At its launch at UNC in 2005, the Quality Safety and Education for Nurses (QSEN) initiative sought to recast nursing education toward an ambitious goal: to prepare new nurses not only to provide excellent care to individuals and families, but to continuously improve the quality and safety of the health care systems in which they work.
Now marking its 10-year anniversary, the program has made impressive inroads on that goal and demonstrated enduring impacts across the United States and around the globe.
Overcoming Systemic Gaps to Improve Patient Safety
Founded at UNC with funding from the Robert Wood Johnson Foundation, QSEN is part of a broad effort to emphasize the role and functioning of health care teams to improve quality of care and patient safety and to reduce medical errors. Preventable harm in hospitals has been estimated to contribute to 200,000-400,000 premature deaths per year in the United States, and about 80 percent of medical errors are attributed to a lack of teamwork or communication among members of health care teams.
“We want health professionals to graduate not only feeling what they already feel—which is a sense of vigilance around the individual care that they provide to patients—but also feeling accountable for vigilance regarding the system of care in which they work,” said Linda Cronenwett, PhD, RN, FAAN, dean emeritus and professor at the School of Nursing, who served as principal investigator for QSEN from 2005-2012. “The goal is for nurses to be better prepared to work along with other health professionals to do all the work that’s urgently needed to address these huge patient safety problems.”
A key goal of QSEN is to cultivate the knowledge, skills and attitudes nurses need to work effectively in health care teams that are accountable to quality and safety goals. This requires not only good nursing skills as an individual, but a comprehensive understanding of one’s own role, the roles of other health care professionals and how the system works as a whole.
As an example, Dr. Cronenwett pointed to the prevention of pressure sores, painful lesions resulting from prolonged bedrest or use of a wheelchair that are estimated to affect more than 2.5 million people in the United States each year. To prevent pressure sores, mobility-limited patients must be frequently turned or repositioned. Instead of simply repositioning a patient as needed during a given shift, nurses taking a more systems-oriented approach might also write a note to remind other staff members to turn the patient, seek information about the rate of pressure sores on their unit as compared to other units and find systemic ways to improve pressure sore prevention for the hospital as a whole.
That type of full-spectrum approach has been lacking in many health care environments, said Dr. Cronenwett. In addition, QSEN aims to imbue in new nurses the need to include patients as a member of the health care team. “Patient-centered care means ensuring that you know the patient’s values and preferences and that you’re considering those values and preferences as you employ evidence-based practice,” said Dr. Cronenwett.
A Legacy of Enduring Impacts
QSEN has grown and evolved through several phases during its 10-year history. Initially, project leaders and consultants focused on building will within the nursing community to develop and implement new curricular components that focused on six quality and safety competencies: patient-centered care, teamwork and collaboration, evidence-based practice, quality improvement, safety and informatics. Working with experts from institutions across the country, Dr. Cronenwett and co-investigator Gwen Sherwood, PhD, RN, FAAN, defined these core competencies—including the critical information, skills and attitudes that nurses need in order to implement broad improvements in care quality and patient safety.
Since then, the project team has been working diligently to deploy a multipronged implementation of the QSEN competencies in nursing education and practice. This work has included holding national annual conferences; conducting regional professional development workshops; working to incorporate QSEN competencies into nurse education licensing, accreditation and certification; and publication of a new textbook, Quality and Safety in Nursing: A Competency Approach to Improving Outcomes, edited by Dr. Sherwood and Dr. Jane Barnsteiner.
“Everyone knows about problems with patient safety in this country, and once faculty members realize there’s something they can do in the preparation of our future health professionals to address this problem—when that lightbulb comes on—they are ready to take action,” said Dr. Cronenwett. “I think one of our most important jobs is getting that lightbulb to come on for all faculty members.”
The QSEN website, a hub of information geared toward increasing awareness and adoption of quality and safety competencies, attracts 900-1,000 visits per day.
QSEN transitioned from UNC to Case Western Reserve University in 2012, where the QSEN Institute is currently led by Dr. Mary A. Dolansky at the Frances Payne Bolton School of Nursing. (read more about this project milestone)
A new award—the Linda Cronenwett Award—was instituted this year at the 2015 QSEN National Forum and will be given annually to outstanding individuals who advance the goals of the quality and safety education. Dr. Cronenwett, this year’s Forum keynote speaker, was the award’s first recipient.
Image: Dr. Cronenwett (right) accepted the Linda Cronenwett Award from Dr. Mary Dolansky at this year’s QSEN National Forum.