1. Testing for QSEN: Identifying gaps and reflections for practice
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David H. James DNP, RN-BC, CCNS
Patricia Patrician PhD, RN, FAAN
Rebecca “Suzie” Miltner PhD, CNL, NEA-BC
April 14, 2017

2. Objectives
Describe how one large academic medical center uses the QSEN competencies and associated selected Knowledge, Skills, and Attitudes (KSAs) as a framework for general nursing orientation.
Discuss findings and implications from a pre and post- orientation QSEN knowledge test.

3. Conflict of Interest???

4. UAB Center for Nursing Excellence Staff
Special Thanks…
UAB Center for Nursing Excellence Staff
Revision of lectures to reflect QSEN competencies.
Assistance with testing logistics.

5. A Call To Action…
Institute of Medicine (IOM): Core Competencies for Health Professionals-
Provide Patient Centered Care
Work in interdisciplinary Teams
Employ Evidenced Based Practice (EBP)
Apply Quality Improvement
Utilize informatics
(*QSEN added “Safety” list)
The Institute of Medicine (IOM) is an independent, nonprofit organization that works outside of government to provide unbiased and authoritative advice to decision makers and the public. 

6. Nursing Response – QSEN Project
Quality & Safety Education for Nurses (QSEN) – funded by RWJF
Goal:
Address the challenge of preparing future nurses with the knowledge, skills, and attitudes (KSA) necessary to continuously improve the quality and safety of the healthcare systems in which they work.

7. Does the practice setting look anything like academia?
Minding the Gap…
How do we ensure that we are building on content taught in nursing programs?
Does the practice setting look anything like academia?
What about RN hired before patient safety movement (before QSEN)?
What about RN from A.D.N. programs?

8. Admissions: >50,000/year 10 city blocks & 4.2 million square feet
UAB Hospital
1157 beds ( )
Medical Staff: 1141
RN Staff: 3000
Admissions: >50,000/year
10 city blocks & 4.2 million square feet
ADC: 962

9. Revising RN Orientation

10. PDCA 2010 – Major Revision 2 weeks (one week blended orientation)
Did include QSEN framework – Content not “really” clearly mapped objectives
2015 – Major Revision
Reduced to one week + follow up day
Comprehensive cross walk w/ QSEN competencies
Pre/post test
2015 – June Test Revisions
21 items same for pre and post
2016 – Moderate Revisions
Revisited cross walk
Lecture updates, splitting of computer training day
PDCA

12. Generic RN Orientation Model
24 Cohorts per year
750+ RNs

15. Developed “Cross Walk table” for each day’s agenda
Mapped the topic with specific Pre-Licensure QSEN competencies
Gap analysis for speakers
QSEN Competency
# of Obj. Covered
PFCC 12
Teamwork 6
EBP 5 QI 7
Safety
Informatics

16. Meeting the Objectives
Content / Key Points
Objectives
Patient & Family Centered Care – Dee Dee Story
Value seeing health care situations “through patients’ eyes” (PFCC)
Examine common barriers to active involvement of patients in their own health care processes. (PFCC)
Examine how the safety, quality and cost effectiveness of health care can be improved through the active involvement of patients and families. (PFCC)
Scripted Debriefing: “Debriefing with Good Judgement”
Reactions
“I Saw”; “I think”; “I wonder”
Generalizations to practice

17. Meeting the Objectives….
Content / Key Points
Objectives
Medication Safety & Pain Mang.
(Blended Afternoon)
Recognize personal held values and beliefs about the management of pain and suffering (journal club activity)(PFCC).
Appreciate the role of the nurse in relief of all types of sources of pain and suffering (PFCC).
Read original research and evidence reports related to area of practice.(EBP)
Describe approaches for changing processes of care(QI)
Bell, L., & Duffy, A. (2009). Pain assessment and management in surgical nursing: a literature review. British Journal Of Nursing, 18(3), p.

19. Testing – Methodology
IRB was obtained.
A total of 281 participants (from 4 different cohorts) were eligible to participate in the study.
153 (54.4%) consented for their data to be used for research purposes.

20. 21 item multiple choice test
Testing Blueprint …
21 item multiple choice test
Test questions developed by content experts at UABH & UABSON.
Pretest (Day One of RN orientation)
Posttest (RN follow up day – 4 weeks later)
Focused on three QSEN domains
EBP, QI, & PS
Pre and Post tests were paired with employee generated user id code

21. There no significant difference in pre and post-test results (p = .12)
Overall testing
There no significant difference in pre and post-test results (p = .12)
Pretest Mean = 14.89; Posttest Mean = 15.16
Subscale Analysis
No difference in EBP or QI subscales (p = .68)
Statistically significant difference in PS subscale (p < .01)

22. Test scores and Educational Level
Results…
Test scores and Educational Level
Significant difference in pre and post test subscale scores QI and EBP.
No significant difference in PS subscale by education
Note: Two participants had graduate degrees. They were not included in this analysis

23. Subscale Analysis by Educational Level
p value
ADN – Mean Score
BSN – Mean Score
Total Score
Pre Test
13.41
15.24
<.01
Post Test
13.97
15.50 QI
3.81
4.61
<0.01
3.97
4.54
.02
EBP
4.17
4.87
4.25
4.98 PS
5.41
5.76
.05
5.75
5.97
.23

24. Limited foundation in QI and EBP Expected for ADN programs
Discussion Points…
Pre-Test scores
Limited foundation in QI and EBP
Expected for ADN programs
Sample was mostly newly graduated BSN
Strong foundation in PS
Cornerstone of nursing practice
Explore how PS is threaded throughout curriculum

25. Gap for ADN & BSN knowledge
Discussion Points..
Gap for ADN & BSN knowledge
In line with previous work by Cabaniss, 2014.
Highlight need for practice settings to tailor educational programs.

26. Lessons learned from academia Experiential learning
Discussion Points…
Posttest Results
Our results highlight that a one time bolus of QI and EBP content is insufficient to address the educational gap of new hires.
Lessons learned from academia
Experiential learning
Threaded concepts into existing content
Don’t Re-invent the Wheel

27. QSEN is a viable educational framework for Practice Settings.
Discussion Point…
QSEN is a viable educational framework for Practice Settings.
QSEN competencies are clearly aligned with JC & Magnet (Lyle-edrosolo & Waxman 2016).
QSEN KSA provide excellent scaffolding for RN Orientation, Residency, and continued staff development.
Leverage point for practice and academia partnerships

29. Conclusion..
Incorporating QSEN into practice setting provides a validation for new graduate RNs that what they learned in their course work is valued in practice.
It ensures experienced RN have exposure to the IOM core competencies.
It requires a systematic approach to thread competencies into current education – not a new program or initiative.

30. David H. James djames@uabmc.edu
Questions..
David H. James

31. References:
Cabaniss, R. (2014). Faculty identification of competencies addressing quality and safety education in Alabama Associate Degree Nursing Education Programs. Teaching and Learning in Nursing, 9,
Cronenwett, L. R. (2012). A national initiative: Quality and safety education for nurses (QSEN). In G. Sherwood & J. Barnsteiner (Eds.). Quality and safety in nursing: A competency approach to improving outcomes (pp ). West Sussex, UK: Wiley-Blackwell.
Lyle-Edrosolo, G., & Waxman, K. (2016). Aligning Healthcare Safety and Quality Competencies: Quality and Safety Education for Nurses (QSEN), The Joint Commission, and American Nurses Credentialing Center (ANCC) Magnet® Standards Crosswalk. Nurse Leader, 14(1), doi: /j.mnl