Date of Award

Summer 8-2018

Document Type


Degree Name

Doctor of Philosophy (PhD)



First Advisor

Alex Heckert, Ph.D.

Second Advisor

Beth Mabry, Ph.D.

Third Advisor

Brandon Vick, Ph.D.


This study was performed in order to determine the impact of nursing attitudes towards Pay -For -Performance (P4P) Initiatives. P4P often requires specific, defined steps be taken during the care of a patient, and compliance with the defined steps impacts an organization’s quality score card and reimbursement. While the P4P requirements meet generally accepted clinical practice guidelines, this project sought to determine whether the mandatory nature of the requirements impacted nursing autonomy, role conflict, burnout, and job satisfaction.

Performance of this study included the creation of three scales to measure nursing attitude towards P4P: a P4P Quality Scale; a P4P Reporting Scale; and a P4P Cynicism Scale. The data showed that these three P4P Attitudinal factors did affect autonomy, role conflict, burnout, and job satisfaction. The study provides health care organizations with insight into how P4P impacts nurses and suggest that nursing buy-in for P4P initiatives may be an important nurse retention tool.