1. Quality and Safety Education for Nurses
(QSEN)
Presented by:
Amanda Berberich
Brandy Everson
Amberlyn Granderson
Sarah Kremers
Molly Pacola

2. Quality Safety Education for Nurses
(QSEN)
What is QSEN?
QSEN begins with all nursing schools who focus on instilling the right knowledge, skills, and attitudes in their nursing students in an effort to improve the quality of care they give when they start practicing in the field (QSEN, 2014). 
The Robert Johnson Foundation through collaboration with the Chapel Hill School of Nursing funded QSEN in October Implementation of this was done in four phases focusing on six key competencies, which will be outlined later (QSEN, 2014).

3. QSEN Phases
Phase I: Phase I started in November The Focus was on patient safety and adjusting what students are to be taught in nursing school. According to QSEN (2014), “In the first 18-month phase, Cronenwett is leading a panel of 17 national nursing leaders to outline the core knowledge, skills, and attitudes that should be mastered by prelicensure nursing students”.
Phase II: Phase II started in April It focused more on the teaching strategies being utilized. A survey was completed to see if the competency of the students is an effective tool to monitor nursing education. Several colleges were selected to incorporate the findings into their curriculum (QSEN, 2014).
Phase III: Phase III started in February This phase focused on equipping students with the skills to handle both current and future issues concerning the health care system (QSEN, 2014).
Phase IV: Phase IV focuses on transitioning nurses to a higher degree of education. Both colleges and universities are doing this. They are working together to promote a smoother transition for students seeking higher degrees. They feel this is now important because patients are living longer and are more diversified. QSEN set the goal to have 80% of nurses attain a bachelors degree or higher by the year 2020 (QSEN, 2014).

4. The six competencies QSEN has chosen to concentrate on are as follows:
1)      Patient centered care
2)      Teamwork and collaboration
3)      Evidence-based practice
4) Quality improvement
5)      Safety
6)      Informatics
(QSEN, 2014)

5. Patient-Centered Care
Cronenwett et al. (2007) defines patient-centered care as being able 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”.
The initiative encourages nurses to place a higher value on subjective information. Nurses should learn what the patient’s wishes are, then develop the care plan. They must also do this with regard to any legal or moral paradoxes that may develop.

6. Patient-Centered Care
Goals of the patient-centered Nurse according to Cronenwett et al. (2007):
Be aware and respectful of how diversity can affect a patient’s attitudes and wishes.
Spend time listening to what the patient’s wishes are and understand how active they wish to be in their own care.
Educate the patient when his or her wishes could lead to harm or illness.
Communicate the patient’s wishes to other members of the health care team.
Be especially sensitive to subjective findings like pain and discomfort.
View the patient as the expert when it comes to his or her own care.
Recognize any legal or moral paradoxes between the patient’s wishes and the health care recommendations or institutional policy.
Be an effective communicator and also be skilled in conflict resolution.

7. Teamwork and Collaboration
Teamwork means to function effectively within nursing and interprofessional teams, fostering open communication, mutual respect, and shared decision-making to achieve quality patient care (Disch, 2010).
Teamwork and collaboration are essential for coordinating complex care involving several health care disciplines (Simmons & Sherwood, 2010).
Teamwork and collaboration use the health professional’s personal strengths to foster effective team functioning, integrate quality and safety science, and communicate among the team members (Sherwood, 2010).
Teamwork and collaboration among members of the health care team is critically important in assuring quality and safety of patient care (Disch, 2012).

8. Teamwork and Collaboration
Teamwork requires flexible leadership that shifts to match expertise and role of the team members (Sherwood & Zomorodi, 2014).
It has been estimated that 70-80% of health care errors are caused by some contribution of human factors within interpersonal interactions (Disch, 2012).
Participating in interprofessional rounds that include patients and families helps to coordinate information, set daily care goals, and manage various issues that may arise (Sherwood & Zomorodi, 2014).
SBAR communication and TeamSTEPPS are two examples that promote interprofessional communication and collaboration (Disch, 2012).

