safety quality

199The Journal of Continuing Education in Nursing · Vol 50, No 5, 2019

The Quality and Safety Education for Nurses (QSEN) Collaboration formed in response to the call from the Institute of Medicine (now the Na-

tional Academy of Medicine) to improve the quality and safety of health care. That call to action identified five com- petencies required by all health care providers to transform the health care system, shifting the emphasis to include patient-centered care, teamwork and collaboration, use of evidence-based practice, quality improvement skills, and the integrated use of informatics in the care provided for patients (Institute of Medicine, 2003). Shortly afterward in 2005, the QSEN collaboration, funded by the Robert Wood Johnson Foundation and led by Linda Cronenwett, adopted those five requisites, added safety as a sixth com- petency, and the newly developed QSEN competencies became the blueprint for nurse educators working to re- channel the focus of formal nursing education programs (Cronenwett et al., 2007). The QSEN competencies pro- vided a clear structure designed to change the identity of nursing from that of a task-oriented role to one driven by the knowledge, skills, and attitudes (KSA) that underpin quality and safety concepts.

What followed was 13 years of transformation as the QSEN competencies were integrated into curriculum plans and accreditation standards for schools of nursing. QSEN provided resources and partnered with national nursing organizations to support the implementation of the competencies in nursing academia. In 2009, graduate- level QSEN competencies that demonstrated enhanced leadership KSAs were developed, but through all this, prac- tice was slow to embrace the QSEN competencies. Dur- ing this same time, practice saw the introduction of the Hospital Value-Based Purchasing program implemented by the Centers for Medicare & Medicaid Services (2018). This program reimbursed hospitals based on quality of care rather than quantity, thus driving efforts to improve quality and safety within health care systems. The Joint Commission Accreditation Standards supported hospitals in meeting the regulatory requirements and Magnet® stan-

dards drove excellence. Through it all, the aims have always been congruent between nursing practice and academia, but the two have not always shared a common language or understanding.

The work of Lyle-Edrosolo and Waxman (2016) has been significant in bridging academia and practice. Us- ing crosswalk methodology, they aligned the six QSEN competencies, the Magnet® standards, and the Joint Com- mission Accreditation Standards. This work demonstrates the relationship among these three driving forces and how nursing education framed in quality and safety aligns with expectations for excellence in nursing practice. Although the QSEN competencies were originally designed for nurs- ing education, this work validates the QSEN competencies as an effective framework to drive excellence and buttress the lifelong learning required by nursing professionals to ensure that the best care is provided to those who access the health care system.

Nurses are the linchpin in achieving quality and safety outcomes, and they are frequently viewed as the last de- fense between the patient and potential errors (Sherwood & Zomorodi, 2014). In order to champion for safer health care for patients and to make an appreciable difference, nurses need to be informed and educated about quality and safety competencies (Sherwood & Zomorodi, 2014). QSEN competencies serve as an appropriate framework for education to address common issues confronting nurs- ing practice, such as medication errors, pressure injuries, and falls.

Why Quality and Safety Education for Nurses (QSEN) Matters in Practice

guest editorial

Dr. Altmiller is Professor, Director of Quality and Safety Education for Nurses (QSEN) Institute Regional Center at The College of New Jersey, Ewing, New Jersey; and Ms. Hopkins-Pepe is Director, Nursing Education and Professional Development, Einstein Healthcare Network, Philadelphia, Pennsylvania.

The authors have disclosed no potential conflicts of interest, financial or otherwise.

Address correspondence to Gerry Altmiller, EdD, APRN, ACNS-BC, FAAN, Professor, Director of Quality and Safety Education for Nurses (QSEN) Institute Regional Center at The College of New Jersey, 2000 Pen- nington Road, Ewing, NJ 08628; e-mail: [email protected].

doi:10.3928/00220124-20190416-04

Authors: Gerry Altmiller, EdD, APRN, ACNS-BC, FAAN; and Loraine Hopkins-Pepe, MSN, RN, CCRN-K

200 Copyright © SLACK Incorporated

Continuing education and professional development educators play a vital role in enhancing quality and safe- ty in the practice setting. To improve care delivery and achieve quality and safety goals, continuing education pro- grams for nurses must be transformed to include expanded content focused on quality and safety competencies (Sher- wood, 2017). Integrating the QSEN competencies into educational initiatives provides a standardized structure for content development and clearly delineates objectives to enhance the clarity of the material delivered. The QSEN competencies provide an effective foundation for nurses to influence and promote high-quality safe care.

