By Alicia Troup, Timothy Burggraf, Kallee Donahue, and Jen Kukla QSEN By Alicia Troup, Timothy Burggraf, Kallee Donahue, and Jen Kukla

What is QSEN? The Quality and Safety Education for Nurses (QSEN) Began in 2005 and funded by the Robert Wood Johnson Foundation Overall goal was to prepare future nurses with knowledge, skills, and attitude (KSA’s) to improve quality and safety of healthcare systems The lead investigator was Linda Cronenwett, PhD, FAAN Consisted of three phases between 2005 and 2012 Image source: http:www.lexlarayhealthocc.wikispaces.com

Phase I 2005-2007 six competencies were defined Five being from the Institute of Medicine: teamwork and collaboration, evidence-based practice, patient-centered care, quality improvement and informatics, and safety KSA’s were created from these competencies to use in nursing school programs Quality and Safety Education for Nurses (2012). http://www.qsen.org/about-qsen/project-overview

QSEN Competency #1 Patient-centered care Acknowledge the patient or power of attorney in charge of their health and collaborator in providing patient-centered care with all their needs in mind. Examples Providing nursing care with the patient and whole family unit with their input of what is right for them. Being culturally aware of the care needed to know the patient values, beliefs, and choices. Communicates efficiently with patients and family. Sherwood, G., & Zomorodi, M. (2014), p. 18

QSEN Competency #2 Teamwork and Collaboration Work side-by-side with nursing and other health personnel, clarify responsibilities and contribute to decision-making to accomplish quality patient care. Examples Recognizes own strengths and inadequacies as a colleague. Communicates and collaborates successfully in the health care teams to achieve best outcomes for the patient. Treats patient and family as actual team members. Sherwood, G., & Zomorodi, M. (2014), p. 18

QSEN Competency #3 Evidence-based practice Provide the most up-to-date evidence based practices with nursing skills. While including patient/family preferences and values to provide the best patient care. Examples Utilizes best evidence-based practices in care interventions. Determines best practices to use from current evidence. Decides changes from standards to accommodate patient beliefs and choices. Sherwood, G., & Zomorodi, M. (2014), p. 18

QSEN Competency #4 Quality improvement Apply data to examine the outcomes of care processes and use strategies to change and improve patient care and safety. Examples Recognizes methods or problems that need changed. Able to recognize safe and reliable practice. Implement method advancement strategies to change processes for the better. Sherwood, G., & Zomorodi, M. (2014), p. 18

QSEN Competency #5 Safety Decrease the risk of harm to patients and health professionals by using procedure effectiveness and individual responsibility. Examples Employs new safety knowledge for recognition of failures in processes. Aware of mistakes or near misses and reports them to increase patient safety. Joins in examination of mistakes and near misses for origin of cause. Sherwood, G., & Zomorodi, M. (2014), p. 18 Image retrieved from https://www.lawyersandsettlements.com/blog/oops-not-welcome-here-your-hospitalyour-drug- store.html

QSEN Competency #6 Informatics Utilize evidence and technology to communicate, operate skills and expertise, diminish error, and aid in decision-making. Examples Uses skills in data and information management to access latest evidence. Uses standard communication strategies ex: SBAR Documents patient data in electronic health records. Sherwood, G., & Zomorodi, M. (2014), p. 18 Image retrieved from http://www.businessresearchguide.com

Phase II 2007-2009 participating schools integrated the competencies into their nursing programs In April 2007, QSEN.org was established The website provided teaching strategies and resources Also allowed for work to be shared by participating groups on the site Quality and Safety Education for Nurses (2012). http://www.qsen.org/about-qsen/project-overview

Phase III 2009-2012 The Robert Wood Johnson Foundation allocated funds to AACN and the UNC school of nursing to continue the study Dr. Cronenwett continued as lead investigator with the assistance of Geraldine Bednash, PhD, RN, FAAN These groups developed the faculty knowledge needed to teach, instill, and promote continued instruction on these competencies During 2010-2012, held several conferences to support and promote the standards Quality and Safety Education for Nurses (2012). http://www.qsen.org/about-qsen/project-overview

Promoting Standards A series of QSEN Faculty Development Institutes held in 2010-2011 provided strategies to integrate quality and safety standards into the nursing curriculum. Focused on the six core competencies and taught 1. how to incorporate these into the curriculum 2. mentor students to carry out safe and effective patient care 3. Show faculty how to accomplish this Barnsteiner, J., Disch, J., Johnson, J., Mcguinn, K., Chappell, K., &Swartwout, E. (2013)

Phase IV Currently in process This phase is focused on faculty development for disseminating the graduate QSEN competencies. Barnsteiner, J., Disch, J., Johnson, J., Mcguinn, K., Chappell, K., &Swartwout, E. (2013) Image retrieved from http://mondspeer.deviantart.com/art/Famous-Smileys-Doctoral-Hat-emotee-516841721

