After reviewing the 2012 QSEN Graduate Competencies, identify a quality/safety issue that you have seen in your practice or clinical setting.
Explain to your classmates the issue you have identified and the reasons why it is an issue. Include the potential negative outcomes that can arise if the issue is not resolved.
For example, you notice the provider is not following the American Cancer Society’s recommendation for cervical cancer screening. This issue in quality competency can lead to under-testing, over-testing, increased cost, and increased potential for surgical procedures. These factors can have negative consequences, such as higher risk for preterm labor, or infertility.
As you create your post, review the knowledge, skills and attitudes of the relevant competency regarding the quality/safety issue you have identified.
with refrences
1
Graduate-Level QSEN Competencies
Knowledge, Skills and Attitudes
September 24, 2012
Background
The Robert Wood Johnson Foundation (RWJF) has made significant and ongoing contributions to ensure that
nursing professionals are provided the knowledge and tools needed to deliver high quality, safe, effective, and
patient-centered care. Much of this work has focused on nurses in entry-level roles. Beginning with Phase I,
the Quality and Safety Education in Nursing (QSEN) project, led by Dr. Linda Cronenwett, identified the
knowledge, skills, and attitudes (KSAs) that nurses must possess to deliver safe, effective care (Smith,
Cronenwett, & Sherwood, 2007). This phase met the challenge of preparing future nurses to continuously
improve the quality and safety of the healthcare systems within which they work. In Phase II, QSEN faculty,
a National Advisory Board, and 17 leaders from 11 professional organizations representing advanced nursing
practice defined graduate-level quality and safety competencies for nursing education and proposed targets
for the KSAs for each competency (Cronenwett et al., 2009). Additionally, in QSEN Phase III, RWJF funded
significant work at the American Association of Colleges of Nursing (AACN). This work developed the
capacity of faculty engaged in pre-licensure nursing education of all types to mentor their colleague faculty
members in the integration of the evidence-based content that will educate entry-level students about the six
QSEN competencies.
The growing focus on ensuring and measuring quality and efficiency of healthcare outcomes necessitates
markedly transformed graduate-level nursing education. In keeping with the Institute of Medicine’s report on
the Future of Nursing (2011), graduate nurses will be the future leaders in practice, administration, education,
and research. Due to healthcare reform, multiple changes in the delivery of care, and the number of
Americans with access to this care, the need for highly educated nurses will expand dramatically. It is
essential that these nurses understand, provide leadership by example, and promote the importance of
providing quality health care and outcome measurement.
In February 2012, RWJF engaged AACN in an effort to expand the reach of the national QSEN initiative in
graduate education programs. Building on work completed by AACN at the undergraduate level and also in
Phase II of the earlier QSEN initiative, this new project was launched to provide educational resources and
training to enhance the ability of faculty in master’s and doctoral nursing programs to teach quality and safety
competencies. During this phase of QSEN, AACN collaborated with expert consultants and stakeholders to
achieve four primary goals, specifically:
• Update and reach consensus on the quality and safety competencies that must be accomplished in a
graduate nursing program;
• Create learning resources, modules, and interactive case studies to help prepare graduates with the
competencies needed to provide quality and safe care across all settings;
• Host workshops to train faculty from over half of the nation’s graduate-level nursing programs and
their clinical partners to facilitate the implementation of the consensus-based competencies; and
• Develop a Web-based learning program, a speakers’ bureau, an online collaboration community, and
content-specific teaching materials for graduate-level faculty and their clinical partners.
In order to accomplish the first goal, AACN convened a panel of experts in the field of quality and safety
education and graduate-level practice as well as representatives of key stakeholder organizations. This
advisory group reviewed the existing QSEN graduate competencies, as well as AACN’s recently revised
Essentials of Master’s Education in Nursing (2011), to determine the competencies that graduate-prepared
nurses must possess to meet contemporary care standards.