QSEN competencies have served as the underpinning of transition-to-practice programs but why not as the frame- work for continuing education? Integrating the QSEN competencies enables continuing education and profes- sional development educators to emphasize the “why” behind nursing interventions while also highlighting the evidence driving care. Additionally, framing educational offerings in the QSEN competencies allows all educators to promote the universal language of quality and safety.

Finally, and perhaps most significantly, integrating the QSEN competencies into practice-based education pro- grams challenges educators to update and revitalize course content. Continuing education and professional develop- ment educators are often tasked with repeatedly teaching the same required courses containing content that becomes stagnant over time. By critically evaluating existing courses and revising them to integrate the QSEN competencies, these educators may begin teaching from a different lens, shifting their focus from teaching tasks to teaching concepts about how to influence and promote high-quality safe care.

Continuing education and professional development edu- cators are influential in enhancing the quality and safety of care delivery, and The Journal of Continuing Education in Nursing will support QSEN competency implementa- tion in practice through the Teaching Tips column, begin- ning with this issue, by sharing strategies and ideas with educators so that they may perform this work effectively. Reframing continuing education programs in the QSEN competencies supports the work of continuing education and professional development educators as they work to better highlight the critical impact of the nursing profes- sion on quality care and patient outcomes.

REfERENcES Center for Medicare & Medicaid Services. (2018). Hospital value-based

purchasing. Retrieved from https://www.cms.gov/Medicare/Quality- Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/ HVBP/Hospital-Value-Based-Purchasing.html

Cronenwett, L., Sherwood, G., Barnsteiner, J., Disch, J., Johnson, J., Mitchell, P., . . . & Warren, J. (2007). Quality and safety education for nurses. Nursing Outlook, 55, 122-131.

Institute of Medicine. (2003). Health professions education: A bridge to quality. Washington, DC: National Academies Press.

Lyle-Eldrosolo, G.L., & Waxman, K.T. (2016). Aligning healthcare safety and quality competencies: Quality and Safety Education for Nurses (QSEN), The Joint Commission, and American Nurses Credential- ing Center (ANCC) Magnet® Standards Crosswalk. Nurse Leader, 14, 70-75.

Sherwood, G. (2017). Driving forces for quality and safety: Changing mindsets to improve health care. In G. Sherwood & J. Barnsteiner (Eds.), Quality and safety in nursing: A competency approach to improv- ing outcomes (2nd ed., pp. 1-20). Hoboken, NJ: Wiley Blackwell.

Sherwood, G., & Zomorodi, M. (2014). A new mindset for quality and safety: The QSEN competencies redefine nurses’ roles in practice. Ne- phrology Nursing Journal, 41, 15-22.

Editor’s Note: This special guest editorial is presented as a beginning to a series in the Teaching Tips column that focuses on QSEN (Quality and Safety Education for Nurses). This new emphasis is designed to support nurses in practice as they enrich their knowledge, skills, and attitudes in addressing quality and safety issues.

As The Journal of Continuing Education in Nursing celebrates our next half-century of editorial excellence, we welcome manuscripts that describe the ways continuing education/professional development educators prepare nurses with competencies for ensuring quality and safety in nursing care and demonstrate the link to improved patient outcomes.

~ Patricia S. Yoder-Wise, RN, EdD, NEA-BC, ANEF, FANOL, FAAN

Reproduced with permission of copyright owner. Further reproduction prohibited without permission.

Assessment 01 – Enhancing Quality and Safety For this assessment, you will develop a 3–5-page paper that examines a safety quality issue in a health care setting. You will analyze the issue and examine potential evidence-based and best-practice solutions from the literature as well as the role of nurses and other stakeholders in addressing the issue.

