The document discusses the Quality and Safety Education for Nurses (QSEN) project which aims to empower nurses to apply competencies related to quality, safety, informatics, patient-centered care, and evidence-based practice. It provides an overview of several QSEN competencies including patient-centered care, teamwork and collaboration, evidence-based practice, quality improvement, informatics, and safety. The document then describes how these competencies were assessed and applied during a nursing simulation involving different roles such as charge nurse, registered nurse, nursing assistant, and observer. It discusses areas where the competencies guided appropriate nursing interventions and areas for improvement.

1. Running head: QSEN 1
Quality and Safety Education for Nurses
Jazmine Randolph, Andrea Ritchie, Lindsey Rogers, Idalis Sanchez-Mclean & Olivia Savalle
Oakland University

2. QSEN 2
Quality and Safety Education for Nurses (QSEN) is a project designed to empower
baccalaureate prepared nurses to apply basic goals of quality, safety, informatics, patient
centered care and evidence based practice into the healthcare environment. Each competency is
defined by specific targets for knowledge, skills and attitudes nurses should aspire to. The
purpose of this paper is to discover how QSEN competencies guide nursing interventions in a
simulated environment.
Overview of QSEN Competencies
Patient centered care describes the ability to recognize the patient or designee as the
source of control and full partner in providing compassionate and coordinated care based on
respect for patient’s preferences, values, and needs (QSEN Institute, 2014). Nurses should
understand multiple aspects of patient centered care including communication, individual values,
coordination between different care delivery systems, and cultural diversity. Proficient skills for
a nurse to execute patient centered care involves the ability to infer individual patient preferences
and values through therapeutic communication (QSEN Institute, 2014). A nurse should be able
to effectively communicate these wishes to others members of the care team and identify barriers
to care that are a function of the individual’s cultural, lifestyle or health scenario. QSEN
guidelines recommends nurses should be able to communicate and advocate for patient needs at
varying levels of care and across transitions of care delivery systems (QSEN Institute, 2014).
Nursing attitudes to guide patient centered care should reflect ideas which value the patient
health experience as a function of their individual cultural and ethnic experience. Nurses who
approach the patient experience as a learning opportunity to improve advocacy are compliant
with QSEN guidelines for patient centered care.

3. QSEN 3
Teamwork and collaboration refers to the ability to function effectively within nursing
and inter-professional teams, fostering open communication, mutual respect, and shared
decision-making to achieve quality patient care (QSEN Institute, 2014). Teamwork and
collaboration requires nurses to understand the scope of practice occupied by the nursing role. A
nurse should understand how managerial roles do or do not overlap to identify responsibility of
different team members. Nurses should hold accountability for strengths and limitations of each
member of the team (QSEN Institute, 2014). Nursing skills for teamwork and collaboration
involve the ability to occupy a team leader role, the ability to develop a self-improvement plan
for communication, support group members for a collective outcome and identify the roles of
others to improve coordination of effective workflow (QSEN Institute, 2014). Nurses can
participate in patient care conferences and initiate their role to resolve conflicts. Nursing attitudes
to support healthy teamwork and collaboration value the expertise of each member involved
(QSEN Institute, 2014). Nurses can display supportive roles or leadership roles depending on the
composition of group team members, including the various communication styles which exist.
Evidence based practice describes the ability to integrate best current evidence with
clinical expertise and patient/family preferences and values for delivery of optimal health care
(QSEN Institute, 2014). Nurses utilize evidence based practice to determine and support best
clinical practices. Interpreting research from reputable sources is essential to proper application
(QSEN Institute, 2014). Understanding results and differentiating clinical experience from
research studies allows nurses to modify clinical practice. Nursing practice should strive to
modify work environment to properly facilitate evidenced based practice guidelines (QSEN
Institute, 2014). Participation in supporting evidenced based practice in nursing interventions is
critical to this QSEN competency. Nurses should possess positive attitudes toward research

4. QSEN 4
methods and value the importance of ongoing emerging clinical practices. The ability to
critically decipher strengths and weaknesses of evidence is a useful tool to propel evidenced
based practice in nursing (QSEN Institute, 2014).
Quality improvement uses 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. This knowledge is used to measure the actual performance of a process or
event as well as its outcome. The data acquired is compared with that from other departments in
the same or similar organizations (Dolansky & Moore, 2013). The knowledge learned is used to
create quality improvement efforts geared towards reaching an optimal zero occurrence for the
event (Dolansky & Moore, 2013). Skills necessary for quality improvement include the ability to
measure occurrences and seek ways to improve processes through quality initiatives so that the
event does not reoccur (Sherwood & Zomorodi, 2014). Quality improvement is geared towards
the importance of shifting the focus away from blame to identifying where breakdown exists
(Sherwood & Zomorodi, 2014). Once weaknesses are identified, data is collected and used to
redesign the process to prevent the error from reoccurring (Sherwood & Zomorodi, 2014).
Informatics uses information and technology to communicate, manage knowledge,
mitigate error, and support decision-making. As Dolansky and Moore (2013) describe, various
applications are being used to provide safety alerts informing providers of the need to act. In the
healthcare industry, informatics technology, such as electronic health records, plays an integral
part in the delivery of quality healthcare. This is achieved via helping to communicate care
coordination by recording and sharing information about a patient (Dolansky & Moore, 2013).
The skills necessary include the ability to conduct data and research queries and being
knowledgeable of the informatics system being used by the facility.

