An Integrative Review of the Barriers and Facilitators to Nurse Engagement in Quality Improvement in the Clinical Practice Setting

Abstract

Background: Nurse engagement in quality improvement (QI) improves health care quality and outcomes but is typically low in clinical settings. Purpose: An integrative review was conducted to identify facilitators and barriers of nurse engagement in QI. Methods: This integrative review was conducted using an electronic search of databases with search terms specific to nursing engagement in QI. The Johns Hopkins Nursing Evidence-Based Practice Evidence Level and Quality Guide was used to rate quality and level of evidence. Results: Nine articles met the criteria for review. Top barriers were leadership, education and training, resource constraints, data, culture, and time. Top facilitators were leadership, education and training, culture, mentors, and champions. Conclusion: High-quality literature exploring barriers and facilitators of nurse engagement in QI is lacking. Research is needed to examine the degree to which these barriers and facilitators impact engagement and how they can be addressed to increase it.

A qualitative study on barriers and facilitators of quality improvement engagement by frontline nurses and leaders

“…Researchers concluded that leaders play a key role in fostering strong procedural justice by building a communication mechanism that gives nurses a say in decisions that affect their daily work (Djukic et al, 2021). This finding aligns with the results of our integrative review and may be a critical variable for expanding nurses' engagement (Alexander et al, 2022). Another strategy is the adoption of The American Association for Critical‐Care Nurse Standards for Establishing and Sustaining a Healthy Work Environment as a pathway for improving staff engagement, psychological safety, organisational performance and patient outcomes (American Association of Critical‐Care Nurses [AACN], 2005).…”

“…The major themes from this study align with extensive research that has identified leadership and culture as critical drivers for QI engagement (Alexander et al, 2022;Flynn & Hatfield, 2016;Mery et al, 2017). Flynn and Hatfield (2016) are essential components of QI initiatives, it is a habitual application of QI knowledge and skills that is critical for success (Flynn & Hatfield, 2016;Lucas & Nacer, 2015;Mery et al, 2017).…”

“…Nurses and leaders both agreed that lack of accountability and resistance to change made it difficult to move QI initiatives forward. Similarly, our integrative review also identified hierarchy, lack of accountability and resistance to change as significant barriers to engagement (Alexander et al, 2022).…”

“…A leader's job is to encourage, coach and foster partnerships so nurses can address the complex issues of health care delivery. Similarly, in our integrative review, leadership was the most often cited facilitator (Alexander et al, 2022), but to what degree a leader's QI knowledge and skills influence nurse engagement is currently unknown.…”

Quality improvement engagement

“…The list of barriers and facilitators included on the N-QuIP tool was developed through an integrative review identifying common factors contributing to nurse engagement in QI. 6 In the event that a perceived barrier or facilitator wasn't listed, respondents could provide a free-text response, thus capturing any additional factors that may influence engagement in QI. The tool has established validity and reliability.…”