Before you complete the instructions detailed in the courseroom, first select one of the safety quality issues below to analyze for this assessment. After you have selected one of the issues from the list below, return to the detailed instructions in the courseroom to complete your assessment.

● LGBTQ+ and Transgender-Specific Care Needs: LGBTQ+ and transgender individuals often face unique health challenges and disparities. A lack of knowledge or sensitivity toward their specific needs can lead to inadequate care, discrimination, and even avoidable health complications. Here's why addressing understanding and addressing the specific needs of these populations is essential:

- Affirmation and Respect: Using correct pronouns, names, and understanding the specific health needs of transgender and LGBTQ+ individuals can create an environment of respect and affirmation. This respect is foundational to building trust and ensuring that patients feel safe and understood in healthcare settings.

- Mental and Emotional Well-being: Due to societal stigmas and discrimination, LGBTQ+ and transgender individuals may face higher rates of anxiety, depression, and other mental health challenges. Being sensitive to these needs and providing appropriate support is crucial for holistic care.

- Addressing Health Disparities: LGBTQ+ and transgender individuals might be at higher risk for certain health issues. For instance, transgender women might be at a higher risk for HIV/AIDS, while lesbian and bisexual women may be at a higher risk for certain cancers. Knowledge of these disparities can guide preventive care, screenings, and early interventions.

- Gender-Affirming Care: Transgender individuals might seek various medical interventions as part of their transition, such as hormone therapies or surgeries. Understanding the medical and emotional aspects of these treatments is crucial for providing comprehensive care.

- Avoiding Discrimination: Discrimination or bias, whether overt or subtle, can deter LGBTQ+ and transgender individuals from seeking care, adhering to medical advice, or disclosing essential information about their health. Ensuring an inclusive and non-discriminatory environment is vital for effective care delivery.

- Sexual and Reproductive Health: LGBTQ+ individuals often face barriers in accessing sexual and reproductive health services. Being knowledgeable and non-judgmental about diverse sexual orientations and practices can lead to better patient education and care in this domain.

- Social and Community Support: Recognizing the importance of community and chosen family for many LGBTQ+ and transgender individuals can guide care plans, especially when considering mental health support or discharge planning.

- Legal and Ethical Considerations: In many regions, there are legal protections in place to ensure non-discrimination based on sexual orientation or gender identity. Being aware of these protections is not only a legal obligation but an ethical one, ensuring that all patients receive equitable care.

● Patient Identification Errors in Healthcare: Ensuring the correct identification of patients is a foundational aspect of safe healthcare delivery. When errors occur in this basic step, the ripple effects can be catastrophic. Here's why understanding and preventing patient identification errors is essential:

- Patient Safety and Well-being: The most immediate and alarming consequence of patient identification errors is the potential harm to the patient. Administering the wrong medication, performing surgery on the wrong site, or providing inappropriate treatments can lead to severe complications, prolonged recovery, or even death.

- Loss of Trust: When patients or their families experience or witness identification errors, their trust in the healthcare system can be severely eroded. This loss of trust can make patients hesitant to seek care in the future or follow medical advice, potentially compromising their health.

- Professional Reputation: For healthcare professionals, being involved in an identification error can have lasting implications on their reputation. Such errors can lead to disciplinary actions, loss of licensure, or legal consequences.

- Legal and Financial Implications: Patient identification errors can result in lawsuits, leading to significant financial penalties for healthcare institutions. Beyond the direct costs of litigation, there's the potential for increased insurance premiums and the costs associated with implementing corrective measures

- Operational Disruptions: Identification errors can disrupt the normal flow of operations in a healthcare setting. They may necessitate additional tests, procedures, or interventions to correct the error, leading to delays and inefficiencies.

- Emotional Toll on Healthcare Providers: Realizing that one has been involved in an identification error can be emotionally devastating for healthcare providers. Feelings of guilt, anxiety, and doubt can lead to burnout and may even cause some professionals to question their career choice.

- Increased Healthcare Costs: Beyond the direct costs associated with correcting the error, there are indirect costs to consider. These might include extended hospital stays, additional treatments, and the long-term care needs of patients who experience complications due to the error.

