicators, can be used as nursing-sensitive measurements for value-based purchasing initiatives. Nursing-sensitive measures are an important component of value-based purchasing.

Conclusions: Value-based purchasing is in its infancy. Devising an effective system that recognizes and incorporates nursing measures will facilitate the success of this initiative. NSVBP needs to be designed and incentivized to decrease adverse events, hospital stays, and readmission rates, thereby decreasing societal healthcare costs.

Clinical relevance: NSVBP has the potential for improving the quality of nursing care by financially motivating hospitals to have an optimal nurse practice environment capable of producing optimal patient outcomes by aligning cost effectiveness for hospitals to that of the patient and society.

MeSH terms

  • Health Care Reform
  • Humans
  • Nursing Staff, Hospital / economics*
  • Nursing Staff, Hospital / supply & distribution*
  • Organizational Policy
  • Quality of Health Care / economics*
  • United States
  • Value-Based Purchasing*