5. QSEN 5
Safety minimizes the risk of harm to patients and providers through both system
effectiveness and individual performance. Quality improvement and safety measures are directly
related. Quality is more involved with the process itself while safety, on the other hand, is related
to averting medical errors and unfavorable patient outcomes (Dolansky & Moore, 2013).
Knowledge concerning safety measures is acquired through constant vigilance and surveying the
healthcare environment to prevent mistakes from happening. Applying good nursing skills and
adhering to proper procedures will improve patient safety. As a healthcare provider, nurses must
always be aware of the potential for patient injury. This mindset allows for prompt identification
of safety hazards and risks facilitating steps to be taken to address weaknesses among clinical
practices, tasks, and systems errors (Dolansky & Moore, 2013).
Assessment of QSEN competencies in Simulation
The transfer of essential information and the responsibility for care of the patient from
one healthcare provider to another is an integral component of communication in health care.
This critical transfer point is known as a handoff. An effective handoff supports the transition of
critical information and continuity of care and treatment. However, the literature continues to
highlight the effects of ineffective handoffs: adverse events and patient safety risks. Team
collaboration is essential (Hughes, 2008). Unfortunately, a few minor laps during patient
handoff, can lead to delays in some patients receiving care. Through teamwork and
communication, the RNs can identify patient needs and utilize both the charge nurse and nurse
assistant in providing care. The importance of quality teamwork in healthcare has been the
subject of several studies in healthcare. Teamwork has been associated with a higher level of job
staff satisfaction, a higher quality of care, an increase in patient safety, greater patient
satisfaction with their care, more productivity, and a decreased stress level. Lack of

6. QSEN 6
communication creates situations where medical errors can occur. These errors have the potential
to cause severe injury or unexpected patient death. Medical errors, especially those caused by a
failure to communicate, are a pervasive problem in today’s healthcare organizations (Hughes,
2008).
Simulation Analysis/Evaluation
The priorities of the charge nurse are to act as a team leader for the rest of the nursing
staff, keep track of patient status and help manage clinical emergencies. Additionally, a priority
of the charge nurse is to act as a consult for clinical issues, a planner and director (Cherry &
Jacob, 2014). The charge nurse can serve as a support system and can offer guidance, advice, and
opinions when needed by nursing staff. They determine the daily assignment list and organizing
nursing staff as necessary (Cherry & Jacob, 2014). The charge nurse can carry all the
responsibilities of an RN in addition to charge nurse duties. Throughout the simulation, I
coordinated and delegated care by ensuring that nurses were well supported in the care provided.
As charge nurse, I relied on the QSEN competencies of leadership, teamwork, and
communication. For example, I made sure to check on each RN and their patients and offer
options for care. Also, I was sure to direct the nurses if need be and determined the client
assignments. More specifically, a patient was quickly declining and the RN needed assistance. A
code was called and the patient was resuscitated. As charge nurse, I believe I did well directing
the nursing staff and was able to help them through situations by offering different ideas and
perspectives. For example, another patient was hemorrhaging and had a low hemoglobin I
suggested contacting the provider to get blood and an increase of fluids ordered. I believe I did a
good job focusing the nurses and directing them with what they could do next (via democratic
leadership). However, there were things that I could have improved on. One patient was a

7. QSEN 7
mannequin and, unfortunately, was put on the back burner. Moreover, when we were
resuscitating a patient I needed to be more careful about the patient’s situation and medications
to be given. The QSEN competencies of teamwork and communication were used as the RN and
I worked together to quickly determine our plan of action and resuscitate the patient.
The nursing practice of teamwork and communication as part of a multi-disciplinary team
is crucial in providing quality patient centered care (Cherry & Jacob, 2014). During simulation,
as an RN, I relied heavily on the QSEN competencies of safety, communication, and teamwork
along with evidence-based practices to provide care to my patients. Nurses are critical to the
surveillance and coordination that reduce adverse outcomes. I effectively communicated with the
nurse assistant to ensure the patient suffering from Dementia and shortness of breath was safe
and receiving oxygen. Unfortunately, my second patient had fallen and was complaining of chest
pain. I assessed the patient’s neurological status while checking for ecchymosis as the patient
was on a heparin drip. Once I ensured that my patient was stable, I safely transferred her to a
nearby chair and contacted the provider to order a CT-scan for further evaluation. An area of
improvement was in my initial assessment of the patient by hesitating to place my patient on
supplemental oxygen and ordering of morphine for her chest pain. Had I reviewed the patient's
chart more in depth during report I would have been more aware of my patient’s complaint of
shortness of breath and elevated respiratory rate. Once I identified that patient's chest pain was
respiratory related, with the assistance of the charge nurse, I placed her on oxygen and contacted
the provider for morphine and lab work.
A nurse’s ability to think critically, and use acquired knowledge and evidenced-based
practice while providing care to patients, is essential to the patient’s well-being and safety.
During the simulation experience, as an RN, I utilized QSEN competencies. Both patients