- Regulatory and Accreditation Implications: Healthcare facilities are subject to regulations and standards set by accrediting bodies. Identification errors can lead to penalties, increased scrutiny, and potential challenges in maintaining accreditation.

199The Journal of Continuing Education in Nursing · Vol 50, No 5, 2019

The Quality and Safety Education for Nurses (QSEN) Collaboration formed in response to the call from the Institute of Medicine (now the Na-

tional Academy of Medicine) to improve the quality and safety of health care. That call to action identified five com- petencies required by all health care providers to transform the health care system, shifting the emphasis to include patient-centered care, teamwork and collaboration, use of evidence-based practice, quality improvement skills, and the integrated use of informatics in the care provided for patients (Institute of Medicine, 2003). Shortly afterward in 2005, the QSEN collaboration, funded by the Robert Wood Johnson Foundation and led by Linda Cronenwett, adopted those five requisites, added safety as a sixth com- petency, and the newly developed QSEN competencies became the blueprint for nurse educators working to re- channel the focus of formal nursing education programs (Cronenwett et al., 2007). The QSEN competencies pro- vided a clear structure designed to change the identity of nursing from that of a task-oriented role to one driven by the knowledge, skills, and attitudes (KSA) that underpin quality and safety concepts.

What followed was 13 years of transformation as the QSEN competencies were integrated into curriculum plans and accreditation standards for schools of nursing. QSEN provided resources and partnered with national nursing organizations to support the implementation of the competencies in nursing academia. In 2009, graduate- level QSEN competencies that demonstrated enhanced leadership KSAs were developed, but through all this, prac- tice was slow to embrace the QSEN competencies. Dur- ing this same time, practice saw the introduction of the Hospital Value-Based Purchasing program implemented by the Centers for Medicare & Medicaid Services (2018). This program reimbursed hospitals based on quality of care rather than quantity, thus driving efforts to improve quality and safety within health care systems. The Joint Commission Accreditation Standards supported hospitals in meeting the regulatory requirements and Magnet® stan-

dards drove excellence. Through it all, the aims have always been congruent between nursing practice and academia, but the two have not always shared a common language or understanding.

The work of Lyle-Edrosolo and Waxman (2016) has been significant in bridging academia and practice. Us- ing crosswalk methodology, they aligned the six QSEN competencies, the Magnet® standards, and the Joint Com- mission Accreditation Standards. This work demonstrates the relationship among these three driving forces and how nursing education framed in quality and safety aligns with expectations for excellence in nursing practice. Although the QSEN competencies were originally designed for nurs- ing education, this work validates the QSEN competencies as an effective framework to drive excellence and buttress the lifelong learning required by nursing professionals to ensure that the best care is provided to those who access the health care system.

Nurses are the linchpin in achieving quality and safety outcomes, and they are frequently viewed as the last de- fense between the patient and potential errors (Sherwood & Zomorodi, 2014). In order to champion for safer health care for patients and to make an appreciable difference, nurses need to be informed and educated about quality and safety competencies (Sherwood & Zomorodi, 2014). QSEN competencies serve as an appropriate framework for education to address common issues confronting nurs- ing practice, such as medication errors, pressure injuries, and falls.

Why Quality and Safety Education for Nurses (QSEN) Matters in Practice

guest editorial

Dr. Altmiller is Professor, Director of Quality and Safety Education for Nurses (QSEN) Institute Regional Center at The College of New Jersey, Ewing, New Jersey; and Ms. Hopkins-Pepe is Director, Nursing Education and Professional Development, Einstein Healthcare Network, Philadelphia, Pennsylvania.

The authors have disclosed no potential conflicts of interest, financial or otherwise.

