With hospitals experiencing an increase in adverse events and patient harm in recent years, nursing schools are introducing their students to the concepts of safety and quality of care as key aspects of their learning.
Educators should make capacity in such areas a top priority for doctors and nurses, especially as health systems are still dealing with the adverse effects of staff shortages and widespread training disruptions, said Patricia McGaffigan, vice president of the Institute for Health Improvement.
“Any significant improvement in safety will be difficult to achieve without major education reform… that will create clinicians who have the ability to play an active role in the design of systems and solutions to reduce risk,” said McGaffigan.
Clinical follow-up focused on safety and quality has historically been a hard sell. However, in response to industry needs and accreditation requirements from professional groups, many nursing schools are working to incorporate the standards set by nationally recognized institutions into their teaching. Academic institutions are also forming partnerships with hospitals to connect classroom learning with clinical experience.
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Setting educational standards
Several organizations have published guidelines to help schools incorporate safety and quality into nursing curricula. However, resources can vary in their approach and effectiveness, says Mary Dolansky, former director of the Institute for Quality and Safety Education for Nurses.
Founded in 2005, the institute has outlined dozens of quality and safety competencies for schools to use as targets for assessing nurses’ skills and knowledge upon graduation. Dolansky said key competencies include safe medication administration, evidence-based practice, quality improvement leadership, patient-centered care, and communication around diagnosis and treatment. The Institute also provides faculty development resources and teaching strategies for quality and safety curricula.
In 2021, the Association of American Colleges of Nursing will begin requiring all schools accredited through the Commission on Collegiate Nursing Education to teach the same quality and safety competencies outlined by QSEN.
The Institute for Health Improvement Open School, which provides virtual education for students and healthcare professionals, has 13 courses on different aspects of safety and quality that individuals can take to earn certifications on these topics.
As of 2020, more than 65,000 students, faculty, and healthcare professionals have completed the basic certification, which is free for students and residents, says McGaffigan. She emphasizes the importance of minimizing change and maximizing efficiency.
“We see more and more academic programs contacting us to replicate this work,” she said. “The motivation is there.”
A systematic approach
Using resources from the Institute for Quality and Safety Education for Nurses, the Institute for Health Improvement, and others, nursing schools adopt a variety of approaches to integrate key safety and quality competencies into their curricula.
At Bloomsburg University in Pennsylvania, faculty are redesigning every course to include lessons in safety and quality, said Rebecca Toothaker, an associate professor of nursing. She said leaders will convene next month to discuss upcoming changes.
“It will be more in-depth and more systematically interwoven throughout the curriculum,” says Toothaker.
She said nursing students are introduced to the concepts of human and system error, patient harm and root cause analysis of adverse events, as well as ways to improve teamwork and communication. Many classes involve activities such as reflective logging, which helps students connect what they are learning every day about safety factors to their clinical practice, and simulations where students are brought into a hospital room and guided to identify errors.
With the updated curriculum—which will include more interdisciplinary, diverse, equitable, and inclusive approaches to learning, as well as lessons on safety factors—the goal is for every nursing graduate to know their role in overall system safety and a culture of equity, instilling a sense of professional responsibility, she said.
The school measures program effectiveness by conducting a “safe transition to practice,” or STEP, a study that interviews students six months after graduation about the impact of education on health care delivery.
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More than a dozen schools also offer graduate-level education for clinicians who want a career focused on quality and safety and who are working in positions such as quality improvement director or patient safety officer.
Students at the University of Pennsylvania School of Nursing in Philadelphia can pursue a minor or post-master’s degree in quality improvement and safety procedures, as well as a full master’s degree in quality and safety, said Susan Keim, associate professor of practice and director of nursing and healthcare management.
The School of Nursing has developed and delivered a safe and quality curriculum in collaboration with the university’s medical faculty. Keim says the courses allow students with different clinical backgrounds to learn in the same environment and work as a multidisciplinary team to achieve better outcomes for their patients.
“We really wanted to create an interdisciplinary learning environment where doctors and nurses could learn together about improving quality and patient safety,” she said.
Through courses available to all graduate nursing students, students learn how systems work; how to prevent medical errors and develop comprehensive patient safety programs; how to analyze data to conduct quality improvement research; and how to create a culture where clinicians feel comfortable speaking up about unsafe conditions.
As a most important project, students design and implement a quality improvement initiative in their area of clinical expertise, test results, and implement changes to their process.
Forging clinical partnerships
Some schools look to health system partners for feedback on how to prepare nurses to meet real-world safety and quality needs.
As members of the advisory committee for Grand Canyon University’s College of Nursing and Healthcare Professions, healthcare leaders from systems like HCA Healthcare, Banner Health, and St. Luke’s Health System provides input into the school’s quality and safety programs while taking into account their own workforce requirements.
Christy Torkildson, head of master’s programs in public health nursing, health care quality and patient safety at the school, said the Phoenix-based university uses a standards-based curricula from several institutions, looks at information, in addition to course reviews by faculty and students, and decides whether its methodology needs modification.
“We make sure our courses and experiences are in sync with the needs of the profession and the standards of the profession,” says Torkildson. “We wanted to make it as relevant and applicable as possible.”
Bloomsburg University also works with its clinical partners to provide students with as much hands-on experience as possible and support the transition to practice, Toothaker said. When it comes to quality, health systems tend to see a gap between education and practice for new graduates across the country, she said.
“Our students are very understanding of the textbook and curriculum, rather than being able to start running when they start practicing it,” she said. “[Hospitals] wanted a nurse who could make decisions when they arrived at the facility, could think critically and put those concepts together quickly, especially at the bedside.”
In addition to partnering with schools on core competencies and graduate requirements, Dolansky said, hospitals should make changes to their operations to support quality and safety procedures, especially for new nurses.
“We really need leadership in hospitals to ensure that the culture of safety is a priority, as well as staffing and other standards for nurses to deliver safe care,” she said.