9. Teamwork and Collaboration
TeamSTEPPS
Situation, Background,
Assessment, and Recommendation
(SBAR)
TeamSTEPPS is an evidence-based curriculum for developing teamwork to improve quality and safety (Hughes, 2008).
TeamSTEPPS principles in patient care are used to reduce clinical errors, patient and staff satisfaction, and improve patient outcomes (Hughes, 2008).
Research shows that the risk of serious adverse events is reduced when team training has been implemented (Hughes, 2008).
SBAR technique provides a framework for communication between members of the health care team about a patient's condition ("SBAR Technique for," 2014).

10. Evidence-Based Practice (EBP)
EBP integrates the best current evidence with clinical expertise and patient or family preferences and values for delivery of optimal health care (Barnsteiner et al., 2013).
According to Didion et al. (2013), “Scientific evidence provides the basis for the planned interventions, which are geared to the students' novice skill level”.
According to Odell and Barta (2011), “In order to safely and effectively practice professional nursing in today's ever-changing healthcare environment, one of the many necessary skills for nurses is being able to identify and operationalize evidence-based practice (EBP)”.
The profession of “nursing has been voted the most trusted profession in America due to honesty and ethical standards, according to Gallup's annual survey of professions” (Lim, 2013). This is the direct result of including such components of QSEN into education as EBP.

11. EBP in Education
QSEN has laid out two major challenges before nursing educators. These challenges are to educate nurses who will perform safe care as well as create safe systems, which will minimize the gap between education and practice (Didion et al., 2013).
“The Institute of Medicine and the Carnegie Foundation for Health Education have called for significant changes in nursing education to reduce medical errors and improve health outcomes” (Didion et al., 2013).
EBP is reported as the most highly integrated competency across schools in nursing education (Barnsteiner et al., 2012).
Students learn how to identify and determine if data are scientifically valid and appropriate to guide practice (Barnsteiner et al., 2012).
In order to gain trust of our patients and the community, the nursing curriculum must provide evidence-based content that helps the student grow and develop moral standards (Lim, 2013).

12. Quality Improvement Goal to improve outcomes of patient care
“Describe nationally accepted quality measures and benchmarks in the practice setting” (QSEN, 2014).
QSEN is measured by Medicare, Medicaid, JAHCO, and many other boards and associations.
Quality improvement explains variances with charts, diagrams and analysis.
Analyzes ethical issues with patient confidentiality
“Analyze the impact of context such as access, cost, environment, workface, team functioning, or community engagement on improvement efforts” (QSEN, 2014).
Encourage public reporting and choices in healthcare to various government agencies as needed.

13. Safety
Safety “promotes competencies via in textbooks and licensing, accreditation and certificate standards” QSEN (2014).
Safety is important to minimize possible dangers to patients and providers with encouragement of near misses or “good catches”.
Each state has QSEN measures for all nurses to meet for educational requirements that can be found on their Board of Nursing website.
Safety involves identifying and practicing best practice standards and procedures.
Nurses must promote a culture of safety.
“Identify Best Practices that promote patient, community, and provider safety in the practice setting” (QSEN, 2014).
“Methods to identify and prevent verbal, physical and psychological harm to patients and staff” (QSEN, 2014).
Safety encourages nursing leadership and role models to develop and incorporate safety and principles.

14. Informatics
As defined by the International Medical Informatics Association (IMIA), nursing informatics is the "science and practice [that] integrates nursing, its information and knowledge, with management of information and communication technologies to promote the health of people, families, and communities worldwide" (IMIA, 2014).
Technology has been involved in nursing care in some form since 1950’s (QSEN, 2014).
The following is how informatics affects nursing practice today:
The technology helps the nurse to do her job, not inhibit it
Technology promotes knowledge in nursing by giving nurses resources to
gain additional information
Promotes safe practice by storing policies and procedures
Stores patient records for quick access
Allows quick navigation of the care plan
Provides another route to communicate between healthcare professionals (IMIA,
2014).

15. Informatics in Education
According to Institute of Medicine, “The United States has the opportunity to transform its healthcare system, and nurses can and should play a fundamental role in this transformation” (IOM, 2014).
Competencies used to educate on safety using patient simulation
Web-based near miss reporting system
Data collection and evaluation of students (Leader to Leader, 2010).

