Running head: QUALITY AND SAFETY NEEDS ASSESSMENT AND PLAN

Everest Institute Quality and Safety Needs Assessment and Plan

Amy J. Herrington
Ferris State University

QUALITY AND SAFETY NEEDS ASSESSMENT AND PLAN

Abstract
Redesigning the traditional nursing curriculum to include quality and safety education is
imperative. Nurse educators play a significant leading role in preparing future nurses with the
knowledge, skills and attitudes needed to provide safe, quality care. Everest Institute is a forprofit, private practical nursing school. Everest Institutes current curriculum lacks quality and
safety education. High reliability standards, quality improvement models and Just Culture are
significant pieces of quality and safety education and practice. To address Everest Institutes
need of quality and safety education, a plan to assimilate the Quality and Safety Education for
Nurses (QSEN) competencies into clinical education is developed. The plan to incorporate
quality and safety education can result in improved delivery of nursing care and is tied to the
nursing-sensitive indicator of education. The professional nurse is responsible for providing
quality, safe care, and reducing harm. Implementation of QSEN competencies into the
curriculum can prepare the future nurse with the knowledge, skills, and attitudes to meet ethical
responsibilities.
Keywords: quality, safety, QSEN, curriculum

QUALITY AND SAFETY NEEDS ASSESSMENT AND PLAN

Everest Institute Quality and Safety Improvement Need Assessment and Plan
A culture dedicated to quality and safety improvement in healthcare is essential to
improve patient outcomes. As the largest professional sector in healthcare, the nursing
profession has the ability to impact other healthcare professions and advocate for quality and
safety improvement. Nurses must be educated on the importance of quality and safety
improvements, as well as identifying opportunities for improvement. Nurse educators have the
opportunity to instill a culture of quality and safety into future nurses. The preparation of
nursing students with the knowledge, skills, and attitudes to improve quality and safety is the
responsibility of nurse educators. Nurse educators are faced with the challenge of integrating
quality and safety education into an already overburdened curriculum. The purpose of this paper
is to assess the challenge of assimilating quality and safety education into a nursing curriculum
and to identify a plan to resolve that challenge.
Needs Assessment of Quality and Safety Education
The Institute of Medicine published two reports in 1999 and 2001, the reports prompted
increasing media coverage on quality and safety in patient care (Chenot & Daniel, 2010). When
considering the number of medical errors that occur each day, it is evident that healthcare
professionals need to be prepared with the knowledge and skills to provide safe, quality care.
However, only marginal evidence shows pre-licensure students are equipped with the skills
needed to scrutinize safety and quality concerns (Chenot & Daniel, 2010).
There have been many efforts to drive improvement in patient safety and quality. The
role of the educational leader in quality and safety improvement is becoming apparent (Chenot &
Daniel, 2010). According to an article by Chenot & Daniel (2010), educational leaders in health
care should strive to develop curriculum frameworks that place appropriate emphasis on patient
safety (p. 560). The shift to patient-centered, safe, quality care calls for a shift in nursing
curriculum.

QUALITY AND SAFETY NEEDS ASSESSMENT AND PLAN

The practical nursing program at Everest Institute would benefit from the integration of
quality and safety education into the curriculum. Everest Institute is a for-profit, private institute.
The faculty members teaching in the practical nursing program are primarily bachelors prepared
nurses, with a minimal number of faculty members masters prepared or enrolled in a masters
program. Due to the number of faculty members with the highest level of education at the
bachelors level, many faculty members are not familiar with quality and safety initiatives, such
as the Quality and Safety Education for Nurses (QSEN) initiative. The integration of quality and
safety education into the curriculum would be beneficial for students and faculty members.
Safety and quality improvement education is not evident in the practical nursing
curriculum at Everest Institute. Safety and quality are embedded in certain classroom and
clinical content; however it varies from instructor to instructor. This lack of quality and safety
within the curriculum demands more attention. Safety and quality improvement should be
fundamental parts of any nursing curriculum (Chenot & Daniel, 2010). Ideally, course objectives
and program outcomes would be constructed around quality and safety.
Consistency in quality and safety education is also a concern. Currently, clinical
instructors are not given any guidance on the structure of post-conference or the content needed
to be covered in clinical. In the past, this has resulted in select clinical groups benefitting from
post-conferences concentrated on quality and safety topics, while other clinical groups may
never discuss quality and safety issues. This identifies a need to develop a teaching guide for
post-conference topics.
Many factors play into the need for additional quality and safety education at Everest
Institute. Education of faculty on the importance of the educators role in developing a culture of
quality and safety is a primary focus, as well as educating faculty on quality and safety
initiatives. Integrating quality and safety into the curriculum is critical to the development of