The KSAs on pages 5-18 represent the advisory group’s consensus on the graduate-level quality and safety
competencies that are relevant to the existing standards for all graduate nursing education. Sections in bold
represent content from the 2009 Nursing Outlook article by Dr. Cronenwett and colleagues; the non-bolded
sections are the revisions recommended by the advisory group.
4
Definitions of QSEN Competencies
Quality Improvement (QI): Use data to monitor the outcomes of care processes and use
improvement methods to design and test changes to continuously improve the quality and safety
of healthcare systems.
Safety: Minimize risk of harm to patients and providers through both system effectiveness and
individual performance.
Teamwork and Collaboration: Function effectively within nursing and interprofessional teams,
fostering open communication, mutual respect, and shared decision-making to achieve quality
patient care.
Patient-centered Care: 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.
Evidence-Based Practice (EBP): Integrate best current evidence with clinical expertise and
patient/family preferences and values for delivery of optimal health care.
Informatics: Use information and technology to communicate, manage knowledge, mitigate
error, and support decision making.
5
Graduate-Level QSEN Competencies
Quality
Knowledge Skills Attitudes
Describe strategies
for improving
outcomes at all
points of care
Translate aims for
quality improvement
efforts
Align the aims,
measures, and changes
involved in improving
care
Commit to concepts of transparency,
managing variability measurement and
accountability
Describe nationally
accepted quality
measures and
benchmarks in the
practice setting
Use a variety of
sources of information
to review outcomes,
compare benchmarks
of care, and identify
potential areas for
improvement (e.g.,
National Database of
Nursing Quality
Indicators; Hospital
Compare; Center for
Medicare/ Medicaid
Services (CMS)
indicators, Joint
Commission: ORYX,
National Public Health
Performance Standards
and others)
Participate in analysis
of databases as sources
of information for
improving patient care
Use quality indicators
and benchmarks for
improving system
processes and outcomes
Commit to achieving the highest level of
processes and outcomes of care
Inspire others to achieve benchmark
performance
Model behaviors reflective of a
commitment to high quality outcomes
Evaluate the
relevance of quality
indicators and their
associated
Identify useful measures
that can be acted on to
improve outcomes and
processes
Value the importance of the use of data
in quality improvement
6
measurement
strategies
Explain variance
and its common
causes in patient
care process and
outcomes including
costs
Select and use quality
improvement tools
(e.g., run charts,
control charts, root
cause analysis, flow
diagrams and GANTT
charts) to achieve best
possible outcomes
Commit to reducing unwarranted
variation in care
Analyze ethical
issues associated
with continuous
quality
improvement
Participate in the
design and monitoring
of ethical oversight of
continuous quality
improvement projects
Maintain
confidentiality of any
patient information
used in quality
improvement efforts
Value ethical conduct in quality
improvement efforts
Value the roles of others, such as IRBs,
in assessing ethical and patient
rights/informed decision making
Analyze the impact
of context such as
access, cost,
environment,
workforce, team
functioning, or
community
engagement on
improvement
efforts
Lead improvement
efforts, taking into
account context and best
practices based on
evidence
Demonstrate commitment to process
improvement
Value context (e.g., work environment,
team functioning, social determinants)
as an important contributor in quality
care
Understand
principles of
change
management
Apply change
management principles
by using data to
improve patient and
systems outcomes
Appreciate that all improvement is
change
Demonstrate leadership in affecting the
necessary change
Evaluate the effect
of planned change
on outcomes
Design, implement,
and evaluate small
tests of change in daily
work (e.g., using an
experiential learning
method such as Plan-
Do-Study-Act)
Value planned change
Analyze the impact
of linking payment
to quality
Use benchmarks that
carry financial penalties
(e.g., serious reportable
Consistent with the National Quality
Strategy, commit to achieving the
highest quality of care in the practice
7
improvement events) to improve care setting (e.g., National Strategy’s aims of
Better Care, Healthy People, and
Affordable Care)
Describe the intent
and outcomes of
public reporting
