Second Generation QSEN

Preface

Second-Generation Quality and

Safety Education for Nurses

Jane Barnsteiner, PhD, RN, FAAN

Nurs Clin N Am 47 (2012) xi–xiiihttp://dx.doi.org/10.1016/j.cnur.2012.0029-6465/12/$ – see front matter �

Joanne Disch, PhD, RN, FAAN

Guest Editors

Since 2005, the Quality and Safety Education for Nurses (QSEN) initiative has beenengaging nursing faculty and clinicians in preparing nurses with the necessary knowl-edge, skills, and attitudes for delivering, and continuously improving, nursing care.1

With significant support from the Robert Wood Johnson Foundation, a number of keyoutcomes have been achieved: (1) the definition of 6 competencies related to qualityand safety (QS), adapted from those developed by the Institute of Medicine, that wouldapply to all registered nurses; (2) the creation of teaching strategies for incorporating thecompetencies into nursing curricula; (3) pilot testing the competencies in a diversesubset of 15 nursing schools; (4) 9 regional Institutes that have educated more than1200 faculty from 49 states in the competencies and strategies for incorporating theminto curricula; (5) the launching of the QSEN website (www.qsen.org) with a rich repos-itory of strategies and tools for teaching the competencies; (6) the identification ofa national panel of QSEN consultants who are available for helping schools and otherorganizations incorporate the competencies; (7) the development of a set of graduatecompetencies for use by faculty in educating graduate faculty and students about the6 QSEN competencies; (8) an annual conference where faculty and clinicians sharesuccessful strategies for incorporating the QSEN competencies into educationprograms and clinical practice; and (9) publication of numerous articles, book chapters,and,most recently,Quality andSafety inNursing: ACompetencyApproach to ImprovingOutcomes.2 Expectations for impact have been greatly exceeded.

The QSEN initiative has been one of the most influential and widespread nationalmovements in nursing history. Disch3 outlined several key lessons that have beenlearned along the way. Among them are these two: that, while the original intent ofthe project was to identify QS competencies and add them to the curriculum, what

07.012 nursing.theclinics.com2012 Elsevier Inc. All rights reserved.

Prefacexii

emerged was a national mandate to reshape nursing curricula in general; and that,while the original focus was on helping nursing faculty learn the content, it quickly be-came apparent that clinicians also needed to understand better “the emerging scienceof QS and its impact on safe patient care and quality improvement.”3

Out of this original work a number of additional new insights have emerged, or whatwe are calling, the second generation of QSEN work. During the first several years ofthe project, the focus was on prelicensure nursing programs and QS issues in acutecare settings. Over time, it has become increasingly apparent that the application ofquality and safety principles has to bemade to new settings, and through new partner-ships. New strategies and tools are needed. In working to improve QS, we have wit-nessed the emergence of unintended consequences, and the need for a new culture inboth clinical and academic settings.

This issue ofNursing Clinics of North America focuses on some of these new issuesthat have evolved from the original QSEN work. Benike and colleagues examine QSchallenges in 3 ambulatory settings and identify some of the organizations from thatrealm that are targeted toward improving QS in nonacute settings. Patrician andcolleagues describe their work with the Veterans Administration Quality Scholarsprogram that now includes research partnerships between medicine and nursingscholars; Djukic and her colleagues describe a model for scaling up and sustaininginterprofessional education that they are using at New York University. New usesfor simulation are reviewed by Jarzemsky, while Altmiller describes the use of con-structive criticism in helping students learn these new competencies. One of the inter-esting, yet unfortunate, findings from the QSEN work is that there can be unintendedconsequences that arise from QS work. Sendelbach describes the phenomenon ofalarm fatigue caused by our increasing reliance on alarms to alert clinicians of poten-tial problems but which, instead, cause auditory overload and ignoring of or, in somecases, turning off these aids. In a poignant piece, Hall and Scott review the literatureon the second victim syndrome, or the situation in which “health care providers whoare involved with a patient-related adverse event or medical error, and as a result, ex-perience emotional and sometimes physical distress” and provide recommendationsfor recognition and treatment. Disch raises the question of the quality burden itself, as-serting that in our efforts to improve QS, enormous pressures are being put on clini-cians and others to do the work required for monitoring, tracking, recording,improving, and evaluating quality indicators. Finally, Barnsteiner and Disch extendthe application of just culture to schools of nursing and raise several questions re-garding current practices in schools of nursing for handling, tracking, and trendingnursing student errors and near-misses.

The QSEN initiative has captured the interest and attention of nurses around theworld through its commitment to improving quality and safety education in schoolsof nursing. A logical extension of this work requires us to apply the learnings fromthis first wave of effort to new settings, with new partners, adding new tools to ourrepertoire and, inevitably, experiencing new phenomena. This issue of Nursing Clinicsof North America examines several of these “second-generation QSEN” concepts andmakes recommendations for dealing with them. Undoubtedly, ripples out from the firstgeneration of QSEN work will continue to unfold. What will “third-generation QSEN”look like?

Jane Barnsteiner, PhD, RN, FAANSchool of Nursing

University of PennsylvaniaPhiladelphia, PA 55403, USA

Preface xiii

Joanne Disch, PhD, RN, FAANUniversity of Minnesota School of Nursing

308 Harvard St SE, 5-140 WDHMinneapolis, MN 55455, USA

E-mail addresses:barnstnr@nursing.upenn.edu (J. Barnsteiner)

disch003@umn.edu (J. Disch)

REFERENCES

1. Cronenwett L, Sherwood G, Barnsteiner J, et al. Quality and safety education fornurses. Nurs Outlook 2007;55(3):122–31.

2. Sherwood G, Barnsteiner J. Quality and safety in nursing: A competency approachto improving outcomes. West Sussex, UK: Wiley-Blackwell; 2012.

3. Disch J. QSEN? What’s QSEN? Nurs Outlook 2012;60(2):58–9.