Running head: QSEN 1

Quality and Safety Education for Nurses

Jazmine Randolph, Andrea Ritchie, Lindsey Rogers, Idalis Sanchez-Mclean & Olivia Savalle

Oakland University

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       Quality and Safety Education for Nurses (QSEN) is a project designed to empower

baccalaureate prepared nurses to apply basic goals of quality, safety, informatics, patient

centered care and evidence based practice into the healthcare environment. Each competency is

defined by specific targets for knowledge, skills and attitudes nurses should aspire to. The

purpose of this paper is to discover how QSEN competencies guide nursing interventions in a

simulated environment.

Overview of QSEN Competencies

 Patient centered care describes the ability to recognize the patient or designee as the

source of control and full partner in providing compassionate and coordinated care based on

respect for patient’s preferences, values, and needs (QSEN Institute, 2014). Nurses should

understand multiple aspects of patient centered care including communication, individual values,

coordination between different care delivery systems, and cultural diversity. Proficient skills for

a nurse to execute patient centered care involves the ability to infer individual patient preferences

and values through therapeutic communication (QSEN Institute, 2014). A nurse should be able

to effectively communicate these wishes to others members of the care team and identify barriers

to care that are a function of the individual’s cultural, lifestyle or health scenario. QSEN

guidelines recommends nurses should be able to communicate and advocate for patient needs at

varying levels of care and across transitions of care delivery systems (QSEN Institute, 2014).

Nursing attitudes to guide patient centered care should reflect ideas which value the patient

health experience as a function of their individual cultural and ethnic experience. Nurses who

approach the patient experience as a learning opportunity to improve advocacy are compliant

with QSEN guidelines for patient centered care.

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Teamwork and collaboration refers to the ability to function effectively within nursing

and inter-professional teams, fostering open communication, mutual respect, and shared

decision-making to achieve quality patient care (QSEN Institute, 2014). Teamwork and

collaboration requires nurses to understand the scope of practice occupied by the nursing role. A

nurse should understand how managerial roles do or do not overlap to identify responsibility of

different team members. Nurses should hold accountability for strengths and limitations of each

member of the team (QSEN Institute, 2014). Nursing skills for teamwork and collaboration

involve the ability to occupy a team leader role, the ability to develop a self-improvement plan

for communication, support group members for a collective outcome and identify the roles of

others to improve coordination of effective workflow (QSEN Institute, 2014). Nurses can

participate in patient care conferences and initiate their role to resolve conflicts. Nursing attitudes

to support healthy teamwork and collaboration value the expertise of each member involved

(QSEN Institute, 2014). Nurses can display supportive roles or leadership roles depending on the

composition of group team members, including the various communication styles which exist.

Evidence based practice describes the ability to integrate best current evidence with

clinical expertise and patient/family preferences and values for delivery of optimal health care

(QSEN Institute, 2014). Nurses utilize evidence based practice to determine and support best

clinical practices. Interpreting research from reputable sources is essential to proper application

(QSEN Institute, 2014). Understanding results and differentiating clinical experience from

research studies allows nurses to modify clinical practice. Nursing practice should strive to

modify work environment to properly facilitate evidenced based practice guidelines (QSEN

Institute, 2014). Participation in supporting evidenced based practice in nursing interventions is

critical to this QSEN competency. Nurses should possess positive attitudes toward research

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methods and value the importance of ongoing emerging clinical practices. The ability to

critically decipher strengths and weaknesses of evidence is a useful tool to propel evidenced

based practice in nursing (QSEN Institute, 2014).

  Quality improvement uses data to monitor the outcomes of care processes and use

improvement methods to design and test changes to continuously improve the quality and safety

of health care systems. This knowledge is used to measure the actual performance of a process or

event as well as its outcome. The data acquired is compared with that from other departments in

the same or similar organizations (Dolansky & Moore, 2013). The knowledge learned is used to

create quality improvement efforts geared towards reaching an optimal zero occurrence for the

event (Dolansky & Moore, 2013). Skills necessary for quality improvement include the ability to

measure occurrences and seek ways to improve processes through quality initiatives so that the

event does not reoccur (Sherwood & Zomorodi, 2014). Quality improvement is geared towards

the importance of shifting the focus away from blame to identifying where breakdown exists

(Sherwood & Zomorodi, 2014). Once weaknesses are identified, data is collected and used to

redesign the process to prevent the error from reoccurring (Sherwood & Zomorodi, 2014).

  Informatics uses information and technology to communicate, manage knowledge,

mitigate error, and support decision-making. As Dolansky and Moore (2013) describe, various

applications are being used to provide safety alerts informing providers of the need to act. In the

healthcare industry, informatics technology, such as electronic health records, plays an integral

part in the delivery of quality healthcare. This is achieved via helping to communicate care

coordination by recording and sharing information about a patient (Dolansky & Moore, 2013).