16. How practice standards influence or relate to our nursing practice…

17. Amanda Berberich, RN
At Sparrow Hospital, Quality and Safety Education for Nurses (QSEN) plays a huge role in how we practice and educate our nurses. There is an online learning module system (LMS) located through our intranet that nursing administrators and educators continuously add learning modules to throughout the year. Evidence-based practice, continuing education requirements, new and improved policy standards, and other nursing boards and organizations guide these modules . It is the responsibility of each nurse to complete this education in a timely manner.Department managers and fellow nurses give any pertinent information not provided through the online environment face-to-face . Some modules, such as blood borne pathogens and HIPPA, are repeated annually to ensure compliance and understanding.
Sparrow takes all six components of QSEN very seriously. Most competencies are completed through the intranet and LMS. The biggest concern is patient and employee safety. Any disruption in patient safety results in a new policy. For example, if a patient falls, the primary nurse must give a post-fall huddle to all staff on the floor. This brings awareness to the situation and allows insight on how to prevent another event from occurring. There is also a very strong IT department that is highly involved in our electronic medical record and intranet.
Holding all these high standards and following such guidelines as QSEN is what makes Sparrow a successful Magnet hospital.

18. Brandy Everson, RN
Quality and Safety Education for Nurses (QSEN) impacts my current nursing practice by their work with CMS. CMS or Center for Medicare and Medicaid Services is who we submit patient data to. Our scores from our data or Oasis is scored and placed on a website where the public can view our quality outcomes. CMS at any time can call on us to provide our documentation. They also every quarter, make changes to improve patient care. These changes are then expected to be implemented by all companies who care for Medicare patients.
QSEN and CMS are working together to improve quality outcomes that provide the safest care. Yearly our company pays for staff education on Oasis data collection. This teaches the staff expectations for collecting the data. With quarterly changes it also requires our company to stay abreast to the latest improvements, this forces staff to put policies in place that uphold these standards. With the constant education I am learning the latest changes to provide the best patient care. With the scores received by oasis data collection it incentivizes me to gain the most improvements with my patients. I believe that I would provide great patient care regardless, but receiving a score allows me to make a tangible goal and attain it.

19. Amberlyn Granderson, RN
I work at Spectrum Health in Surgical Critical Care. Teamwork and collaboration can be seen in many aspects of the day to day care. A few examples of this are:
Multidisciplinary Huddle: Each discipline (nurse, physician, respiratory therapist, pharmacist, nutritionist, PT/OT/SLP, etc.) working with the patient participates in daily rounds as a group. This allows for everyone to be on the same page and know what will be the next individual course of action for the care of each patient.
Nurse and Nurse Technician checkpoint: The unit it split into teams. The teams consist of two or more nurses working with one nurse technician. Each team consists of one nurse team leader. The lead leader initiates all huddles/checkpoints. After each member has received individual report a team huddle/checkpoint is called. The essential information about each patient is shared among the team.
At 0500/1700 each nurse team leader calls another huddle with their team members. This is to anticipate and identify any needs before the end of the shift.
Charge Nurse and Nurse Team Lead checkpoint: At 1000/2200 the team leads meet with the charge nurse to communicate any anticipated needs and updates.
SBAR. We use SBAR when communication information about our patient’s to the covering physicians.

20. Sarah Kremers, RN
In my current practice of nursing where I specialize in cardiac electrophysiology (EP). Quality and safety education for nurses (QSEN) practice standard influences my nursing practice because of the many education opportunities I am required to both attend and present. It is a collaborative effort to increase the quality of care given at West Michigan Heart. Each month a different group of nurses or physicians presents on a topic. Every year, the eight EP RNs work together to present a four-week series, usually on EKG findings and interpretation. All of the employees are encouraged to attend the learning sessions. To further encourage attendance, the presentations take place during the lunch hour and are also video taped so those who were unable to attend may view them later. Participation also reflects positively during our yearly review.
I find these “lunch and learns” very helpful for learning about the many different aspects of cardiac care, as well as the new technology that is available. It has also been helpful to see the faces of the other specialty employees, and when I have a question about an area of cardiology that I am less versed in, I know who my resources are and who I can call when I have questions about how to provide the best care.