8. QSEN 8
received patient centered care specific to their healthcare needs. Teamwork and collaboration
was an integral part to providing quality care during the simulation. Providing quality care
requires the collaboration of numerous providers (Sherwood & Zomorodi, 2014). While
providing care for a patient admitted with a hip fracture that was experiencing shortness of
breath and appeared to be hemorrhaging, the charge nurse informed me that my other patient was
declining. With teamwork and collaboration with the charge nurse, we were able to stabilize both
patients. When caring for my patient who was experiencing shortness of breath I employed
evidence-based practice by elevating the head of the bed, applying oxygen, and putting on a
pulse oximeter. I ensured safety by keeping the bed lowered, call light within reach, and two
upper side rails raised. I believe that I did well assessing my patients and prioritizing their
problems and my interventions. I did not do a good job juggling two declining patients. I got so
involved in caring for my first patient that I neglected my second patient.
Duties of the nursing assistant typically include taking vital signs and blood glucose
measurements; feeding, bathing, and ambulating patients; and answering patient calls, retrieving
supplies, and keeping the unit clean (Bellury, Hodges, Camp, & Aduddell, 2016). During
simulation, as nursing assistant, I was able to keep the patient that fell safe by assisting the
patient from the floor to the chair, activating the chair alarm, and notifying the charge nurse
about the fall. The charge nurse was then able to assess the patient for injuries and call the
physician for a complete exam. Additionally, I was able to remain as a patient sitter, as the
patient was impulsive and a fall risk. I made sure that the patient kept her oxygen on and did not
pull out her IV. One thing that I could have improved on was to immediately place the oxygen
on the patient when the patient complained of difficulty breathing. Additionally, immediate

9. QSEN 9
attention should have been brought to the RN that the wrong patient’s medication was left in the
room.
As an observer, I was looking for the healthcare team to demonstrate preparedness,
teamwork, collaboration, and communication skills. The team executed these principles
immediately by assigning roles and reviewing the available medical information relative to each
patient. Two patients were assigned to each of the two nurses. The entire team received change-
of-shift report. I believe they did this together to be a single unit, however, in hindsight this time
could been used to do an initial check of the patients. Despite this, the healthcare team
demonstrated teamwork and collaboration by cooperatively identifying goals for each patient,
communicating them, and adjusting priorities as the client's’ conditions changed. For example,
when Andrea’s patient fell, she notified the team by calling for help but remained at the patient’s
bedside. Olivia, charge, and Jazmine, RN, were handling a more critical situation with a code
blue. Andrea was able to maintain the safety of her client until the more critical situation
resolved. Idalis, the nursing assistant, maintained the safety of her client by providing a chair
alarm for a patient demonstrating confusion and increased risk for falls. Jazmine and Olivia
demonstrated critical thinking by evaluating labs for a patient who had significant blood loss
following hip surgery. Overall, each person maintained safety and service excellence for their
patients by prioritizing goals and recognizing the importance of their role within the team.
Effective communication between their individual scope of practice resulted in successful care
of their patients. This simulation experience allowed us to comprehend the full effect of QSEN
competencies as an improvement to the quality and safety of care which can only be realized
when nurses apply them at both individual and system levels of care (Dolansky & Moore, 2013).

10. QSEN 10
References
Bellury, L., Hodges, H., Camp, A., & Aduddell, K. (2016). Teamwork in Acute Care:
Perceptions of Essential but Unheard Assistive Personnel and the Counterpoint of
Perceptions of Registered Nurses. Research in Nursing & Health, 39(5), 337-346.
doi:10.1002/nur.21737
Cherry, B. & Jacob, S.R. (2014). Contemporary nursing issues, trends, & management. (6th
ed.). Missouri: Elsevier Mosby.
Dolansky, M.A., Moore, S.M., (September 30, 2013) "Quality and Safety Education for Nurses
(QSEN): The Key is Systems Thinking" OJIN: The Online Journal of Issues in Nursing
Vol. 18, No. 3, Manuscript 1. DOI: 10.3912/OJIN.Vol18No03Man01
Hughes, R. G. (2008). Patient safety and quality: An evidenced -based handbook for nurses.
Agency for Healthcare Research and Quality, 08(0043). Retrieved from
http://archive.ahrq.gov/professionals/clinicals-providers/resources/nursing/resources/
nurseshdbk/index.html
QSEN Institute. (2014). QSEN competencies. Retrieved November 25, 2016, from
http://qsen.org/competencies/pre-licensure-ksas/
Sherwood, G., & Zomorodi, M. (2014). A new mindset for quality and safety: The QSEN

11. QSEN 11
competencies redefine nurses' roles in practice. The Journal of Nursing Administration,
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