RUNNINGHEAD: QSEN COMPETENCIES 1

QSEN Competencies
Vanessa Benning

Concepts Basic to Nursing

B. Briscoe

Bryant and Stratton College

March 31st 2018

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The project for QSEN (quality and safety education for nurses) started in 2005. Started by the

Robert Wood Johnson Foundation the goal was to address the challenge of preparing future nurses with

the knowledge, skills, and attitudes to improve safety and quality of our healthcare systems. This

nationwide effort was to develop quality and safety content to be integrated into nursing curriculum.

There were 3 phases used to get this project running. Phase one was the defining of the “6 competencies”

which were: patient-centered care, teamwork and collaboration, evidence-based practice, quality

improvement, informatics, and safety. The second phase was to have pilot schools integrate the 6

competencies into their nursing programs. Then phase three was to execute the plan, and pick out the

details with a fine tooth comb. Since this implementation schools and institutions have adopted the

QSEN competencies toward a better education (qsen.org, 2018.)

The first QSEN competency to be discussed is patient-centered care. This competency involves

the care team partnering with the patient, respecting the patient’s preferences, and valuing the patient’s

healthcare needs, wants, opinions, and views. Here the nurse needs to recognize the patient as the source

of control while providing compassionate and coordinated care. While in clinical this semester I was able

to see a nurse that followed this competency crossing her T’s, and dotting her I’s. The wound care nurse

made sure to always keep her patients in the fore-front of their treatment. She always made sure to ask

them what areas they would like her to start with, what position suits them best, how they were feeling

about their progress, and finding ways they can start helping themselves. This was great for me to watch,

because I knew from my schooling that she was doing it right. She might have been crunched for time,

but her patient’s needs always came first. They were consistently involved in every treatment that she

performed.

The second QSEN competency in the list would be teamwork and collaboration. This

competency involves nursing working with other professional teams, sharing decision-making, and

integrating their contributions into the care for patients. With this type of collaboration their needs to be

respect for the unique characteristics of all team members. The nurses involved need to foster open
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communication, and mutual respect to achieve quality patient care. This was definitely something that

was lacking at the facility at which we were temporary team members. There were many instances where

asking for help was met with blank faces, empty “No” remarks, and that was if you could even find a

team member to assist you. Nursing students can definitely be viewed as the bottom of the food chain in

facilities they are visiting. However we were there to help, complete tasks, work with their patients, and

learn how to grow our skill-base to help future patients. There were team members that would not listen

while we reported on our patients, would not help us find tools necessary (such as blood pressure cuffs, or

thermometers to complete their vitals,) and did not give us proper information needed for safe patient

care. They were so busy in their own priorities, that they may have not realized the cold shoulder they

were facing directly at us. This problem did not end with the nursing students unfortunately. While there

I did not see many staff-to-staff interactions, and the report-offs between shifts were next to nothing. This

is where errors can happen, and safety gets jeopardized. The main way I saw this being solved was to

start leaving your personal problems at home. Many of the nurses seemed to come in with poor attitudes,

and when working in a team approachability goes a long way toward progress. I also felt there could

have been places more visible for immediate safety report. Maybe a white board in the med room for

safety precautions or isolation related issues, really just finding designated places for quick information

on patients. Whenever we were looking for sheets with the patient’s names and room numbers they were

hard to find, same with the 24-hour boards with safety monitoring. Having spots where all staff

communicate and agree on could save some stress of constant staff questioning.

The third competency to be reviewed is evidence-based-practice. This involves the use of

research and resources to provide and improve patient care. This utilization of data and analysis helps

seek reasoning behind practices, and provides a better nursing outcome. Integrating the best current

evidence with clinical expertise allows for the delivery of optimal healthcare to our patients. This was

another area the facility we visited was extremely lacking. They were a jumbled up mess of information

trails, and it was hard to understand any area of the patient’s progress. There were pieces of the care
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plans scattered among several books, clipboards, and binders. They use computer charting for vitals

tracking, some in-house tests (TB especially, or flu immunizations,) and nursing notes. However the

admission assessments, medical history, and physician notes were in their “paper” charts. To make things

more confusing they had a separate lab book for labs, another clipboard for people on 24 hour monitoring,

a med book for their medications (which also contained TB lab orders,) and then a completely separate

book containing treatments for the patients (topical medications, wound care, assessments, etc…) With

this information spread among all different areas it was hard to connect-the-dots on the patients history of

care within the facility. How can you collect data responsibly if it is sprawled all over the entire facility?

