Integrating the Quality and Safety for Education of Nursing (QSEN) competencies as individual concepts or “silos” of knowledge into existing nursing curricula limits the student’s ability to apply the concepts in clinical decision making. Nursing academia is obligated to instill knowledge, skills, and attitudes in clinical decision making that promote a culture of safety and quality outcomes (IOM, 2003; QSEN, 2012). The Institute of Medicine (2003) suggested an interdependent relationship between competencies for the clinical education of healthcare professionals. It is believed that the competencies are not relevant to the students unless they see a use for them in clinical decision-making. Illustrating the interdependency of the competencies through practical clinical application encourages the need for and use of all the competencies throughout the decision-making process.
Using the theories of Problem-based Learning (Savery & Duffy, 1995) and Mezirow’s (1995) Transformative Learning Theory, an Interdependent QSEN Competency Model was developed (Hook & Dunagan, 2013). The “Quality House” model illustrates Safety and Quality Improvement as overarching or “roof” competencies supported by the “pillars”: Patient-centered Care, Teamwork and Collaboration, Evidence-based Practice, and Informatics. The nurse at the bedside acts as the “foundation” and “general contractor” of the house. Each component of the house is interdependent and structurally sound only when all parts are equally valued and maintained. A holistic and interdependent view of the competencies is promoted with continual and early application of the model to theory, clinical problem solving, and simulated laboratory experiences. One way to apply the interdependent QSEN competency model is using the following strategy in the clinical setting or simulation laboratory.
An innovative teaching strategy which integrates interdependent QSEN competencies has been developed to prepare nursing students to actively participate as collaborative partners in a transforming health care system. After learning about the Interdependent QSEN Competency Model in the classroom, faculty will implement a teaching strategy in the clinical setting which applies real life healthcare problems to the model. In addition to their patient care assignments, each student will be assigned one of the six QSEN competencies. Students will be instructed to identify issues/situations illustrating use or lack of use of a specific competency in the clinical setting for the day. In post conference, faculty will ask students to share their findings with the group. Faculty will guide discussion with the students to aid them in identifying how an issue with one competency is affected by other competencies. For example, one student may be asked to identify issues/situations surrounding Team-Work and Collaboration. Faculty will assist the student in identifying how an issue with Team-Work and Collaboration may compromise Safety and Quality Improvement; as well as how Informatics and Patient-Centered Care could be a part of the solution.
Changing healthcare systems demand that nurses participate in collaborative partnerships to promote safe, quality care. Within these collaborative partnerships, bedside nurses must be comfortable advocating for a culture of safety and quality (Rutherford, Lee, & Greiner, 2004; Rutherford, Phillips, Coughlan, Lee, Moen, Peck, & Taylor, 2008). To support competencies of safety and quality improvement, students should continually assess for factors that increase patient risk and be willing and able to assume a nursing identity that demonstrates efforts to promote quality outcomes (IOM, 2011). A culture of safety and quality is dependent on the nurse’s ability to apply knowledge, skills, and attitudes associated with each competency both separately and interdependently to clinical problem solving.