Development and Testing of the Quality Improvement Self-efficacy Inventory

Abstract

Quality improvement is paramount for patient safety. Leading change for quality improvement requires nurses with knowledge and skills beyond the clinical management of patients. In this study, staff nurses working in hospitals throughout Alabama were asked via an online survey to rate their quality improvement knowledge and skills using the new 10-item Quality Improvement Self-Efficacy Inventory (QISEI) and their perceptions of the nursing work environment using the Practice Environment Scale of the Nursing Work Index. Nurses ( N = 886) rated the basic quality improvement items higher than the more advanced items. Several nurse characteristics and the nursing work environment were associated with nurses’ ratings of their quality improvement knowledge and skills. Educators and administrators in health care organizations can use QISEI to gauge their nurses’ knowledge and skills and then develop continuous professional development opportunities aimed at improving quality and safety competencies.

Self-efficacy in Quality Improvement Competency of Frontline Acute Care Registered Nurses

“…The lowest-scoring competencies across all demographic variables were specific to QI skills, consistent with other studies finding that attitude and knowledge scores tend to be greater than scores related to QI skills 25-27. In particular, statement 4, Interpreting benchmark and unit outcome data to inform individual and microsystem practice ( M = 3.47, SD = 1.33), and statement 8, Developing a plan for monitoring QI change ( M = 3.68, SD = 1.33), were the lowest-scoring items, reflecting a neutral self-efficacy.…”

“…20,21 Researchers find that RNs experience barriers and limited participation in QI, 22 as well as QI-related competency gaps, 23,24 with varying results in the significance of educational attainment and years of RN experience. [23][24][25][26][27] Embracing Bandura's Self-efficacy theory, whereby self-efficacy reflects perceived capacity and skills to achieve a desired goal 28 and may predict performance, 29 RNs with greater experience, encouragement, and exposure to QI may have greater QI self-efficacy. Insufficient study about RNs' self-efficacy in QI, combined with new QI-related competency statements in the 2021 AACN Essentials, 12 provides the opportunity to evaluate self-efficacy in entry-level QI competency in frontline acute care RNs.…”

“…The lowest-scoring competencies across all demographic variables were specific to QI skills, consistent with other studies finding that attitude and knowledge scores tend to be greater than scores related to QI skills. [25][26][27] In particular, statement 4, Interpreting benchmark and unit outcome data to inform individual and microsystem practice (M = 3.47, SD = 1.33), and statement 8, Developing a plan for monitoring QI change (M = 3.68, SD = 1.33), were the lowest-scoring items, reflecting a neutral self-efficacy. The competency statements about benchmarking, outcomes, and analyzing data to guide practice, as well as developing a product or plan to monitor change, may be more complex, though considered by the AACN 12 to be part of entry-level QI-related competency.…”

“…Researchers find that RNs experience barriers and limited participation in QI,22 as well as QI-related competency gaps,23,24 with varying results in the significance of educational attainment and years of RN experience 23-27. Embracing Bandura's Self-efficacy theory, whereby self-efficacy reflects perceived capacity and skills to achieve a desired goal28 and may predict performance,29 RNs with greater experience, encouragement, and exposure to QI may have greater QI self-efficacy.…”

Incorporating a Patient Safety and Quality Course Into the Nursing Curriculum: An Assessment of Student Gains

“…Previous literature has shown how self-efficacy scoring helps academic and health care leaders to gather information about the level of QI knowledge and skills of respective faculty or staff. The scoring helps highlight opportunities for targeted intervention aimed at improving and incorporating QI competencies into nursing education and practice 29 . Existing studies have also reported increase in safety incident reporting with self-efficacy defined as an individual’s competence to tackle response to PS issue 30 .…”