Secondly with them not being fully on board with computerized charting they do not have access that

most hospitals do have for evidence-based information. There was nothing that I had seen in the charts,

or in the computerized mainframe that gave nurses the opportunity to research medications, or diseases

that their patients may be victim to. I started to ask the question, “How can we help our patients, if we as

nurses don’t have the resources to help ourselves?” The main way that I see this being solved is jumping

on the bandwagon with most of the civilized world and adopting computerized charting. This will give

nurses in this facility the opportunity to have information at their fingertips. This will not only help with

patient education, but with making nursing diagnosis’s as well. It will also provide uniformity among

nursing care, so that each patient gets the individualized care they deserve.

The fourth QSEN competency to address is quality improvement. This involves using data

collected to make changes in healthcare processes, testing those changes for effect, and monitoring

outcomes to improve care. With this process we want to continuously improve the quality and safety of

our healthcare systems. I can’t say that I was fortunate enough to see any of this happening at the facility

we visited in clinical. However this is completed on a regular basis at the hospital I am employed at. We

have constant monitoring of errors, nursing processes, treatment goals, patient satisfaction, and

regulations. We take data from randomized checks, med error print-outs, safety reports, patient

comments, and weekly staff meetings to compile data. We then take that data and hold meetings to try
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and solve issues, better conditions, and make processes run more smoothly. This is not only done

throughout management, but with employee and patient involvement. Adopting teamwork and

collaboration into this competency is key to getting a better-rounded outcome. These changes improve

our policies, processes, treatment, patient care, teamwork, and safety.

The fifth QSEN competency to mention is informatics. This involves valuing technologies role

in clinical decision making, management, nursing support, and identifying essential information to supply

quality care. Here we use information from technology to communicate, manage knowledge, decrease

errors, and support decision making. As stated above the facility we visited lacked severely in this area.

There was information spread all over the place, and they did not use technology as a benefit. The

employees were not supplied with an email, so it was almost impossible to communicate amongst each

other. There was only one computer supplied per nursing station, which was at the disposal of all staff

(doctors, CNA’s, nurses, therapists, MA’s, and students.) A lot of information was submitted by fax,

which was not only time consuming, but easy to create errors. When you were looking for information on

a patient it took forever to find, and you needed to look in several places to piece it all together. This

leaves room for things to get missed, and safety can be at risk. This could easily also be solved with the

adoption of computerized charting. If this takes place all the information will be there for you at the click

of a mouse, and less room for mistakes. If there is a warning you will see it, if there is a lab that came in

you will see it, you can actually read the physicians orders, and you will have information right there to

perform evidence-based-practice.

The last of our six competencies to go over is one of the most important – safety. This involves

minimizing the risk of harm to both patients and staff. This also includes putting value in monitoring and

analyzing errors to identify potential improvement in processes. The over-all safety relies heavily on both

system effectiveness, and individual performance. The one thing I took notice too while at the facility

was the safety of information. There were patient documents left open, people forgetting to log out of

their charting, and charts left on open tables. This creates a safety risk that can easily be solved. Having
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a set “time-out” on the computer log-in may help in the case of someone forgetting to sign out. Also

having the nurses keep their carts close and locked while with them on med passes. This will help with

keeping information locked up and out of sight. Another safety risk worth mentioning was diet

restrictions. There was nothing on, or around patient noting their swallowing restrictions. While there I

noticed a therapist give a patient water that was on thickened liquids. This patient started gurgling and

needed to be sat up in their chair to cough up their liquids. There was nothing noted on the patients wrist-

band or chair stating that they were on thickened liquids. This creates a safety issue when patients are just

sitting in the hallways. If a patient is unable to tell you their diet restrictions, or allergies, then it creates a

big safety problem for the facility. The main way to solve this issue completely is by stating any special

precautions on their wrist-bands. That way staff can look right away and take note of what the patient can

and can’t have while staying at the facility.

As a nurse in training it is vital to learn and understand these six QSEN competencies to gain the

expertise needed to provide quality care to patients. It is vital that we understand, and put these

competencies to practice before graduating and entering the work-field. Each competency leads us

toward the knowledge, skills, and attitudes necessary to enter the professional world of nursing. We will

be the future image of nursing, and need to exude the confidence necessary to earn our patients trust.

Nursing is all about growth, improvement, and procedure. In order to provide the best care possible we

need to have the processes down to improve our craft, and nursing processes as a whole. Understanding

the QSEN competencies is the backbone to any form of progression, and can be used not only in school

but throughout our nursing careers.

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Resources

Health Information Technology (HITS) for Nursing Faculty: QSEN: Quality and Safety Competencies.

(n.d.). Retrieved April 01, 2018, from http://libguides.webster.edu/c.php?g=98020&p=633889

(n.d.). Retrieved April 01, 2018, from http://qsen.org/about-qsen/project-overview/

Wilkinson, J. M. (2016). Fundamentals of nursing. Philadelphia, PA: F.A. Davis.

Blais, K., & Hayes, J. S. (2016). Professional nursing practice: Concepts and perspectives. Hoboken, NJ:

Prentice Hall.