21. Molly Pacola, RN
I have realized that QSEN benchmarks the control measures I utilize in the emergency room. This is the reason that an EKG needs to be obtained within 8 minutes of a patient being registered in the emergency room with chest pain. The benchmark is that I have to give aspirin and nitro with an IV start. This is also true for stroke patients having their head CT done within a certain amount of time. QSEN is also included in my yearly competencies on culture, pain, caring for a patient during the continuum of life and how to adapt to the growing needs of patients. This also holds true with my ACLS and PALS certifications that I have to stay updated on. The hospital I work for promotes “Good Catches” and SBAR. QSEN sets the minimum of continuing education for nurses.

22. Conclusion
Quality and Safety Education for Nurses (QSEN) is raising the standards for graduate nurses, which is increasing their overall knowledge base on patient-centered care, teamwork and collaboration, evidence-based practice (EBP), quality improvement, safety, and informatics. Through a comprehensive effort through the American Association of Colleges of Nursing and the Robert Wood Johnson Foundation, they are pioneering this project for all graduate nurses. This effort is broadening the horizons of new graduate nurses so they are better equipped to prepare the our future nurses.

23. References
Armstrong, G. (2010). Quality and Safety Education for Nurses Update. Leader to Leader. (pp. 1-10). Retrieved
from
Barnsteiner, J., Disch, J., Johnson, J., McGuinn, K., Chappell, K., & Swartwout, E. (2013). Diffusing QSEN
competencies across schools of nursing: The AACN/RWJF faculty development institutes. Journal of Professional Nursing, 29(2), Retrieved from
Cronenwett, L., Sherwood, G., Barnsteiner, J., Disch, J., Johnson, J., Mitchell, P., Sullivan, D.T., & Warren, J.
(2007). Quality and safety education for nurses. Nursing Outlook, 55(3),
Didion, J., Kozy, M., Koffel, C., & Oneail, K. (2013). Academic/clinical partnership and collaboration in quality
and safety education for nurses. Journal of Professional Nursing, 29(2), Retrieved from
Disch, J. (2012). Teamwork and collaboration competency resource paper. Retrieved from
Disch, J. (2012). Teamwork and collaboration. In G. Sherwood & J. Barnsteiner (Eds.), Quality and safety in
nursing: A competency approach to improving outcomes (pp ). Hoboken, NJ: Wiley-Blackwell.
Hughes, R. G. (2008). Tools and strategies for quality improvement and patient safety. In R.G. Hughes (Ed.),
Patient safety and quality: An evidence-based handbook for nurses (pp. 1-40). Retrieved from
Institute of Medicine. (2014). Retrieved from
Copyright © QSEN All Rights Reserved. This is where I got my citations from. qsen.org ( )

24. References
International Medical Informatics Association. (2014). Retrieved from
Lim, F. (2013). Nursing as a virtue: Strategies for value education. MedSurg Nursing, 22(4), S10+. Retrieved from
=ITOF&sw=w&asid=e fc0f3bf302d7b20baa4bf5a.
Odell, E. & Barta, K. (2011). Teaching evidence-based practice: The bachelor of science in nursing essentials at
work at the bedside. Journal of Professional Nursing, 27(6), Retrieved from
Quality and Safety Education for Nurses Institute. (2014). Retrieved from
Sherwood, G. (2010). New views of quality and safety offer new roles for nurses and midwives. Nursing & Health
Sciences, 12(3), doi: /j x
Sherwood, G., & Zomorodi, M. (2014). A new mindset for quality and safety: The QSEN competencies redefine
nurses' roles in practice. Nephrology Nursing Journal, 41(1), 15.
Simmons, D., & Sherwood, G. (2010). Neonatal intensive care unit and emergency department nurses’ descriptions
of working together: Building team relationships to improve safety. Critical Care Nursing Clinics of North America, 22 (2), Retrieved from
SBAR technique for communication: A situational briefing model. (2014). Retrieved from