Quality improvement engagement and competence: A comparison between frontline nurses and nurse leaders

Self-efficacy in Quality Improvement Competency of Frontline Acute Care Registered Nurses

BACKGROUND

Registered nurses (RNs) are attuned to health care quality and safety concerns but may lack competency in quality improvement (QI) to advance care quality.

PURPOSE

To describe frontline acute care RNs' self-efficacy in QI competencies, evaluate differences based on educational attainment, and evaluate relationships based on years of RN experience.

METHODS

The study used a descriptive, quantitative, correlational, comparative cross-sectional survey design to evaluate RNs' self-efficacy in QI competency using the 2021 American Association of Colleges of Nursing The Essentials : Core Competencies for Professional Nursing Education .

RESULTS

Frontline RNs' overall QI self-efficacy showed variability in knowledge, skills, and attitudes, with no relationship between self-efficacy and years of RN experience, nor difference based on educational attainment.

CONCLUSIONS

Insufficient self-efficacy signals the need for further QI focus in nursing education, nursing practice, and health care policy to harness RNs' ability to advance care outcomes.

Quality Dashboards in Hospital Settings: A Systematic Review With Implications for Nurses

BACKGROUND

Dashboards visually display quality and safety data to aid nurses in making informed decisions.

PURPOSE

This systematic review evaluated quality improvement (QI) dashboard characteristics associated with interventions to improve patient outcomes and positive end-user evaluation.

METHODS

Literature was searched from 2012 to 2022 in PubMed, CINAHL, Scopus, MEDLINE, and Google Scholar.

RESULTS

Sixteen articles were included. Varied dashboard characteristics were noted, with mixed patient outcomes and end-user responses. Graphs and tabular presentations were associated with improved patient outcomes, whereas graphs were associated with end-user satisfaction. Benchmarks were noted with improved patient outcomes but not end-user satisfaction. Interactive dashboards were important for end users and improved patient outcomes.

CONCLUSION

Nurses can find dashboards helpful in guiding QI projects. Dashboards may include graphs and/or tables, benchmarks, and interactivity but should be useful, usable, and aligned to unit needs. Future research should focus on the use of quality dashboards in nursing practice.

Identifying engagement and associated factors in nursing students: An exploratory study

BACKGROUND

Burnout and engagement in health students surpass work life. Although levels of burnout in Nursing students are high, academic engagement is an understudied topic in Nursing, which has shown benefits. The aims were to know the level of engagement of Nursing students and to identify factors that prompt higher levels of engagement.

METHODS

An exploratory study was conducted during 2019 in three Universities in Spain. The UWES-S-17 questionnaire was used.

RESULTS

The sample consisted of 808 Nursing students. An average level of engagement was found. Engagement differed significantly by gender and age, with females and older students showing greater attitudes. Participants in the second year showed lower scores in the willingness to dedicate effort and persistence than those in the first and third year (p < 0.05).

CONCLUSIONS

The identification of the level of engagement and factors involved are an opportunity to probe into this approach by reinforcing positive attitudes in Nursing students. These findings show the need to seek strategies through specific educational interventions and policies. Engagement should be upheld throughout the degree and once they enter the job market to ensure the well-being during academic and future work life, a high-quality nursing care and patient safety.

Original Research: Exploring Frontline Nurses' Self-Perceived Levels of QI Engagement and QI Competence

BACKGROUND AND PURPOSE

Nurse engagement in quality improvement (QI) is critical in the delivery of safe high-quality care, yet few studies have evaluated frontline nurses in this area. The purpose of this study was to identify and compare levels of self-reported QI engagement and QI competence among frontline nurses and nurse leaders.

METHODS

This study used a cross-sectional descriptive design. A convenience sample of frontline nurses (bedside RNs and advanced practice nurses) and nurse leaders from acute and ambulatory care sites completed the Nursing Quality Improvement in Practice (NQuIP) tool, which measures engagement and competence (knowledge, skills, and attitudes) in QI.

RESULTS

Data from 6,351 surveys completed by frontline nurses and nurse leaders representing 66 sites nationwide were analyzed. Only 52.5% of all respondents reported participating in QI. Knowledge scores were relatively high, while skills scores-especially those related to using QI tools-were low. Overall attitudes toward QI were positive. Nurse leaders scored significantly higher in engagement and competence than the frontline nurses they supervise.

CONCLUSIONS

The study findings indicate that nurse engagement in QI is limited. Although nurses' knowledge levels appear to be high, their limited competency in QI-related skills may contribute to low QI engagement. Leaders must make efforts to increase nurse engagement in order to attain high-quality outcomes. Using the NQuIP tool will allow leaders to evaluate nurses' self-perceived QI competence and engagement, which will aid in identifying target areas and developing effective strategies for improvement.

Examining QI Knowledge Among Frontline Nurses and Nurse Leaders

BACKGROUND

Frontline nurses deliver direct patient care and by participating in quality improvement (QI) can have an impact on health care quality and safety. Unfortunately, nurses are not participating in QI, which may be due to a lack of QI knowledge.

PURPOSE

The purpose of this study was to evaluate nurses QI knowledge utilizing the revised Quality Improvement Knowledge Application Tool (QIKAT-R), with newly created nursing scenarios, among frontline nurses and nurse leaders.

METHODS

Using a cross-sectional design, this study evaluated nurses QI knowledge utilizing the QIKAT-R.

RESULTS

Overall, QI knowledge among nurses was low. The frontline nurses (n = 44) scored higher than nurse leaders (n = 11) on overall QI knowledge scores, although not significant. Frontline nurses scored higher in QI knowledge related to aim and measure, whereas nurse leaders scored higher in change.

CONCLUSIONS

Understanding frontline nurses QI knowledge, such as with the QIKAT-R with newly created nursing scenarios, can assist with creating targeted strategies for improving overall engagement in QI.

Development of the Nurse Occupational Stigma Scale

Introduction

Objective

Methods

Results

Conclusion

Quality improvement engagement: Barriers and facilitators

A comparison of frontline nurses, advanced practice nurses, and nurse leaders.

Qualitative Study on Barriers and Facilitators of Quality Improvement Engagement by Frontline Nurses and Leaders

AIM

To understand the facilitators and barriers of quality improvement (QI) from the perspective of nurses and leaders at the frontline.

BACKGROUND

Nurse engagement in QI has been associated with quality care and improved patient outcomes, yet nurse reported participation is low.

METHODS

A descriptive qualitative design and purposive sampling was used to examine barriers and facilitators of nurse engagement.

RESULTS

Facilitators 1) A leader's influence on a QI culture. Sub themes: creating buy-in, support of a just culture and working in partnership with nurses. Barriers 1) Barriers in organizational culture for nurses to lead QI. Sub themes: hierarchy, absence of a just culture, nurses' role not valued, lack of accountability for QI in nursing role, and resistance to change 2) Barriers in organizational structure for nurses to lead QI. Sub themes: manager disengagement, time pressure, lack of access to timely data, lack of QI knowledge, siloed departments, and lack of QI experts.

CONCLUSION

Barriers to QI engagement prevent nurses from fully engaging in QI. Creating a just culture and building the infrastructure to support nurse engagement is critical for success.

IMPLICATIONS FOR NURSING MANAGEMENT

Specific facilitators and barriers were identified that nurse leaders can assess in their practice setting and use relevant strategies to support engagement in QI.