QUALITY AND SAFETY NEEDS ASSESSMENT AND PLAN

well-prepared nursing professionals. Standardization of the content to be covered by clinical

nursing instructors is also needed.
High Reliability Standards, Just Culture Principles, & Quality Improvement Models
High reliability organizations include industries such as aviation and nuclear plants.
However, other industries have started examining high reliability standards and attempting to
become a high reliability organization, including healthcare. High reliability organizations
consistently reach their goals, avoid errors and revel in the identification of near misses (Agency
for Healthcare Research and Quality [AHRQ], 2008). All employees in a high reliability
organization must be committed to collective mindfulness (AHRQ, 2008). High reliability
includes five characteristics of mindfulness thinking, including sensitivity to operations,
preoccupation with failure, deference to expertise, resilience, and reluctance to simplify (AHRQ,
2008).
Becoming a high reliability organization is a process that occurs over time and must be
completed in steps (AHRQ, 2008). In a school of nursing, the focus would be taking steps to
ensure success and prevent failure. This would begin with leadership and all faculty members
equally committed to a goal of student success (Chassin & Loeb, 2013).
Educating nursing students on aspects of high reliability organizations and quality
improvement models could be beneficial to students when they enter the workforce and
potentially become part of the high reliability thinking. This could include education on Six
Sigma and Lean. It is important for future nurses to understand the Lean process because Lean
plays a role in improving patient outcomes, costs and staff satisfaction (Graban, 2012).
When an error occurs in a Just Culture, the focus is on identifying the cause rather than
blaming an individual. A Just Culture environment is not punitive when the error was not
deliberate or an action was not measured accurately (ANA, 2010). When an action is malicious
or intentional and results in an error, this is punishable and not tolerated (ANA, 2010). This type
of environment has the ability to result in increased reporting of errors or near misses because the

QUALITY AND SAFETY NEEDS ASSESSMENT AND PLAN

individual does not fear repercussions, ultimately resulting in improved quality and safety (ANA,
2010).
In a school of nursing, it is imperative to develop a Just Culture. Educating nursing
students on the importance of reporting errors and near misses can impact how a student handles
errors in professional practice. A safe, trusting relationship must be developed between students
and clinical instructors. In a Just Culture, nursing students should feel more comfortable
reporting errors or safety concerns to the clinical instructor because punishment is not feared.
Educating nursing students on high reliability organizations and quality improvement
models will be beneficial in their professional practice. The education will allow the student to
understand the significance of high reliability organizations and quality improvement models.
Immersing students in a Just Culture while in nursing school will provide a safe environment
where students will be comfortable reporting errors to instructors. Students exposed to a Just
Culture in nursing school may aid in the transition to a Just Culture in professional practice.
Proposed Plan for Change
To develop a culture of safety in a learning institution and prepare students with the
knowledge, skills, and attitudes needed to deliver safe, quality care; safety and quality concepts
need to be assimilated throughout the entire nursing curriculum (Jones, 2013). The importance
of incorporating QSEN competencies into nursing education has been revealed in the literature,
highlighting the need to begin incorporating QSEN competencies in the first semester through
the last (Jones, 2013). Due to a content laden curriculum, adding quality and safety education
into the curriculum does present some barriers. However, utilizing clinical and post conference
time affords an opportunity to provide quality and safety education. Incorporation of quality and
safety education into clinical will also resolve the issue of discrepancies in education received in
clinical post-conference.
The plan will begin by assessing the quality and safety knowledge of practical nursing
faculty members at Everest Institute. Having an idea of the different levels of understanding and

QUALITY AND SAFETY NEEDS ASSESSMENT AND PLAN

familiarity with QSEN will provide direction for staff education. This could be done by a brief
survey or through interviews.
Following staff assessment, providing education to faculty members at Everest Institute
on the importance of quality and safety education and why it must be integrated into the
curriculum would be the next step. QSEN and the knowledge, skills, and attitudes will be
reviewed. Information could be dispersed through PowerPoints, staff meetings and emails with
helpful facts and tips.
The practical nursing program is three semesters for the full-time program and six
semesters for the part-time program. The set-up of the semesters would allow for integration of
two QSEN competencies per semester for the full-time program and one QSEN competency per
semester for the part-time program. The first two competencies covered would be patient
centered care and informatics, followed by quality improvement and safety, and the final
competencies of teamwork and collaboration and evidence-based practice. Based on each
competency, a teaching plan would be developed with various activities and assessment plans.
Each plan would allow for flexibility per clinical instructor but ultimately students would need to
meet new safety and quality outcomes developed.
Following development of teaching plans for specific competencies, additional faculty
education would be provided to review teaching strategies, student outcomes, activities, and
assessment methods. This would also allow for faculty input and feedback. This plan would
give faculty members the opportunity to become more familiar with the QSEN initiative and
become leaders in the quality and safety arena.
In the past, nursing students have not been adequately prepared by a traditional nursing
curriculum to transition to a professional role (Jones, 2013). The QSEN initiative provides
valuable information, tools and strategies to incorporate quality and safety into a nursing
curriculum and bridge the gap between nursing education and professional practice (Jones,