Future Direction Faculty need help with the teamwork and collaboration competency. They need to find a better ways to bring together students and clinicians from different areas of the hospital. Nursing graduates are not receiving the necessary KSAs to work effectively as a team member. Patients lives depend on this competency Students need to understand how complex health care systems are and how much it impacts the quality and safety of their patients. Barnsteiner, J., Disch, J., Johnson, J., Mcguinn, K., Chappell, K., &Swartwout, E. (2013)

Future Direction Continued Nurses from clinical practice have been asked to create clinical partnerships with nursing faculty to continue the QSEN mission forward. QSEN has spread to the VA Quality Scholars program that offers pre and post-doctoral fellowships to nurses. QSEN website has advanced into a one-stop site for quality and safety education in nursing. QSEN website has eliminated log in requirements to better provide access to resources and learning. ( Tullai-McGuiness, 2014)

ANA’s stance on QSEN Nurses are responsible and accountable for maintaining and demonstrating their competence when implementing the plan of care. Knowledge, skills, abilities and judgement, all of which are based on the established science and current practice expectations, must be integrated in the nurse’s actions. Martin, 2012, pp.89

ANA’s Stance Continued All nurses need to acquire, knowledge, skills and attitudes that lead to competency in the area identified by QSEN. (Brown, 2012, p.179) patient centered care; collaboration; team-based, evidence-based practice; quality improvement and safety; and informatics. (Brown, 2012, p.179) The word collaborate comes from the Latin, com (together) and laborare (to labor), to exert together, to work one with another, to cooperate, especially in a joint effort toward mutual goals. (Brown, 2012, p.173)

Alicia Troup RN I currently work on a medical/surgical unit at West Shore Medical Center (WSMC) in Manistee. QSEN influences my nursing practice by providing the most up-to-date evidence based practices. Although my facility is not QSEN accredited, many of the QSEN standards are taken into consideration for policies/procedures for the safest and most sufficient patient care. My facility adheres very strictly to infection control standards and we follow a “Wash in, Wash out” policy. We sanitize our hands when we enter a patient room and sanitize them again on our way out of the room. This is done every time for every patient. I use sterile precautions when starting IVs. If a medication is to be administered via the IV route, the access site is sterilized. All six competencies influence how I care for my patients to provide the best and safest care. They also enhance my role as a team member at my hospital.

Kallee Donahue RN In my current practice area as a pediatric gastroenterology nurse the QSEN standards influence my nursing practice with the collaboration with the MA’s in the office and the doctor. Patient centered care is very important to our office as well. We communicate with the patient and their parents about how to best treat their symptoms and diseases.

Jen Kukla, RN Working as an emergency room (ER)/Trauma nurse, QSEN influences my nursing practice in several ways. Teamwork and collaboration between RNs, Physicians, our ER pharmacist, and other ER staff members is vital in stabilizing trauma patients or those presenting with life threatening issues. Patient centered care is on the forefront of our practice in the ER when considering if a patient wished to have life saving treatment or not. (Full code vs. DNR, partial DNR) Safety is one main goal in the ER, not only through safe nursing practice, but due to the potential for harm with mental health patients or victims of shootings having the suspect retaliate in the emergency room. Image retrieved from http://www.ipharmd.net/symbol/caduceus/caduceus_medical_logo_symbol.html

Timothy(Timmy) Burggraf RN, EMT-P Emergency Collaboration is without question one of the forefront aspects of my daily professional behavior in the ED. In a scenario where a Trauma 1or 2 comes to the ED then an alert is performed, this allows for a convergence of appropriate ancillary staff as well as ED staff to arrive. This collaboration is required in STEMI alerts as well as any code event. I sit on multiple committees, one being a STEMI bypass and alert committee, the other is a Shared Governance committee. Both committees are committed to the advancement of evidence based medicine and empirical processes within the MidMichigan health system.

References Barnsteiner, J., Disch, J., Johnson, J., Mcguinn, K., Chappell, K., &Swartwout, E. (2013). Diffusing QUES Compentencies Across Schools of Nursing: The AACN/RWJF Faculty Development Institutes. Journal of Professional Nursing. 68-74. Doi:10.1016/j.profurs.2012.12.003 Brown, P. (2012). Standard 13. Collaboration. White, K. O’Sullivan, A. (Ed), In The essential guide to nursing practice: Applying ANA’s scope and standards in practice and education (pp. 173-185). Silver Spring, MD: American Nurses Association Martin, B. (2012). Standard 5. Implementation. White, K. O’Sullivan, A. (Ed), In The essential guide to nursing practice: Applying ANA’s scope and standards in practice and education (pp. 87-103). Silver Spring, MD: American Nurses Association

Reference Quality and Safety Education for Nurses. (2012) The evolution of the quality and safety education for nurses (QSEN) initiative. Retrieved from QSEN Institute website: http://www.qsen.org/about- qsen/project-overview Sherwood, G., & Zomorodi, M. (2014). A new mindset for quality and safety: The QSEN competencies redefining nurses’ roles in practice. Nephrology Nursing Journal, 41(1), 15- 22. doi: 10.1097/NNA.0000000000000124