Hardwiring Nursing Quality

Nursing quality is rapidly moving to center stage in health care. On October 1, 2008, reimbursement from the Centers for Medicaid and Medicare Services (CMS) made a dramatic change in the pay for performance schema of recent years. The carrot replaced the stick, and hospitals began declining to reimburse for eight hospital-acquired conditions (HAC), most of which have implications for nursing practice.

Among the eight HACs, quality issues such as pressure ulcers, falls with injury, and catheter-associated urinary tract infection are readily identified as nursing-sensitive quality indicators. Maas, Johnson, and Moorehead first coined the term “nursing sensitive indicators” in 1996 to denote patient outcomes affected in large part by nursing practice.¹ In 2004, the American Nurses Association recognized nursing-sensitive quality indicators as “measures and indicators that reflect the impact of nursing action on outcomes.”²