Little progress in participation of early-career registered nurses in hospital quality improvement activities

January 28, 2013

Nurses are the largest group of health care providers in the U.S., and health care leaders and experts agree that engaging registered nurses (RNs) in quality improvement (QI) efforts is essential to improving our health care system, patient care and our nation's health. Unfortunately, despite studies demonstrating the value of nurse-led quality improvement efforts, far too few nurses are involved in these efforts, and the number is not growing, according to a study published in the Journal of Nursing Care Quality.

The study—part of the RN Work Project funded by the Robert Wood Johnson Foundation (RWJF)—compared the participation levels for RNs who were first licensed between 2004 and 2005, and RNs first licensed between 2007 and 2008 in hospital QI activities. The research team found little difference in participation levels between the two cohorts for a variety of activities, including performance measurement, working to improve processes or systems of care, monitoring sustainability of improved practices, and efforts at . The only exception was "use of appropriate strategies to improve compliance to reduce nosocomial infection rates." (.)

"We expected to find a greater variation in QI participation between the two groups," said Djukic. "These findings underscore the need for hospitals to collaborate with nursing schools to develop effective strategies to ensure that RNs expect and are prepared to engage in QI activities. Nurses are an important resource in efforts to improve care and , and right now, that resource is too often being underutilized."

The team noted that there has been an increase in the number of hospitals who participate in formal programs aimed at increasing nurses' engagement in quality and safety initiatives since 2008. They expected that trend would increase the likelihood of participation in QI activities for the later cohort. Among those initiatives are Transforming Care at the Bedside, National Database of Nursing Quality Indicators Program, the hospital Magnet Recognition Program, and the "Quality and Safety Education for Nurses Initiative" (QSEN), funded by RWJF.

The research team cited several promising programs for engaging staff RNs in QI activities, including the Integrated Nurse Leadership Program in California, and the Bi-State Nursing Workforce Innovation Center's Clinical Scene Investigator Academy in Kansas and Missouri. They also recommended better data systems for monitoring quality outcomes specific to nursing care, so that RNs receive timely feedback on their performance. Other recommendations for hospital leadership include:

  • Subscribing to programs that allow RNs to complete self-directed online modules to learn about QI, such as the Institute for Improvement Open School for Health Professions and QSEN;
  • Having more experienced colleagues guide early-career RNs in translating newly-acquired QI knowledge into action;
  • Ensuring that staffing levels are high enough and that RNs have sufficient release time to participate in QI activities; and
  • Ensuring RNs have access to an information technology infrastructure that provides meaningful, timely and actionable QI data.
The study was based on surveys of 539 RNs who work in hospitals in 15 states: Alabama, Kentucky, Maryland, Michigan, North Carolina, New Jersey, Nevada, New York, Oklahoma, Oregon, Pennsylvania, South Carolina, Tennessee, Texas and West Virginia. The National Council of State Boards of Nursing Center for Regulatory Excellence provided funding for the study, in addition to the RWJF support.

The RN Work Project is a 10-year study of newly licensed (NLRNs) that began in 2006. It is the only multi-state, longitudinal study of new nurses' turnover rates, intentions and attitudes—including intent, satisfaction, organizational commitment and preferences about work. The study draws on data from in 34 states and the District of Columbia, covering 51 metropolitan areas and nine rural areas.

Explore further: Increased collaboration between nursing home RNs and LPNs could improve patient care

More information: journals.lww.com/jncqjournal/A … pation_in.99824.aspx

Related Stories

Increased collaboration between nursing home RNs and LPNs could improve patient care

March 14, 2012
Researchers estimate nearly 800,000 preventable adverse drug events may occur in nursing homes each year. Many of these incidents could be prevented with safety practices such as medication reconciliation, a process in which ...

Improving patient care by improving nurses' work environment

November 30, 2011
While nurse-to-patient ratios are widely recognized as an important factor in determining the quality of patient care, those ratios are not always easy to change without significant cost and investment of resources. What's ...

New registered nurses' lack of geographic mobility has negative implications for rural health

December 9, 2011
A study on the geographic mobility of registered nurses (RNs) recently published in the December Health Affairs magazine suggests that the profession's relative lack of mobility has serious implications for access to health ...

Web learning improves nurses' triage skills

January 17, 2013
(HealthDay)—Web-based learning is effective at standardizing training for triage skills of registered nurses (RNs), according to a review published in the January issue of the Journal of Emergency Nursing.

Fewer patient deaths after surgery in hospitals known for good nursing care

October 22, 2012
Patients treated in magnet hospitals (specially designated for their nursing excellence) had 14 percent lower odds of death than those in non-magnet hospitals in a four-state study of 564 hospitals led by the University of ...

Recommended for you

To combat teen smoking, health experts recommend R ratings for movies that depict tobacco use

July 21, 2017
Public health experts have an unusual suggestion for reducing teen smoking: Give just about any movie that depicts tobacco use an automatic R rating.

Aging Americans enjoy longer life, better health when avoiding three risky behaviors

July 20, 2017
We've heard it before from our doctors and other health experts: Keep your weight down, don't smoke and cut back on the alcohol if you want to live longer.

Opioids and obesity, not 'despair deaths,' raising mortality rates for white Americans

July 20, 2017
Drug-related deaths among middle-aged white men increased more than 25-fold between 1980 and 2014, with the bulk of that spike occurring since the mid-1990s when addictive prescription opioids became broadly available, according ...

Parents have critical role in preventing teen drinking

July 20, 2017
Fewer teenagers are drinking alcohol but more needs to be done to curb the drinking habits of Australian school students, based on the findings of the latest study by Adelaide researchers.

Fresh fish oil lowers diabetes risk in rat offspring

July 19, 2017
Fresh fish oil given to overweight pregnant rats prevented their offspring from developing a major diabetes risk factor, Auckland researchers have found.

High-dose vitamin D doesn't appear to reduce the winter sniffles for children

July 18, 2017
Giving children high doses of vitamin D doesn't appear to reduce the winter sniffles, a new study has found.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.