I'm writing in response to the article entitled "Pay-for-performance: Will it work?" in the July 2006 issue. The article presents the overwhelming need for change in our healthcare system. Education is going to be a pivotal key to success in the shift toward evidence-based medicine (EBM). The author suggests adding a course in EBM to the current curriculum in medical schools. I feel that this would also be beneficial in nursing schools if we're all to work together to bring forth this change, and as nurse leaders, take on the coaching role as presented by the author.

I'm currently enrolled in the clinical nurse leader program at Florida Atlantic University, and part of my practicum hours included time spent in the case management and utilization departments. What an eye-opening experience. I don't think most nurses know or understand the payer process involved with healthcare and the importance of such measures as documentation in getting reimbursement. Having this knowledge will be necessary so that physicians and nurses will be able to work as a team to be successful in improving patient outcomes.

This article is inspiring for my future role as a clinical nurse leader. It demonstrates the need for education, which I believe will be a large component of this new role. I've discovered in my current practice that both physicians and nurses aren't aware of the shift to EBM and payment for evidence-based quality measures. I look forward to being a part of this movement and improving patient outcomes in the facility in which I'm employed. I hope to be as successful as the hospitals participating in the CMS/Premier Demonstration Project and welcome future articles that will aid in that success.

Susan L. Clark, RN, BSN

Stuart, Fla.