The skills necessary include the ability to conduct data and research queries and being

knowledgeable of the informatics system being used by the facility.

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Safety minimizes the risk of harm to patients and providers through both system

effectiveness and individual performance. Quality improvement and safety measures are directly

related. Quality is more involved with the process itself while safety, on the other hand, is related

to averting medical errors and unfavorable patient outcomes (Dolansky & Moore, 2013).

Knowledge concerning safety measures is acquired through constant vigilance and surveying the

healthcare environment to prevent mistakes from happening. Applying good nursing skills and

adhering to proper procedures will improve patient safety. As a healthcare provider, nurses must

always be aware of the potential for patient injury. This mindset allows for prompt identification

of safety hazards and risks facilitating steps to be taken to address weaknesses among clinical

practices, tasks, and systems errors (Dolansky & Moore, 2013).

Assessment of QSEN competencies in Simulation

The transfer of essential information and the responsibility for care of the patient from

one healthcare provider to another is an integral component of communication in health care.

This critical transfer point is known as a handoff. An effective handoff supports the transition of

critical information and continuity of care and treatment. However, the literature continues to

highlight the effects of ineffective handoffs: adverse events and patient safety risks. Team

collaboration is essential (Hughes, 2008). Unfortunately, a few minor laps during patient

handoff, can lead to delays in some patients receiving care. Through teamwork and

communication, the RNs can identify patient needs and utilize both the charge nurse and nurse

assistant in providing care. The importance of quality teamwork in healthcare has been the

subject of several studies in healthcare. Teamwork has been associated with a higher level of job

staff satisfaction, a higher quality of care, an increase in patient safety, greater patient

satisfaction with their care, more productivity, and a decreased stress level. Lack of

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communication creates situations where medical errors can occur. These errors have the potential

to cause severe injury or unexpected patient death. Medical errors, especially those caused by a

failure to communicate, are a pervasive problem in today’s healthcare organizations (Hughes,

2008).

Simulation Analysis/Evaluation

The priorities of the charge nurse are to act as a team leader for the rest of the nursing

staff, keep track of patient status and help manage clinical emergencies. Additionally, a priority

of the charge nurse is to act as a consult for clinical issues, a planner and director (Cherry &

Jacob, 2014). The charge nurse can serve as a support system and can offer guidance, advice, and

opinions when needed by nursing staff. They determine the daily assignment list and organizing

nursing staff as necessary (Cherry & Jacob, 2014). The charge nurse can carry all the

responsibilities of an RN in addition to charge nurse duties. Throughout the simulation, I

coordinated and delegated care by ensuring that nurses were well supported in the care provided.

As charge nurse, I relied on the QSEN competencies of leadership, teamwork, and

communication. For example, I made sure to check on each RN and their patients and offer

options for care. Also, I was sure to direct the nurses if need be and determined the client

assignments. More specifically, a patient was quickly declining and the RN needed assistance. A

code was called and the patient was resuscitated. As charge nurse, I believe I did well directing

the nursing staff and was able to help them through situations by offering different ideas and

perspectives.  For example, another patient was hemorrhaging and had a low hemoglobin I

suggested contacting the provider to get blood and an increase of fluids ordered. I believe I did a

good job focusing the nurses and directing them with what they could do next (via democratic

leadership).  However, there were things that I could have improved on. One patient was a

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mannequin and, unfortunately, was put on the back burner. Moreover, when we were

resuscitating a patient I needed to be more careful about the patient’s situation and medications

to be given. The QSEN competencies of teamwork and communication were used as the RN and

I worked together to quickly determine our plan of action and resuscitate the patient.

The nursing practice of teamwork and communication as part of a multi-disciplinary team

is crucial in providing quality patient centered care (Cherry & Jacob, 2014). During simulation,

as an RN, I relied heavily on the QSEN competencies of safety, communication, and teamwork

along with evidence-based practices to provide care to my patients. Nurses are critical to the

surveillance and coordination that reduce adverse outcomes. I effectively communicated with the

nurse assistant to ensure the patient suffering from Dementia and shortness of breath was safe

and receiving oxygen. Unfortunately, my second patient had fallen and was complaining of chest

pain. I assessed the patient’s neurological status while checking for ecchymosis as the patient

was on a heparin drip. Once I ensured that my patient was stable, I safely transferred her to a

nearby chair and contacted the provider to order a CT-scan for further evaluation. An area of

improvement was in my initial assessment of the patient by hesitating to place my patient on

supplemental oxygen and ordering of morphine for her chest pain. Had I reviewed the patient's

chart more in depth during report I would have been more aware of my patient’s complaint of

shortness of breath and elevated respiratory rate. Once I identified that patient's chest pain was

respiratory related, with the assistance of the charge nurse, I placed her on oxygen and contacted

the provider for morphine and lab work.

