QSEN: Training Nurses to be Innovation Leaders

By Rick Docksai & Gwen Sherwood, PhD, RN, FAAN, Co-Founder of QSEN

As populations of patients grow ever larger, and the technology and tools of the trade become ever more complicated, hospital systems have to become more open than ever to innovation and improvement, says Gwen Sherwood, a professor and associate dean for academic affairs at the University of North Carolina-Chapel Hill School of Nursing. Fortunately, she adds, nurses can be a leading part of the solution. Sherwood is a co-founder of Quality and Safety Education for Nurses (QSEN), a curriculum that trains nurses to not only work in a constantly changing health-care paradigm, but to implement change within the health-care facilities where they work.

“Health care professionals remain in a continuous learning mode, and that means asking questions: Why am I doing what I’m doing; is there a different way to do it; and so on. In that spirit of inquiry is the room for innovation,” she says.

QSEN began in 2005 as a project with funding from the Robert Woods Johnson Foundation, which gave grants to Professor Linda Cronenwett, Sherwood and a few colleagues to devise new educational training materials for aspiring nurses. QSEN was the result. It identifies six key competencies with the behavioral knowledge, skills, and attitude objectives for preparing nursing students in mastering them. The competencies are as follows:

Patient-Centered Care. This means giving the patients and their family authority over what happens in their care. Nurses who excel at patient-centered care will share as much information as possible with patients and their loved ones, and will include them in on important decisions instead of deciding everything for them.

“It’s treating patients and their families as allies rather than interlopers,” Sherwood says.

Teamwork and Collaboration. To keep providing safe, high-quality care today, health-care practitioners need to work together like never before—across disciplines and across systems. Sherwood explains that hospitals’ traditional operating mode of centralized command structures with strict hierarchies and set procedures will not work anymore.

“Hospitals have largely functioned by rules and procedures and now with evidence based practice. We need to make decisions on when is it appropriate to go outside those rules and procedures to honor patients’ wishes and unique circumstances,” she says.

Evidence-Based Practice. Nurses are the health care professionals who spends the most time with patients, Sherwood notes, and that means that nurses get to know the patients like no one else, and to see firsthand what a particular patient finds helpful or not helpful. She advises nurses to consistently gather data on hospital practices and their impacts on patients, and to convey all their findings to the health team.

“It’s a wonderful opportunity for nurses to have a voice in what happens in health care,” she says.

Quality Improvement. Like any other line of professionals, nurses set standards for the service that they want to offer. They call them “benchmarks”—specific goals that they want their care to meet. “Quality improvement” involves measuring the actual practice and making sure that it is as close to the benchmark as possible.

An example that Sherwood cites is many hospitals’ recording of incidents when patients tripped and fell. Nurses noted each time that a patient fell and why—i.e., the floor was wet, the patient was disoriented, etc. Then the hospital staff figured out ways to minimize falls. Some institutions have in this way decreased incidents to less than one per month.

Informatics. As nurses observe important details on patients’ health and hospital practices, they must record them in electronic format for the information to be useful. The use of technology and support tools to collect and manage data is “informatics.”

Safety. Hospitals have always held individual nurses and doctors accountable for patients’ safety. But nowadays, Sherwood says, they must go further and maximize safety throughout the entire hospital system. This means continually looking for, and correcting, any safety shortcomings within the system.

Sherwood shared the anecdote of a nurse who accidentally gave an infant an adult-size dose of the anticoagulant Heparin, causing the infant to suffer an adverse reaction. The hospital could have simply penalized the nurse.

Instead, it reviewed the incident to determine what led to this mistake. It found the following: The staff had been storing the vial of adult-size doses side-by-side with the child-size dosages, and the vials of both bore similar labels. They consequently decided to separate the two sizes of dosages from then on, and they successfully petitioned the drug manufacturer to change the labeling to make the child and adult vials easier to distinguish.

“That’s taking it from an individual who made a mistake to a poor design decision that then gets corrected,” Sherwood says.

QSEN Across the Nation

In the roughly six years since Sherwood and her colleagues began developing QSEN, the curriculum has made its way into the canon of U.S. nursing education, at both the undergraduate and graduate level. The two groups that accredit nursing schools across the United States—the National League for Nursing and the American Association of Colleges of Nursing—have called upon every nursing school to incorporate QSEN into its instruction. Although not every school has completely followed through on it, almost all are getting there.

“We can begin to expect that every nurse will begin to be educated in these competencies,” Sherwood says.

Many graduate schools will soon be using a QSEN textbook that Sherwood herself co-edited with University of Pennsylvania pediatric-nursing professor Jane Barnsteiner :
Quality and Safety in Nursing: A Competency Approach to Improving Outcomes (Wiley-Blackwell, 2012). The book was published in March of this year and is expected to be in classrooms this coming fall.

Going Worldwide

Now that QSEN has gained acceptance in nursing schools around the United States, Sherwood and her colleagues are interested in sharing the curriculum to health systems all across the world. Health care in western Europe, China, and other regions all differ markedly from U.S. health care, but Sherwood and her colleagues are researching the respective systems to see if training nurses in the QSEN competencies can benefit them, too.

“Every system in the world is reporting problems of quality and safety,” says Sherwood.