More on Community Benefit

Higher quality improvement participation levels needed among nurses

A recent study published in the Journal of Nursing Care Quality found that improvement is needed when it comes to the participation levels of newly-registered nurses in hospital quality improvement levels.

According to the study, funded by the Robert Wood Johnson Foundation, the participation levels in hospital quality improvement activities for RNs first licensed between 2004 and 2005 and RNs first licensed between 2007 and 2008 hardly improved.

[See also: Nurse staffing, burnout linked to HAIs]

The research team compared the participation levels between the two groups in several activities, including performance measurement, working to improve processes or systems of care, monitoring sustainability of improved practices and efforts at performance improvement. The only category that researchers found a marked improvement in participation levels was the use of appropriate strategies to improve hand-washing compliance to reduce hospital-acquired infections.

“We expected to find a greater variation in QI participation between the two groups,” said Maja Djukic, assistant professor at the College of Nursing at New York University and an author of the study. “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 quality improvement activities. Our most important message is that in order to improve the quality of care, nurses will have to take a greater responsibility and improve upon their participation levels in quality improvement.”

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 research team also found 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.Djukic expected that trend would increase the likelihood of participation in quality improvement activities for the more recently-licensed nurses.

[See also: Nurses at Massachusetts hospital take pay cut for 'safer' staffing levels]

Djukic said she and her team of researchers have several recommendations for hospital leadership to improve their RN participation levels, including subscribing to programs that allow RNs to complete self-directed online modules to learn about quality improvement, such as the Institute for Health Care Improvement Open School for Health Professions; having more experienced colleagues guide early-career RNs in translating newly-acquired quality improvement knowledge into action; ensuring that staffing levels are high enough and that RNs have sufficient release time to participate in quality improvement activities; and better data systems for monitoring quality outcomes specific to nursing care, so that RNs receive timely feedback on their performance.

“Coming out of this study, the key is that quality of care in the U.S. remains … sub-optimal and continues to be the most expensive compared to many nations. Nurses have been under-utilized in quality improvement initiatives for hospitals,” she said.


[See also: Quality improvement programs put strain on nursing shortage]