Use public reporting
information to advance
quality improvement
efforts
Appreciate that consumers will be more
empowered to make decisions based on
quality information
Value community engagement in quality
improvement decision making
Safety
Knowledge Skills Attitudes
Analyze factors that
create a culture of safety
and a “just culture”
Use existing resources to
design and implement
improvements in practice
(e.g., National Patient
Safety Goals)
Use evidence and research-
based strategies to promote
a “just culture”
Commit to being a safety
mentor and role model
Accept the cognitive and
physical limits of human
performance
Value a systems approach
to improving patient care
instead of blaming
individuals
Identify best practices
that promote patient,
community, and provider
safety in the practice setting
Integrate strategies and
safety practices to reduce
risk of harm to patients, self
and others
(e.g., risk evaluation and
mitigation strategy
[REM])
Value the process of risk
reduction in health systems
Analyze human factors
safety design principles as
well as commonly used
unsafe practices (e.g.,
work-arounds, risky
behavior, and hazardous
abbreviations)
Demonstrate leadership
skills in creating a culture
where safe design principles
are developed and
implemented
Engage in systems focus
when errors or near misses
occur
Promote systems that
reduce reliance on memory
Appreciate the role of
systems problems as a
context for errors
Accept the limitations of
humans
8
Identify effective strategies
to promote a high reliability
organization
Create high reliability
organizations based on
human factors research
Report errors and support
members of the health
care team to be
forthcoming about errors
and near misses
Anticipate/prevent systems
failures/hazards
Commit to working to
achieve a high reliability
organization
Value the contribution of
standardization and
reliability to safety
Value open and honest
communication with
patients and families about
errors and hazards
Encourage reporting of
errors as a foundational
element to improve quality
and systems
Describe evidence-based
practices in responding to
errors and good catches
Use evidenced-based best
practices to create policies
to respond to errors and
“good catches”
Value the use of
organizational error and
reporting systems
Identify process used to
analyze causes of error
and allocation of
responsibility and
accountability (e.g., root
cause analysis and failure
mode effects analysis)
Design and implement
microsystem changes in
response to identified
hazards and errors
Commit to identification of
errors and hazards
Commit to individual
accountability for errors
Summarize methods to
identify and prevent
verbal, physical and
psychological harm to
patients and staff
Encourage a positive
practice environment of
high trust and high respect
Develop culture where
hostile work environment is
not tolerated.
Use best practices and legal
requirements to report and
prevent harm
Value a work and patient
care culture where dignity
and respect are fostered
inclusive of prevention of
assaults and loss of dignity
for patients, staff and
aggressors
Analyze potential and
actual impact of national
patient safety resources,
initiatives and regulations
on systems and practice
Use national patient safety
resources to design and
implement improvements in
practice
Value the relationship
between national patient
safety campaigns and
implementation of system
and practice
improvements
9
Teamwork and Collaboration
Knowledge Skills Attitudes
Analyze self and other team
members strengths,
limitations, and values
Demonstrate awareness of
personal strengths and
limitations as well as those
of team members
Value the contributions of
self and others to effective
team function
Understand the roles and
scope of practice of each
interprofessional team
member including patients,
in order to work effectively
to provide the highest level
of care possible
Work with team members
to identify goals for
individual patients and
populations
Function competently
within own scope of
practice as a member of
the health care team
Ensure inclusion of patients
and family members as part
of the team based on their
preferences to be included
Respect the centrality of
the patient/family as core
member of any health
care team
Value the team approach to
providing high quality care
Analyze the impact of
team-based practice
Act with integrity,
consistency, and respect
for differing views
Continuously plan for
improvement in self and
others for effective team
development and
functioning
Commit to being an
effective team member
Be open to continually
assessing and improving
your skills as a team
