Deference to Expertise: Making Care Safer.

Since the seminal report by the Institute of Medicine, To Err Is Human, was issued in 1999, significant efforts across the health care industry have been launched to improve the safety and quality of patient care. Recent advances in the safety of health care delivery have included commitment to creating high-reliability organizations (HROs) to enhance existing quality improvement activities. This article will explore key elements of the HRO concept of deference to expertise, describe the structural elements that support nurses and other personnel in speaking up, and provide examples of practical, evidence-based tools to help organizations support and encourage all members of the health care team to speak up.

Expanding leadership capacity: educational levels for nurse leaders.

A master's degree in nursing administration prepares the nurse to lead nursing and interprofessional teams, to create new and innovative approaches to improve care processes and outcomes, as well as traditional management responsibilities related to budgets, human resources, quality and safety, and a healthy work environment. Are we not at a critical juncture in our profession when we should challenge the profession to require a master's degree education for all levels of nursing administration?

Preparing nursing students to be effective health team partners through interprofessional education.

This article will provide an overview of recent significant activities related to interprofessional education to promote care quality through teamwork and collaboration, followed by a discussion of what nursing schools can do to develop the knowledge, skills, attitudes, and values to enhance health care team performance and care outcomes.

Exploring the changing landscape of jobs for new graduates: practice, education, and new graduate imperatives.

Numerous expert sources have reported a reduction in positions available for new graduate nurses, largely because of general economic conditions, although there are conflicting data and significant geographic variances. Nursing education, nursing practice, and new graduates themselves must develop partnerships to better prepare graduates for more challenging employment searches so that these newest members of the nursing workforce are retained and available for practice in preparation for the expected shortage of nurses in the near future.

Using virtual environments to enhance nursing distance education.

Distance education has traditionally been two-dimensional, with limited interaction. Virtual environments enhance distance education learning through real-time interaction and social collaboration that mimic the real world. Virtual environments offer the option to create social and professional relationships that have been a missing component of distance learning.

Assessing quality and safety competencies of graduating prelicensure nursing students.

The Quality and Safety Education for Nurses (QSEN) project is focused on enhancing nursing curricula and fostering faculty development to support student achievement of quality and safety competencies. The purpose of this descriptive study was to assess student perspectives of quality and safety content in their nursing programs along with self-reported levels of preparedness and perceived importance of the 6 QSEN competencies. Graduating students (n = 565) from 17 US schools of nursing completed an electronic student evaluation survey. Students reported exposure to QSEN knowledge areas, more often in classroom and clinical learning settings than in skills lab/simulation settings. Clinical experience outside of formal education was associated with perceptions of a higher level of preparedness for QSEN skills in several competencies. In general, students reported relatively high levels of preparedness in all types of prelicensure nursing programs and endorsed the importance of quality and safety competencies to professional practice.

Quality and safety education for advanced nursing practice.

The Quality and Safety Education for Nurses (QSEN) project is a national initiative to transform nursing education to integrate quality and safety competencies. This article describes a two-year process to generate educational objectives related to quality and safety competency development in graduate programs that prepare advanced practice nurses in clinical roles. Knowledge, skills, and attitudes for each of 6 competencies are proposed to stimulate development of teaching strategies in programs preparing the next generation of advanced practice nurses.

Evaluation of a discharge education protocol for pediatric patients with gastrostomy tubes.

INTRODUCTION: To evaluate the impact of a preprocedure education protocol for children who receive a gastrostomy tube (GT). METHODS: A preintervention-postintervention design, using surveys and comparison between preprotocol and postprotocol cohorts, was used to evaluate the effect of implementation of a standardized GT education protocol with 26 subjects on caregiver, patient, and provider outcomes. RESULTS: The use of a preprocedure education protocol resulted in improved patient outcomes and increased caregiver knowledge and confidence and was considered a positive change by the providers. DISCUSSION: Often education is a forgotten part of a medical procedure, and the importance of education is typically only recognized after an adverse event occurs. Establishing a standardized evidence-based education protocol for GT care improves overall care and satisfaction. Use of a systematic and family-centered interdisciplinary approach markedly improves patient care.

Quality and Safety Education for Nurses.

Quality and Safety Education for Nurses (QSEN) addresses the challenge of preparing nurses with the competencies necessary to continuously improve the quality and safety of the health care systems in which they work. The QSEN faculty members adapted the Institute of Medicine(1) competencies for nursing (patient-centered care, teamwork and collaboration, evidence-based practice, quality improvement, safety, and informatics), proposing definitions that could describe essential features of what it means to be a competent and respected nurse. Using the competency definitions, the authors propose statements of the knowledge, skills, and attitudes (KSAs) for each competency that should be developed during pre-licensure nursing education. Quality and Safety Education for Nurses (QSEN) faculty and advisory board members invite the profession to comment on the competencies and their definitions and on whether the KSAs for pre-licensure education are appropriate goals for students preparing for basic practice as a registered nurse.