Partners in Nursing Education

Tremendous responsibility is placed on nurses as they practice and learn to accommodate to the accelerating changes and complexity within the U.S. healthcare system.

In 2003, the Institute of Medicine’s Health Professions Education Report substantiated this trend and called for changes in nursing curricula nationwide.

In response, the Quality and Safety Education for Nurses (QSEN) initiative was created in 2005.

The overriding goal of the Robert Wood Johnson Foundation (RWJF)-funded project is to “prepare future nurses to continuously improve the quality and safety of the healthcare system in which they work.”1

An expert panel of nursing educators from around the country formed by the QSEN project arrived at six core competencies to be incorporated into nursing curricula nationwide, including:2

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  • patient-centered care;
  • teamwork and collaboration;
  • evidence-based practice;
  • quality improvement;
  • safety; and
  • informatics.

 

Preparing nurses with these competencies will become increasingly necessary to meet the goals the QSEN has for all nurses, which also demand professional accountability and a commitment to lifelong learning.

Seeking Consensus

Since the QSEN initiative began, the American Association of Colleges of Nursing (AACN) and the University of North Carolina School of Nursing, Chapel Hill, NC, have been awarded $4.25 million in grants from RWJF.2

In the first phase of the QSEN initiative, the expert panel of nursing educators sought national consensus on definitions of quality and safety competencies to institute changes in nursing education for all registered nurses.1

In the second phase, the panel surveyed schools of nursing to determine which the six core competencies are already included in curricula, whether faculty are sufficiently expert to teach them, and how well nursing students are learning them.2

The third phase of the QSEN project includes:2

  • developing faculty expertise necessary for nursing schools to teach the competencies;
  • instilling the competencies in textbooks, licensing, accreditation and certification standards; and
  • promoting continued innovation in teaching the six core competencies.

Knowledge, Skills & Attitudes

 

Few nurse educators have a clear understanding of the six core competencies proposed by QSEN. How to execute them, especially in the clinical setting, remains problematic for most educators.

Staff educators in hospitals and other facilities are equally challenged in preparing nurses already working in the healthcare system to implement new Knowledge, Skills and Attitudes (KSAs) that define the quality and safety competencies.

Most conclude nursing graduates are entering practice lacking the KSAs about patient care quality and safety to function in today’s environment. But few schools have successfully executed a comprehensive quality and safety curriculum into their nursing programs.4

In addition to seeking national consensus on the six core competencies, the first phase of QSEN project involved identifying the KSAs expected of new nursing graduates and are appropriate for pre- and post-licensure education.5

Framework for Success

Nurse educators working together with staff educators need to understand the importance in partnering in education.

Working together, clinical and staff educators can educate both students and staff already in the system, these important concepts and help reinforces the QSEN competencies.

Clinical nurse educators together with staff educators need to partner and co-facilitate learning and teaching both staff and student. This would ensure new graduates seamlessly transfer what they have learned as a student into the workplace.

Staff nurses already in the system would benefit from the co-facilitative learning experience and implementation of new KSAs that define quality and safety, could be introduced and reinforced as well.

Implementation of Competencies

Quality, Improvement & Safety

Clinical rotations should begin with a formal orientation to the unit by the nurse manager or an appointee familiar with unit policies and procedures.

To help students begin to understand and incorporate the Quality and Improvement and Safety competency, the error reporting system in place should be reviewed and encouraged to use.

Safety issues, concerns and current problems on the unit should be reviewed along with any particularities significant to the unit. Students should be oriented to and encouraged to document patient care in the electronic charting system.

Informatics & Evidence-Based Practice

Practice with navigating electronic health records is an important aspect of the Informatics competency.

Familiarity with the electronic charting system would also promote and facilitate students and staff as they seek best practice evidence, fulfilling some components of the Evidence-Based Practice competency.

Students need to know they are included and considered partners in care along with patients and their family members.

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Patient-Centered Care, Teamwork & Collaboration

Ensuring and incorporating patient values and preferences supports the Patient-Centered Care competency.

Staff members must be willing to work with students and demonstrate the KSA involved with delivering patient care.

Meaningful interactions with physicians and other health professionals should be encouraged by the students. In this way, mutual respect and the KSAs associated with the Teamwork and Collaboration competency can be identified and instituted.

As students are educated in this way, both student and staff benefit and learn to identify each competency as they practice together.

Evaluation

Review and discussion of the QSEN competencies and the associated KSAs should be analyzed in a post-conference at the end of the student’s day.

Inviting staff members along with the staff educator is beneficial to all and helps reinforce to both the student and the practicing clinician the benefits from creating an education culture of quality and safety.

At Its Core

The six core competencies associated with QSEN do not appear to be new concepts for nurses.

However, incorporating the competencies, by reinforcing the KSAs needed for the increasing complexities nurses encounter daily as they practice, and partnering with staff educators, seems to be an innovative way to bring attention to the importance of being vigilant in preventing errors in today’s complex healthcare setting.

Lectures alone are not enough to embed the necessary knowledge associated with QSEN.

With the increasing introduction of technology comes new ways for errors to occur. No longer can the clinical educator be expected to work in isolation, as educating all nurses is all of our responsibility.

References for this article can be accessed here.

Donna Lisewski is a 2011 graduate of the MSN program at the University of Hartford, College of Education, Nursing and Health Professions, Hartford, CT.

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