Early-Career Registered Nurses' Participation in Hospital Quality Improvement Activities

Abstract

We surveyed 2 cohorts of early-career registered nurses from 15 states in the US, 2 years apart, to compare their reported participation in hospital quality improvement (QI) activities. We anticipated differences between the 2 cohorts because of the growth of several initiatives for engaging nurses in QI. There were no differences between the 2 cohorts across 14 measured activities, except for their reported use of appropriate strategies to improve hand-washing compliance to reduce nosocomial infection rates.

Development and Testing of the Quality Improvement Self-efficacy Inventory

“…In a sample of 436 newly graduated RNs, 38.6% of participants across all education levels reported that they were poorly or very poorly prepared in or had never heard of QI ( Kovner et al, 2010 ). Comparable findings were reported in a study of 541 newly graduated hospital-based RNs from 15 states ( Djukic et al, 2013a ). The other QSEN competencies received higher ratings than the QI competency.…”

“…Few RNs perceived themselves to be adequately prepared in the use of QI models (12%), data collection (33%), data analysis (29%), measurement (28%), project implementation (24%), data analysis and monitoring tools (16%), flowcharting processes (22%), measuring current performance (20%), assessing process gaps (15%), systematically applying QI tools and methods (19%), measuring change (17%), repeating QI activities until desired improvement is reached (14%), and monitoring sustainability (12%). Furthermore, newly graduated nurses reported low frequency of participation in QI activities ( Djukic et al, 2013a ). In two cohorts of early career RNs in hospitals (total N = 539), 21.4–48.7% reported no participation across 10 QI activities.…”

“…For nurses, Kovner et al (2010) developed a 35-question survey based on literature and an expert advisory group. Newly graduated nurses answered how prepared they felt in specific QI topics for both the 2010 and 2013 publications mentioned earlier ( Djukic et al, 2013a ). Most recently, Armstrong et al (2017) developed a 24-item scale, the Nurses’ Attitudes and Skills around Updated Safety Concepts, based on a literature review of updated patient safety definitions and concepts.…”

Variables Associated With Nurse-Reported Quality Improvement Participation

“…1 Engaging nurses in QI, particularly around nurse-sensitive quality indicators such as central line and urinary catheter infections, is an imperative 2 that has not been met on a wide scale. 3 Hospitals that implement focused programs for staff engagement in QI such as the Transforming Care at the Bedside (TCAB) have shown positive results for staff and the fiscal bottom line. 4,5 However, <10% of US hospitals participate in such programs.…”

Quality improvement education innovation: evaluation of Coursera MOOC ‘Take the Lead on Healthcare Quality Improvement’

“…Whereas healthcare professions education programmes now embed QI competency in curricula, and the competencies are included in accreditation standards for healthcare professions' education, older more experienced practitioners often lack preparedness for involvement in QI activities, both in attitudes and skills. A cross-sectional comparative study (Djukic et al., 2013a) found that many newly graduated nurses report never having been involved in key QI processes such as measurement for current performance, gap analysis, use of tools to improve performance, systems improvement, or root cause analysis. Building on the analysis performed in their 2012 study, the same authors found (Djukic et al., 2013b) that overall less than 25% of nurses in the study reported being well prepared for involvement in QI activities.…”