Investigating the Deficiencies of the Nurse Salary Payment System in Public Hospitals of Iran and Providing Solutions: A Qualitative Study

Background and Objectives Shortcomings in the nurse salary payment system are among the major challenges for Iran’s healthcare system. This study aims to investigate the deficiencies of the nurse salary payment system in public hospitals of Iran and provide solutions. Methods This qualitative study was conducted from April 4 to August 1, 2023. The participants were 21 nurses working in hospitals affiliated with Qom University of Medical Sciences. The sampling method was purposeful and continued until data saturation was reached. Data were collected through semi-structured interviews and analyzed using Graneheim and Lundman’s content analysis approach. After transcribing the interviews, meaning units were extracted and coded, and the codes were categorized into subcategories and main categories. Results The main shortcomings of the nurse salary payment system included: Lack of a system to ensure nurses focus solely on nursing care and avoid undertaking medical responsibilities, lack of job classification for nurses working in different hospital departments, lack of individual classification for nurses based on their competencies and experience, lack of clarity of personal and departmental performance in salary and incentive payments, mixing the funds and liquidity required to pay salaries with other expenses of the hospital, insufficient financial resources (specific hospital revenue) to provide timely and adequate compensation for nursing services, failure to include key departmental and hospital performance indicators in nursing service compensation, lack of clear and tangible spiritual/non-monetary rewards for supporting nurses, lack of attention to the workplace of nurses in service compensation, and lack of attention to the nursing hierarchy (staff nurse, head nurse, supervisor) in service compensation. Conclusion Adjusting healthcare tariffs to reflect real costs, setting specific tariffs for nursing services, and incorporating key indicators such as quality of patient care, patient satisfaction, compliance with standards, and professional competence can help improve the nurse salary payment systems.