With hospitals experiencing an increase in adverse events and patient harm in recent years, nursing schools are introducing their students to concepts of safety and care quality as key aspects of their learning.
Educators should make competency in such areas a top priority for physicians and nurses, especially because health systems are still dealing with the detrimental effects of widespread staffing shortages and training disruptions, said Patricia McGaffigan, vice president of the Institute for Healthcare Improvement.
“Any substantive improvements in safety would be difficult to achieve without major education reform ... that would produce clinicians who have the ability to play active roles in designing systems and solutions to mitigate risk,” McGaffigan said.
Clinical tracks focusing on safety and quality have historically been a tough sell. In response to industry needs and accreditation requirements from professional groups, however, more nursing schools are working to incorporate standards set by nationally recognized organizations into their teaching. Academic institutions are also forming partnerships with hospitals to connect classroom learning to clinical experience.
Setting educational standards
Several organizations have published guidelines to help schools incorporate safety and quality into nursing curricula. The resources can vary in their approach and effectiveness, however, said Mary Dolansky, former director of the Quality and Safety Education for Nurses Institute.
Established in 2005, the institute has outlined dozens of quality and safety competencies for schools to use as targets for nurses’ skills and knowledge at graduation. Major competencies include safe medication administration, evidence-based practice, leadership in quality improvement, patient-centered care and communication surrounding diagnosis and treatment, Dolansky said. The institute also offers faculty development resources and teaching strategies for quality and safety curricula.
In 2021, the American Association of Colleges of Nursing began requiring all of the schools it accredits through the Commission on Collegiate Nursing Education to teach the same quality and safety competencies outlined by QSEN.
The Institute for Healthcare Improvement’s Open School, which offers virtual education to students and healthcare professionals, has 13 courses on various aspects of safety and quality that individuals can take to earn a certificate on the topics.
Since 2020, more than 65,000 students, faculty and healthcare professionals have completed the basic certificate, which is free to students and residents, McGaffigan said. She stressed the importance of minimizing variability and maximizing effectiveness.
“We've seen more and more academic programs reach out to us to replicate this work,” she said. “The momentum is there."
A systematic approach
Using the resources from the Quality and Safety Education for Nurses Institute, the Institute for Healthcare Improvement and other organizations, nursing schools take a variety of approaches to integrating key quality and safety competencies into their curricula.
At Bloomsburg University in Pennsylvania, faculty members are redesigning every course to include lessons on safety and quality, said Rebecca Toothaker, associate professor of nursing. Leaders will convene next month to discuss the forthcoming changes, she said.
“It's going to be more in depth and more interwoven systematically throughout the entire curriculum,” Toothaker said.
Nursing students are introduced to concepts of human and system error, patient harm and root-cause analysis of adverse events, as well as ways to improve teamwork and communication, she said. Many classes involve activities like reflective journaling, which helps students connect what they are learning daily about safety factors to their clinical practice, and simulations where students are placed in hospital rooms and instructed to identify errors.
With the updated curriculum—which will include more inter-professional collaboration, diversity, equity and inclusion approaches, and lessons on safety factors—the goal is for each nursing student to graduate knowing the role they play in total system safety and just culture, instilled with a sense of professional accountability, she said.
The school measures program effectiveness by conducting “safety transition into entry of practice,” or STEP, studies interviewing students six months after graduation about the impact their education has on healthcare delivery.
More than a dozen schools also offer graduate-level education for clinicians who want careers focused on quality and safety and who are working toward positions like director of quality improvement or patient safety officer.
Students at the University of Pennsylvania School of Nursing in Philadelphia can pursue a minor or post-master's certificate in quality improvement and safety processes, as well as a full master’s degree in quality and safety, said Susan Keim, practice associate professor and director of nursing and healthcare administration.
The nursing school developed and teaches the quality and safety curriculum in collaboration with the university’s school of medicine. The courses allow students with different clinical backgrounds to learn in the same environment and work as a multidisciplinary team to achieve better patient outcomes, Keim said.
“We authentically wanted to create an inter-professional learning environment in which physicians and nurses could learn together about quality improvement and patient safety,” she said.
Through the coursework, which is available to all graduate nursing students, students learn how systems operate; 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 out about unsafe conditions.
As a capstone project, students design and implement a quality improvement initiative in their area of clinical expertise, examining the outcomes and making changes to their processes.
Forging clinical partnerships
Some schools look to health system partners for feedback on how to prepare nurses for real-world safety and quality needs.
As part of an advisory committee for Grand Canyon University’s College of Nursing and Health Care Professions, healthcare leaders from systems like HCA Healthcare, Banner Health and St. Luke’s Health System provide input on the school’s safety and quality programs and weigh in on their own workforce requirements.
The Phoenix-based university, which uses a curriculum based on several organizations’ standards, reviews the information, in addition to faculty and student course evaluations, and decides whether its approach needs revision, said Christy Torkildson, lead for the master's programs in public health nursing and healthcare quality and patient safety at the school.
“We make sure that the courses and experiences for students are in sync with the needs of the profession as well as with the standards of the profession,” Torkildson said. “We want to make it as relevant and applicable as possible.”
Bloomsburg University also works with its clinical partners to give students as much hands-on experience as possible and aid in the transition to practice, Toothaker said. When it comes to quality, health systems tend to see a gap between education and practice for newer graduates nationwide, she said.
“Our students are very textbook-savvy and curriculum-driven, versus being able to hit the ground running when they get into that practice,” she said. “[Hospitals] want a nurse that's able to make decisions when they get to the facility, that can think critically and put those concepts together quickly, especially at the bedside.”
In addition to collaborating with schools on core competencies and graduate requirements, hospitals should make operational changes that enable quality and safety processes, particularly for newer nurses, Dolansky said.
“We really need leadership in hospitals to ensure that the safety culture is a high priority, and that staffing and other standards for the nurse to deliver safe care are in place,” she said.