member and leader
Analyze strategies for
identifying and managing
overlap in team member
roles and accountabilities
Guide the team in
managing areas of overlap
in team member
functioning
Use effective practices to
manage team conflict
Elicit input from other
team members to improve
individual, as well as
team, performance
Value conflict resolution as
a means to improve team
functioning
Support the development of
a safe team environment
where issues can be
addressed between team
members and conflict can
be resolved
10
Analyze strategies that
influence the ability to
initiate and sustain
effective partnerships with
member of nursing and
interprofessional teams
Initiate and sustain
effective health care teams
Integrate into practice
interprofessional
competencies as developed
(e.g., IPEC teamwork,
collaboration,
understanding each other’s
roles, communication)
Commit to interprofessional
and intraprofessional
collaboration
Analyze impact of cultural
diversity on team
functioning
Communicate with team
members, adapting
communication style to the
needs of team and situation
Commit to cultural humility
within the team
Analyze differences in
communication style and
preferences among
patients and families,
nurses, and other members
of the health team
Communicate respect for
team member competence
in communication
Value different styles of
communication
Describe strategies to
integrate patients/families
as primary members of the
healthcare team
Use patient-engagement
strategies to involve
patients/families in the
healthcare team
Value patients/families as
the source of control for
their health care
Describe strategies to
engage patients, families
and communities in health
promoting activities and
behaviors
Use participatory
engagement strategies to
involve patients, families
and communities as
partners in promoting
healthy behaviors
Value equitable partnership
with patients, families and
communities in determining
health promotion priorities
and strategies
Describe appropriate
handoff communication
practices
Use communication
practices that minimize
risks associated with
handoffs among providers
and across transitions of
care
Appreciate the risks
associated with handoffs
among providers and
across transitions in care
Analyze authority
gradients and their
influence on teamwork
and patient safety
Choose communication
styles that diminish the
risks associated with
authority gradients among
team members
Value the solutions
obtained through
systematic
interprofessional
collaborative efforts
11
Assert own position,
perspectives, and
supporting evidence in
discussion about patient
care
Identify system barriers
and facilitators of effective
team function
Lead or participate in the
design and
implementation of systems
that support effective
teamwork
Value the influence of
system solutions in
achieving team
functioning
Examine strategies for
improving systems to
support team functioning
Apply state and national
policy efforts to practice
setting that improve
teamwork and
collaboration
Value the importance of
state and national policy
work in setting standards
for improvement of
teamwork and collaboration
Patient-Centered Care
Knowledge Skills Attitudes
Analyze multiple
dimensions of patient-
centered care including
patient/family/community
preferences and values, as
well as social, cultural,
psychological, and spiritual
contexts
Based on active listening to
patients, elicit values,
preferences, and
expressed needs as part of
clinical interview,
diagnosis, implementation
of care plan as well as
coordination and
evaluation of care
Commit to the patient being
the source of control and
full partner in his/her care
Analyze the factors that
create barriers to patient-
centered care
Identify and create plans to
address barriers in care
settings that prevents fully
integrating patient-centered
care
Commit to system changes
to create a patient-centered
care environment
Synthesize critical
information about health
literacy based on diversity
of patient population
Assess patients’
understanding of their
health issues and create
plans with the patients to
manage their health
Commit to patient-centered
collaborative care planning.
Accept that health literacy
is a problem in safe care,
especially during the
transition to home-based
care
Value diversity of health
literacy levels among
patient populations
12
Analyze the effectiveness of
methods to engage specific
patients as partners in their
health care
Effectively work with
patients to engage them in
their health care as they
deem appropriate for them
Respect preferences of
patients related to their level
of engagement in health
care decision-making.