A nurse’s ability to think critically, and use acquired knowledge and evidenced-based

practice while providing care to patients, is essential to the patient’s well-being and safety.

During the simulation experience, as an RN, I utilized QSEN competencies. Both patients

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received patient centered care specific to their healthcare needs. Teamwork and collaboration

was an integral part to providing quality care during the simulation. Providing quality care

requires the collaboration of numerous providers (Sherwood & Zomorodi, 2014). While

providing care for a patient admitted with a hip fracture that was experiencing shortness of

breath and appeared to be hemorrhaging, the charge nurse informed me that my other patient was

declining. With teamwork and collaboration with the charge nurse, we were able to stabilize both

patients. When caring for my patient who was experiencing shortness of breath I employed

evidence-based practice by elevating the head of the bed, applying oxygen, and putting on a

pulse oximeter. I ensured safety by keeping the bed lowered, call light within reach, and two

upper side rails raised. I believe that I did well assessing my patients and prioritizing their

problems and my interventions. I did not do a good job juggling two declining patients. I got so

involved in caring for my first patient that I neglected my second patient.   

Duties of the nursing assistant typically include taking vital signs and blood glucose

measurements; feeding, bathing, and ambulating patients; and answering patient calls, retrieving

supplies, and keeping the unit clean (Bellury, Hodges, Camp, & Aduddell, 2016). During

simulation, as nursing assistant, I was able to keep the patient that fell safe by assisting the

patient from the floor to the chair, activating the chair alarm, and notifying the charge nurse

about the fall. The charge nurse was then able to assess the patient for injuries and call the

physician for a complete exam. Additionally, I was able to remain as a patient sitter, as the

patient was impulsive and a fall risk. I made sure that the patient kept her oxygen on and did not

pull out her IV. One thing that I could have improved on was to immediately place the oxygen

on the patient when the patient complained of difficulty breathing. Additionally, immediate

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attention should have been brought to the RN that the wrong patient’s medication was left in the

room.

As an observer, I was looking for the healthcare team to demonstrate preparedness,

teamwork, collaboration, and communication skills. The team executed these principles

immediately by assigning roles and reviewing the available medical information relative to each

patient.  Two patients were assigned to each of the two nurses. The entire team received change-

of-shift report. I believe they did this together to be a single unit, however, in hindsight this time

could been used to do an initial check of the patients. Despite this, the healthcare team

demonstrated teamwork and collaboration by cooperatively identifying goals for each patient,

communicating them, and adjusting priorities as the client's’ conditions changed.  For example,

when Andrea’s patient fell, she notified the team by calling for help but remained at the patient’s

bedside. Olivia, charge, and Jazmine, RN, were handling a more critical situation with a code

blue. Andrea was able to maintain the safety of her client until the more critical situation

resolved. Idalis, the nursing assistant, maintained the safety of her client by providing a chair

alarm for a patient demonstrating confusion and increased risk for falls.  Jazmine and Olivia

demonstrated critical thinking by evaluating labs for a patient who had significant blood loss

following hip surgery. Overall, each person maintained safety and service excellence for their

patients by prioritizing goals and recognizing the importance of their role within the team.

Effective communication between their individual scope of practice resulted in successful care of

their patients. This simulation experience allowed us to comprehend the full effect of QSEN

competencies as an improvement to the quality and safety of care which can only be realized

when nurses apply them at both individual and system levels of care (Dolansky & Moore, 2013).

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References

Bellury, L., Hodges, H., Camp, A., & Aduddell, K. (2016). Teamwork in Acute Care:  

Perceptions of Essential but Unheard Assistive Personnel and the Counterpoint of

Perceptions of Registered Nurses. Research in Nursing & Health, 39(5), 337-346.

doi:10.1002/nur.21737

Cherry, B. & Jacob, S.R. (2014). Contemporary nursing issues, trends, & management. (6th

ed.).  Missouri: Elsevier Mosby.

Dolansky, M.A., Moore, S.M., (September 30, 2013) "Quality and Safety Education for Nurses  

(QSEN): The Key is Systems Thinking" OJIN: The Online Journal of Issues in Nursing

Vol. 18, No. 3, Manuscript 1. DOI: 10.3912/OJIN.Vol18No03Man01

Hughes, R. G. (2008). Patient safety and quality: An evidenced -based handbook for nurses.

Agency for Healthcare Research and Quality, 08(0043). Retrieved from

http://archive.ahrq.gov/professionals/clinicals-providers/resources/nursing/resources/

nurseshdbk/index.html

QSEN Institute. (2014). QSEN competencies. Retrieved November 25, 2016, from

http://qsen.org/competencies/pre-licensure-ksas/

Sherwood, G., & Zomorodi, M. (2014). A new mindset for quality and safety: The QSEN  

competencies redefine nurses' roles in practice. The Journal of Nursing Administration,

44(10), p.510-518. doi:10.1097/NNA.0000000000000124

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