RN, BSN
Because nurses make up the largest occupation in the healthcare field, we greatly influence the quality and safety outcomes for our patients and the healthcare system.
As part of my bachelor’s program, I learned about the competencies of the Quality and Safety Education for Nurses (QSEN) initiative. This initiative came about to tackle “the challenge of preparing future nurses with the knowledge, skills, and attitudes (KSAs) necessary to continuously improve the quality and safety of the healthcare systems in which they work.”
While the QSEN initiative has primarily focused on nursing students, experienced nurses should be encouraged to learn and apply the QSEN competencies within their nursing practice to improve patient care. This blog describes each competency and provides examples of how you can demonstrate each one.
Because your role as an RN in quality and safety can significantly impact patient care, strive to grow your practice with these 6 QSEN competencies:
The patient and their family are integral partners of the care team. Once they are aware of that, they can feel empowered to participate in the plan of care. Each patient should be treated and cared for holistically, where we consider and respect their preferences, values, and needs (physiological, mental, psychosocial, spiritual, and cultural).
Your teammates include the patient, their family, doctors, certified nurse aides (CNA), other healthcare providers, management, housekeeping, pharmacy, etc. Everyone contributes to improving the quality of patient care. Respect and communication between you and your teammates are essential to treating patients comprehensively.
It is fundamental to protect patients and decrease their risk of harm or injury. Everyone is responsible for the patient’s safety – from the patient to you and everyone else in between. As soon as you recognize a safety issue, it is your responsibility to address it.
Along with your clinical expertise and patients’ preferences, the use of sound clinical evidence from peer-reviewed research serves as the basis for your nursing practice. You can stay up to date with new and updated protocols for patient care by evaluating different peer-reviewed research studies.
Nurses use an ongoing, methodical process (e.g., Plan-Do-Study-Act) to improve their procedures and protocols for better patient care based on research and evidence.
Informatics brings nursing and technology together. We use technology to manage and communicate a patient’s healthcare information, aid in making decisions, and reduce errors.
You’re thinking, “This is great information, and it makes sense. But how can I translate these competencies into meaningful patient care?”. Here are three examples of nursing goals (infection prevention, fall prevention, and pain management), where you can apply the QSEN competencies within your practice.
I will assess the patient’s and family’s knowledge of infection transmission. I will educate them on the importance of washing their hands and using hand sanitizer when entering and exiting the patient’s room.
I will coordinate with physicians, PT, OT, and SLP to execute interventions that will help prevent infection (e.g., antibiotics administration, early ambulation, swallow screen, etc.). I will teach the patient how to use an incentive spirometer, have them use it to show understanding, and provide constructive feedback.
I will clean my stethoscope before and after listening to a patient’s heart, lung, and bowel sounds. I will appropriately dispose of needles in a sharps container.
After caring for a patient with Clostridium difficile, I will follow my facility’s standardized practices based on the evidence from peer-reviewed research studies for handwashing by using warm water and soap for at least 20 seconds.
I will take part in a debriefing session for the unit’s trial implementation of proposed infection prevention protocol updates. I will give feedback as to what works well, what doesn’t, and how we can change our protocols and procedures to continue improving.
I will participate in an electronic health records (EHR) review to understand our catheter-associated urinary tract infection (CAUTI) rates and see if my facility is meeting quality and safety standard.
I will conduct a fall risk assessment with the patient. I will educate the patient on the potential risks for falls in the room, fall prevention interventions that will be implemented during their stay, and interventions they can implement at their home to make it safer.
I will give an accurate hand-off report using SBAR to the oncoming nurse about the patient’s risk factors for falls and the precautions that are in place. I will coordinate with the CNA to take turns routinely rounding on the patient to address the patient’s needs proactively.
I will perform an environmental check before leaving the patient’s room. I will put the patient’s call light within reach and instruct them to use it to get help with ambulation. I will clear obstacles (e.g., trash, cords, equipment, etc.) and clean up spills.
I will take part in the search for peer-reviewed research studies from within the past five years that fit the profiles of our orthopedic patients. I will help evaluate those studies for strengths and weaknesses to find evidence-based interventions that can help increase our patients’ chances of faster recovery without increasing their risk of falls.
I will join my unit’s fall prevention committee and help with designing and testing an evidence-based process improvement strategy to reduce the number of falls. I will compare the number of falls before and after the trial period and see how those numbers compare to our facility’s benchmarks and national benchmarks.
I will enter the results of the patient’s fall risk assessment into the EHR system and document the interventions implemented to communicate this data to members of the patient’s care team.
I will educate my patient that pain and its management are unique to each person. I will encourage them to report any pain they are experiencing and rate it according to the appropriate pain scale.
I will work with the patient and doctor to come up with a pain management plan that includes both pharmacologic and nonpharmacologic interventions. I will coordinate with our hospital’s music, pet, and massage therapists to visit the patient based on the patient’s preferences.
I will use the common rights of medication administration to reduce medication errors. I will monitor the patient for adverse reactions to the pain medication. I will protect my patient’s skin when applying heat or cold to help with pain management.
I will question the rationale for the pain management protocol in practice on my hemodialysis unit that is not based on evidence. After evaluating different research studies, I will help create educational training that addresses our nurses’ needs to improve pain management for our hemodialysis patients.
I will administer a survey to patients to assess their satisfaction with our current pain management protocol. The data from the survey will help drive our unit’s quality improvement pain management project.
I will use the barcode scanner first to scan the patient’s wristband and then the pain mediciation. I will confirm in the electronic medication administration record that the patient I scanned can receieve the scanned pain medication at this time. I will use the EHR system to track the patient’s response to the pain medication.
Nursing is a constantly evolving field. Just as future nurses need to be adequately prepared to enter the workforce, it is equally important for experienced nurses to be open to learning to elevate patient care. Practicing nurses can learn more about and develop the QSEN competencies through RN-to-BSN programs. They can also see if their facilities include QSEN in their orientations and in-service training, and, if not, suggest that it be.
Before your shift, I challenge you to set the tone of your day by thinking about how you can demonstrate the KSAs of the six QSEN competencies. As we are at the forefront of patient care, applying the QSEN competencies of patient-centered care, teamwork and collaboration, safety, evidence-based practice, quality improvement, and informatics can hopefully accomplish the following: empower us within our practice, increase the quality and safety of patient care, and see better clinical outcomes for patients.
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