Analyze patient-centered
care in the context of care
coordination, patient
education, physical comfort,
emotional support, and care
transitions
Work with patients to create
plans of care that are
defined by the patient
Commit to respecting the
rights of patients to
determine their care plan to
the extent that they want
Analyze ethical and legal
implications of patient-
centered care
Work to address ethical and
legal issues related to
patients’ rights to determine
their care
Respect that legal and
ethical issues provide a
framework for patient-
centered care
Describe the limits and
boundaries of patient-
centered care
Support patients in their
decisions even when the
decision conflicts with
personal values
Respect the boundaries of
therapeutic relationships
Analyze concepts related to
conflictual decision making
by patients
Assess level of patient’s
decisional conflict and
provide appropriate
support, education and
resources
Respect the complexity of
decision making by patients
Analyze personal attitudes,
values, and beliefs related
to patient- centered care
Continuously assess and
monitor own efforts to be
patient-centered
Commit to continuously
assess own participation in
patient-centered care
Analyze strategies that
empower patients or
families in all aspects of
the health care process
Engage patients or
designated surrogates in
active partnerships along
the health-illness
continuum
Eliminate barriers to
presence of families and
other designated
surrogates based on
patient preferences
Respect patient preferences
for degree of active
engagement in care process
Honor active partnership
with patients or
designated surrogates in
planning, implementation,
and evaluation of care
Value the involvement of
patients and families in care
decisions
Analyze features of
physical facilities that
support or pose barriers
to patient-centered care
Create organizational
cultures so that patient
and family preferences
are assessed and
supported
Appreciate physical and
other barriers to patient-
centered care
13
Assessment of research that
exists for physical designs
that promote patient-
centered care: (e.g.,
modules or pods concepts,
low barriers for children,
color designs that support
rest and stress reduction,
etc.)
Evidence-based practice
Knowledge Skills Attitudes
Demonstrate knowledge of
health research methods
and processes
Use health research
methods and processes,
alone or in partnership
with scientists, to generate
new knowledge for
practice
Appreciate strengths and
weaknesses of scientific
bases for practice
Describe evidence-based
practice to include the
components of research
evidence, clinical
expertise, and
patient/family/community
values
Role model clinical
decision making based on
evidence, clinical
expertise, and
patient/family/community
preferences
Value all components of
evidence-based practice
Identify efficient and
effective search strategies
to locate reliable sources
of evidence
Employ efficient and
effective search strategies
to answer focused clinical
or health system practices
Value development of
search skills for locating
evidence for best practice
Identify principles that
comprise the critical
appraisal of research
evidence
Critically appraise
original research and
evidence summaries
related to area of practice
Value knowing the
evidence base for one’s
practice specialty area
Summarize current
evidence regarding major
diagnostic and treatment
actions within the practice
specialty and healthcare
delivery system
Exhibit contemporary
knowledge of best
evidence related to
practice and healthcare
systems
Value cutting-edge
knowledge of current
practice
Determine evidence gaps
within the practice
specialty and healthcare
delivery system
Promote a research
agenda for evidence that is
needed in practice
specialty and healthcare
system
Value working in an
interactive manner with the
Institutional Review Board
14
Actively engage with the
institutional review board to
implement research
strategies and protect
human subjects
Identify strategies to
address gaps in evidence
based guidelines
Use quality improvement
methods to address gaps in
evidence based guidelines
Appreciate the gaps in
evidence related to practice
Develop knowledge that
can lead the translation of
research into evidence-
based practice
Build consensus among key
stakeholders through the
use of change theory to
create evidence-based care
Lead and marshal the
resources for change that
supports evidence-based
practice
Champion the changes
required that support
evidence-based practice
Analyze how the strength
of available evidence
influences care-
(assessment, diagnosis,
treatment, and evaluation)
Implement care practices
based on strength of
available evidence
Appreciate the strength of
evidence on provision of
care
Evaluate organizational
cultures and structures
that promote evidence-
based practice
Participate in designing
organizational systems that
support evidence-based
practice
Appreciate that
organizational systems can