Address correspondence to Gerry Altmiller, EdD, APRN, ACNS-BC, FAAN, Professor, Director of Quality and Safety Education for Nurses (QSEN) Institute Regional Center at The College of New Jersey, 2000 Pen- nington Road, Ewing, NJ 08628; e-mail: [email protected].

doi:10.3928/00220124-20190416-04

Authors: Gerry Altmiller, EdD, APRN, ACNS-BC, FAAN; and Loraine Hopkins-Pepe, MSN, RN, CCRN-K

200 Copyright © SLACK Incorporated

Continuing education and professional development educators play a vital role in enhancing quality and safe- ty in the practice setting. To improve care delivery and achieve quality and safety goals, continuing education pro- grams for nurses must be transformed to include expanded content focused on quality and safety competencies (Sher- wood, 2017). Integrating the QSEN competencies into educational initiatives provides a standardized structure for content development and clearly delineates objectives to enhance the clarity of the material delivered. The QSEN competencies provide an effective foundation for nurses to influence and promote high-quality safe care.

QSEN competencies have served as the underpinning of transition-to-practice programs but why not as the frame- work for continuing education? Integrating the QSEN competencies enables continuing education and profes- sional development educators to emphasize the “why” behind nursing interventions while also highlighting the evidence driving care. Additionally, framing educational offerings in the QSEN competencies allows all educators to promote the universal language of quality and safety.

Finally, and perhaps most significantly, integrating the QSEN competencies into practice-based education pro- grams challenges educators to update and revitalize course content. Continuing education and professional develop- ment educators are often tasked with repeatedly teaching the same required courses containing content that becomes stagnant over time. By critically evaluating existing courses and revising them to integrate the QSEN competencies, these educators may begin teaching from a different lens, shifting their focus from teaching tasks to teaching concepts about how to influence and promote high-quality safe care.

Continuing education and professional development edu- cators are influential in enhancing the quality and safety of care delivery, and The Journal of Continuing Education in Nursing will support QSEN competency implementa- tion in practice through the Teaching Tips column, begin- ning with this issue, by sharing strategies and ideas with educators so that they may perform this work effectively. Reframing continuing education programs in the QSEN competencies supports the work of continuing education and professional development educators as they work to better highlight the critical impact of the nursing profes- sion on quality care and patient outcomes.

REfERENcES Center for Medicare & Medicaid Services. (2018). Hospital value-based

purchasing. Retrieved from https://www.cms.gov/Medicare/Quality- Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/ HVBP/Hospital-Value-Based-Purchasing.html

Cronenwett, L., Sherwood, G., Barnsteiner, J., Disch, J., Johnson, J., Mitchell, P., . . . & Warren, J. (2007). Quality and safety education for nurses. Nursing Outlook, 55, 122-131.

Institute of Medicine. (2003). Health professions education: A bridge to quality. Washington, DC: National Academies Press.

Lyle-Eldrosolo, G.L., & Waxman, K.T. (2016). Aligning healthcare safety and quality competencies: Quality and Safety Education for Nurses (QSEN), The Joint Commission, and American Nurses Credential- ing Center (ANCC) Magnet® Standards Crosswalk. Nurse Leader, 14, 70-75.

Sherwood, G. (2017). Driving forces for quality and safety: Changing mindsets to improve health care. In G. Sherwood & J. Barnsteiner (Eds.), Quality and safety in nursing: A competency approach to improv- ing outcomes (2nd ed., pp. 1-20). Hoboken, NJ: Wiley Blackwell.

Sherwood, G., & Zomorodi, M. (2014). A new mindset for quality and safety: The QSEN competencies redefine nurses’ roles in practice. Ne- phrology Nursing Journal, 41, 15-22.

Editor’s Note: This special guest editorial is presented as a beginning to a series in the Teaching Tips column that focuses on QSEN (Quality and Safety Education for Nurses). This new emphasis is designed to support nurses in practice as they enrich their knowledge, skills, and attitudes in addressing quality and safety issues.

As The Journal of Continuing Education in Nursing celebrates our next half-century of editorial excellence, we welcome manuscripts that describe the ways continuing education/professional development educators prepare nurses with competencies for ensuring quality and safety in nursing care and demonstrate the link to improved patient outcomes.

~ Patricia S. Yoder-Wise, RN, EdD, NEA-BC, ANEF, FANOL, FAAN

Reproduced with permission of copyright owner. Further reproduction prohibited without permission.