patients' individuality, values, and needs, and uses related population‐based strategies to improve appropriate utilization of health care services. Patient‐centered care is important, because research continues to find that involving patients in decision making about their care results in higher functional status, better outcomes, and lower costs.
2 Ability to effectively work in interprofessional teams: This competency calls for functioning effectively within nursing and interprofessional teams and fostering open communication, mutual respect, and shared decision making to achieve quality patient care. Interprofessional teams have been shown to enhance quality and lower costs, even though this training is challenged by differences in communication norms across disciplines and power and turf controversies among disciplines.
3 Understanding of evidence‐based practices: Evidence‐based practice integrates the best current research evidence with clinical expertise and patient and family preferences and values for delivery of optimal health care. To actively provide EBC, clinicians need the following knowledge and skills: how to locate the best sources of evidence, how to formulate clear clinically‐based questions, and how to determine when and how to translate new knowledge into practice.
4 Ability to measure the quality of care: Clinicians need to be able to 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 health care systems. Clinicians must use comparison benchmarks to identify opportunities for improvement; design, test, and assess quality improvement interventions; identify current and potential errors in care; and implement safety design principles such as recognizing human factors and the need for standardization.
5 Ability to use health information technology: Health care informatics applications use information and technology to communicate, manage knowledge, mitigate errors, and support decision making. They enhance patient safety by driving standardization, as well as by facilitating knowledge management and communication. As more technology becomes available, database systems are linked within and across health care settings. As our evidence‐based measures and decision‐making tools improve, clinicians will need to be able to fully utilize health information technology to improve the quality of health care delivery.
Quality and Safety Education for Nurses (QSEN)
The IOM's 2004 Report on Patient Safety was the first in a series of three reports published since the year 2000 to emphasize the connections among nursing, patient safety, and quality of care. Keeping Patients Safe sets forth the structures and processes that health care workers use in the delivery of care and emphasizes the need to design the nurses' environments to promote the practice of safe nursing care (IOM, 2004b). The importance of organizational management practices, strong nursing leadership, and adequate nurse staffing for providing a safe care environment is critical (Laschinger & Leiter, 2006). The IOM Report (2010) The Future of Nursing Leading Change Advancing Health suggest that nurses should practice to the full extent of their education and training, achieve higher levels of education and training through an improved education system that promotes seamless academic progression, and be full partners with physicians and other health care professionals.
In 2008, the American Association of Colleges of Nursing (AACN) and the National League for Nursing (NLN) embraced the inclusion of quality improvement systems thinking, change strategies, and patient safety, etc., into undergraduate and graduate nursing education curricula. In 2005, the RWJF funded the University of North Carolina at Chapel Hill School of Nursing on a long‐term project aimed at increasing the inclusion of quality in nursing education and the development of well‐prepared faculty to teach the quality and safety competencies recommended by the IOM to make health care safe, effective, patient centered, timely, efficient, and equitable (IOM, 2001). In 2009, the AACN lent its support to this Quality and Safety Education for Nurses (QSEN) project (www.qsen.org) (Kovner et al., 2010).
The QSEN website is now a comprehensive resource for teaching strategies, etc., for the development of quality and safety competency in nursing.
Critical Thinking 2.4
Think about the competencies needed to improve health care education:
1 Patient‐centered care delivery
2 Interdisciplinary teamwork
3 Evidence‐based practice
4 Measurement of the quality of care
5 Health information technology skill
6 Culture of safety
How can you improve your education and experience in each of the competencies now and throughout your career?
Never Conditions
In 2008, the CMS identified hospital‐acquired conditions (never conditions) for which they will not reimburse hospitals for a higher DRG payment (i.e., pressure ulcers; fractures, dislocations, intercranial injury, crushing injury, and burns; catheter‐associated urinary tract infections; vascular catheter‐associated infections, object left in patient during surgery, air embolism, blood incompatibility, and mediastinitis after coronary artery bypass graft). Medicare no longer pays hospitals for these conditions (Waxman, 2008). Clearly the nurse of the future must be educated about never events. The term “Never Event” was first introduced in 2001 by Ken Kizer, MD, former CEO of the National Quality Forum (NQF), in reference to gross medical errors like wrong‐site surgery that should never occur. Over time, the term's use has expanded to signify adverse events that are clearly identifiable and measurable, resulting in death or significant disability, and usually preventable. Since the initial never event list was developed in 2002, it has been revised multiple times, and now consists of 29 “serious reportable events” grouped into seven categories (Abimanyi‐Ochom, Jones, & Cheng, 2019). The latest list from 2016 includes:
1 Surgical or invasive procedure events
2 Product or device events
3 Patient protection events
4 Care management events
5 Environmental events
6 Radiological events
7 Potential criminal events
A complete listing, including the subcategories, is available at www.qualityforum.org
Nurse Shortages
Until recently, shortages of nurses have been cyclical. These nurse shortages are associated with increased demand for patient care services at a time of falling nursing school enrollment, salary compression, and nominal increases in wages. The U.S. is projected to experience a shortage of Registered Nurses (RNs) that is expected to intensify as Baby Boomers age. According to a 2018 survey conducted by the National Council of State Boards of Nursing and The Forum of State Nursing Workforce Centers, 50.9% of the RN workforce is age 50 or older. The HRSA projects that more than 1 million registered nurses will reach retirement age within the next 10–15 years. The RN workforce was expected to grow from 2.9 million in 2016 to 3.4 million in 2026, an increase of 438,100 or 15% (ANA, 2019). According to the Bureau of Labor Statistics' Employment Projections 2016–2026, it projects the need for an additional 203,700 new RNs each year through 2026 to fill newly created positions and to replace retiring nurses. The current nursing workforce has 56% of RNs prepared at the baccalaureate or graduate degree level. The AACN reported a 3.7% enrollment increase in baccalaureate programs in nursing in 2018. According to AACN's report on 2018–2019 Enrollment and Graduations in Baccalaureate and Graduate Programs in Nursing, U.S. nursing schools turned away more than 75,000 qualified applicants from baccalaureate and graduate and nursing programs in 2018. Changing demographics signal a need for more nurses to care for our aging population. Issued in May 2014, the U.S. Census Bureau report on An Aging Nation: The Older Population in the United States, found that by 2050 the number of U.S.