significantly influence
nursing’s efforts in
evidence-based practice
Understand the need to
define critical questions
related to practice and
healthcare system delivery
Use coaching skills to
engage nurses in evidence
based practice and research
Appreciate that all nurses
can participate in creating
evidence-based practice
Informatics
Knowledge Skills Attitudes
Analyze systems theory and
design as applied to health
informatics
Use performance
improvement tools (e.g.,
Lean, Six Sigma, PDSA) in
system analysis and design
to assess use of technology
to improve care)
Use project management
methods in relation to
implementation of new
technologies
Value systems thinking and
use of technology to
improve patient safety and
quality
Appreciate the Systems
Development Lifecycle
(SDLC) in the design of
information systems
15
Model behaviors that
support theories and
methods of change
management
Evaluate benefits and
limitations of common
information systems
strategies to improve safety
and quality
Evaluate the strengths
and weaknesses of
information systems in
practice
Participate in the
selection, design,
implementation, and
evaluation of information
systems
Consistently communicate
the integral role of
information technology in
nurses’ work
Model behaviors that
support implementation
and an appropriate use of
electronic health records
Assist team members in
adopting information
technology by piloting and
evaluating proposed
information technologies
Participate in the design
of clinical decision
supports (CDS) systems
(e.g., alerts and reminders
in electronic health
records)
Anticipate unintended
consequences of new
technology
Recognize nursing’s
important role in selecting,
designing, implementing
and evaluating health
information systems for
practice environments.
Appreciate the need for an
interprofessional team to
make final decisions related
to selection and use of new
information systems
Value the use of
information technologies
in practice
Know the current regulatory
requirements for
information systems use
Use federal and other
regulations related to
information systems in
selecting and implementing
information systems in
practice
Appreciate the role that
federal regulation plays in
developing and
implementing information
systems that will improve
patient care and create more
effective delivery systems
Identify the critical and
useful electronic data
needed to provide high
quality, efficient care
Search, retrieve, and
manage data to make
decisions using
information and
Appreciate the importance
of valid, reliable and
significant data to improve
quality and provide efficient
16
through effective decision
support (clinical, financial
and administrative
outcomes)
knowledge management
systems
Use the existing coding and
billing system to
appropriately reflect the
level and type of service
delivered in practice
Model behaviors that
support implementation and
appropriate use of data
accessed through databases,
electronic health records,
dashboards, remote
monitoring devices,
telemedicine and other
technologies
and effective care
Evaluate benefits and
limitations of different
health information
technologies and their
impact on safety and
quality
Promote access to patient
care information for all
who provide care
Serve as a resource for
documentation of nursing
care at basic and
advanced levels
Develop safeguards for
protected health
information
Comply with HIPAA
regulations in the use of
electronic health records
and other sources of
patient information.
Champion communication
technologies that support
clinical decision-making,
error prevention, care
coordination,
interprofessional
collaboration, and
protection of patient
privacy
Appreciate the need for
consensus and
collaboration in
developing systems to
manage information in
practice
Value the confidentiality
and security of all
electronic information
17
Understand how technology
can be used to engage and
empower patients as
partners in managing their
own care
Model behaviors that
support the use of consumer
informatics (e.g., consumer
website, social networking,
telemedicine, e-visits,
security)
Access and evaluate the use
of mobile technologies
(e.g., sensing devices,
mobile communication
devices, smart phones and
other devices) to improve
quality and safety
Appreciate the benefits of
socio-technology
innovation for improving
patient safety and quality
Describe and critique
taxonomic and
terminology systems used
in national efforts to
enhance interoperability
of information systems
and knowledge
management systems
Access and evaluate high
quality electronic sources of
health care information
Support efforts to develop
interoperable regional
health information systems
Value the importance of
standardized
terminologies in
conducting searches for
information
Appreciate the
contribution of
information technology to
improve patient safety
(e.g, alerts reminders and
other forms of CDS)
Appreciate the time,
effort, and …
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