Dori Taylor Sullivan

Quality and safety education for advanced nursing practice

The Quality and Safety Education for Nurses (QSEN) project is a national initiative to transform nursing education to integrate quality and safety competencies. This article describes a two-year process to generate educational objectives related to quality and safety competency development in graduate programs that prepare advanced practice nurses in clinical roles. Knowledge, skills, and attitudes for each of 6 competencies are proposed to stimulate development of teaching strategies in programs preparing the next generation of advanced practice nurses.

Assessing quality and safety competencies of graduating prelicensure nursing students.

The Quality and Safety Education for Nurses (QSEN) project is focused on enhancing nursing curricula and fostering faculty development to support student achievement of quality and safety competencies. The purpose of this descriptive study was to assess student perspectives of quality and safety content in their nursing programs along with self-reported levels of preparedness and perceived importance of the 6 QSEN competencies. Graduating students (n = 565) from 17 US schools of nursing completed an electronic student evaluation survey. Students reported exposure to QSEN knowledge areas, more often in classroom and clinical learning settings than in skills lab/simulation settings. Clinical experience outside of formal education was associated with perceptions of a higher level of preparedness for QSEN skills in several competencies. In general, students reported relatively high levels of preparedness in all types of prelicensure nursing programs and endorsed the importance of quality and safety competencies to professional practice.

Connecting nursing education and practice: a focus on shared goals for quality and safety.

The gap between the worlds of nursing education and nurses in practice has been highlighted over the past four decades. Cyclical efforts to bridge this gap have met with varying degrees of success. A recent attempt to unite nursing education and practice is the Quality and Safety Education for Nurses (QSEN) initiative, generously funded by the Robert Wood Johnson Foundation (Cronenwett et al., 2007). The major goal of QSEN is to prepare future nurses with the knowledge, skills, and attitudes necessary to continuously improve the quality and safety of care delivery in health care systems. This article summarizes and discusses QSEN’s accomplishments and upcoming activities within a framework of the factors contributing to the separation of the education and practice worlds and makes recommendations for building on the progress derived from QSEN activities.

Using virtual environments to enhance nursing distance education.

Distance education has traditionally been two-dimensional, with limited interaction. Virtual environments enhance distance education learning through real-time interaction and social collaboration that mimic the real world. Virtual environments offer the option to create social and professional relationships that have been a missing component of distance learning.

Preparing Nursing Students to Be Effective Health Team Partners through Interprofessional Education

This article will provide an overview of recent significant activities related to interprofessional education to promote care quality through teamwork and collaboration, followed by a discussion of what nursing schools can do to develop the knowledge, skills, attitudes, and values to enhance health care team performance and care outcomes.

Exploring the Changing Landscape of Jobs for New Graduates: Practice, Education, and New Graduate Imperatives

Numerous expert sources have reported a reduction in positions available for new graduate nurses, largely because of general economic conditions, although there are conflicting data and significant geographic variances. Nursing education, nursing practice, and new graduates themselves must develop partnerships to better prepare graduates for more challenging employment searches so that these newest members of the nursing workforce are retained and available for practice in preparation for the expected shortage of nurses in the near future.

Application of a Proactive Risk Analysis to Emergency Department Sickle Cell Care

Introduction Patients with sickle cell disease (SCD) often seek care in emergency departments (EDs) for severe pain. However, there is evidence that they experience inaccurate assessment, suboptimal care, and inadequate follow-up referrals. The aim of this project was to 1) explore the feasibility of applying a failure modes, effects and criticality analysis (FMECA) in two EDs examining four processes of care (triage, analgesic management, high risk/high users, and referrals made) for patients with SCD, and 2) report the failures of these care processes in each ED. Methods A FMECA was conducted of ED SCD patient care at two hospitals. A multidisciplinary group examined each step of four processes. Providers identified failures in each step, and then characterized the frequency, impact, and safeguards, resulting in risk categorization. Results Many “high risk” failures existed in both institutions, including a lack of recognition of high-risk or high-user patients and a lack of emphasis on psychosocial referrals. Specific to SCD analgesic management, one setting inconsistently used existing analgesic policies, while the other setting did not have such policies. Conclusion FMECA facilitated the identification of failures of ED SCD care and has guided quality improvement activities. Interventions can focus on improvements in these specific areas targeting improvements in the delivery and organization of ED SCD care. Improvements should correspond with the forthcoming National Heart, Lung and Blood-sponsored guidelines for treatment of patients with sickle cell disease.

Deference to Expertise: Making Care Safer

Since the seminal report by the Institute of Medicine, To Err Is Human, was issued in 1999, significant efforts across the health care industry have been launched to improve the safety and quality of patient care. Recent advances in the safety of health care delivery have included commitment to creating high-reliability organizations (HROs) to enhance existing quality improvement activities. This article will explore key elements of the HRO concept of deference to expertise, describe the structural elements that support nurses and other personnel in speaking up, and provide examples of practical, evidence-based tools to help organizations support and encourage all members of the health care team to speak up.

Implementation and Evaluation of the North Carolina Board of Nursing's Complaint Evaluation Tool

Clinical errors can provide value by creating opportunities to learn how to prevent future problems. To promote learning, it is vital that nurses are not automatically disciplined, although nurses who make reckless choices must be held accountable. To achieve a balance between learning from practice errors and using disciplinary action effectively, the North Carolina Board of Nursing developed the Complaint Evaluation Tool (CET) to guide nurse managers in reviewing practice errors and to clarify the criteria for managing at-risk and reckless behavior. This article describes the use of the CET in a community regional medical center.