QUALITY AND SAFETY NEEDS ASSESSMENT AND PLAN

2013). The QSEN initiative competencies are applicable in a practical nursing curriculum and
will aid in developing nursing professionals providing high quality patient care at all levels
(Jones, 2013).
Association to Nursing Sensitive Indicators
The National Center for Nursing Quality manages the National Database of Nursing
Quality Indicators (NDNQI) (American Nurses Association [ANA], 2014). NDNQI is a
database that stores data collected on certain nursing-sensitive indicators (ANA, 2014). Nursing
care structures, processes, and outcomes are revealed in nursing-sensitive indicators (ANA,
2014). Data is currently being collected on 13 quality indicators, including Registered Nurse
Education/Certification.
Integration of quality and safety education into the nursing curriculum could impact the
structure of nursing care. Specifically, the education of nursing staff would be impacted by
integration of QSEN competencies into the curriculum. Preparing future nurses with improved
quality and safety education would change the current nursing education mix. Improving
education of all levels of nursing could result in enhanced patient outcomes.
Ethical Implications
Nursing professionals pledge to do no harm. However, unintentional harm occurs in
healthcare everyday due to challenges in providing safe, quality care. The United States
healthcare system has faced scrutiny related to errors in healthcare leading to morbidity and
mortality. Although there has been a call for a comprehensive plan in the United States to
manage quality and safety improvements, a leading organization has not emerged (Sherwood &
Barnsteiner, 2012).
There has been movement by quality and safety organizations in the United States
pushing for change, regulations and educational initiatives, as well as a just culture (Sherwood &
Barnsteiner, 2012). It is the ethical responsibility of all nursing professionals to identify quality
and safety concerns and participate in quality and safety improvement. According to Sherwood

QUALITY AND SAFETY NEEDS ASSESSMENT AND PLAN

& Barnsteiner (2012), [n]urses have new roles and responsibilities in continuous quality
improvement (p. 18).
Integration of QSEN competencies into a curriculum would have positive ethical
implications. Improved education in quality and safety has the potential to improve patient
outcomes, lessening the risk of errors, patient morbidity, and patient mortality. Graduate nurses
entering the profession would also be prepared to act as leaders in development and progression
of quality and safety initiatives. These factors could result in a renewed trust in the healthcare
system by consumers.
Nursing professionals continue to be rated as the most trusted professionals by consumers
(ANA, 2013). Integrating QSEN competencies into nursing education has the ability to develop
a culture of safety and quality in each new graduate nurse. Preparing future nurses with all
necessary skills to provide safe, quality care will help maintain the honor of nurses being rated as
the most trusted professionals. In addition, the quality and safety education will allow the nurses
to act as leaders of the healthcare team in regards to quality and safety.
Conclusion
Traditional nursing curriculums need to be redesigned to incorporate quality and safety
education to prepare future nurses with the skills, knowledge, and attitudes needed in
professional practice. Everest Institute has not implemented formal quality and safety teaching
into the curriculum. To better prepare the students at Everest Institute, a plan to incorporate
quality and safety into the curriculum is needed.
To address the needed changes in the curriculum at Everest Institute, the valuable
information, tools, and strategies of the QSEN initiative will be utilized. Due to content overload
in the classroom setting, quality and safety education to meet the QSEN competencies will be
merged into the clinical setting. Altering the curriculum to meet the needs of a nursing student
transitioning into professional practice, will impact the education and skill level of nurses

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entering the healthcare field. Improved quality and safety education has the potential to result in
improved patient outcomes and maintaining the consumers trust in the nursing profession.

References
Agency for Healthcare Research and Quality. (2008). Becoming a high reliability organization:
Operation advice for hospital leaders. Retrieved from
http://www.ahrq.gov/professionals/quality-patient-safety/qualityresources/tools/hroadvice/hroadvice.pdf
American Nurses Association [ANA]. (2010). Position statement: Just culture. Retrieved from
http://nursingworld.org/psjustculture
American Nurses Association. (2013). News release: Public rates nurses most honest. Retrieved
from
http://www.nursingworld.org/FunctionalMenuCategories/MediaResources/PressReleases/
Nurses-Most-Ethical-Profession.pdf
American Nurses Association. (2014). Nursing-sensitive indicators. Retrieved from
http://www.nursingworld.org/MainMenuCategories/ThePracticeofProfessionalNursing/Pa
tientSafetyQuality/Research-Measurement/The-National-Database/Nursing-SensitiveIndicators_1
Chassin, M. R. & Loeb, J. M. (2013). High-reliability health care: Getting there from here. The
Milbank Quarterly, 91(3), p. 459-490.
Chenot, T. M. & Daniel, L. G. (2010). Frameworks for patient safety in the nursing curriculum.
Journal of Nursing Education, 49(10), p. 559-568.
Graban, M. (2012). Lean hospitals: Improving quality, patient safety, and employee engagement.
Boca Raton, FL: CRC Press.

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Jones, A. D. (2013). The impact of integrating Quality and Safety Education for Nurses safety
competency in first-year associate degree nursing students. Teaching and Learning in
Nursing, 8(4), p. 140-146.
Sherwood, G. & Barnsteiner, J. (2012). Quality and safety in nursing: A competency approach to
improving outcomes. Chichester, West Sussex: Wiley-Blackwell.