Specifying and standardizing performance measures for use at a national level: implications for nursing-sensitive care performance measures.

This article explicates a comprehensive process for identifying, specifying, testing, and implementing nationally standardized performance measures. A growing body of research ties nurse staffing to patient outcomes, reinforcing the important role of nursing in the delivery of safe, efficacious health care. The Joint Commission has developed a multistep process to identify robust sets of evidence-based measures that includes a review of the evidence, expert advisory panel guidance, use of established criteria, public input and comment, and multistage field testing before implementation. This proven approach to the establishment of performance metrics is applicable to the identification and implementation of nurse-sensitive workforce measures. These metrics can then be used by providers to support performance improvement activities by health care stakeholders to monitor nurse staffing-related issues, and by researchers to better understand the relationship between staffing effectiveness and patient safety, and the quality of health care.