What is QSEN in nursing?

Nurses must demonstrate quality and safety in patient care. Learn about the framework that uses evidence-based standards to provide nurses with the skills to deliver quality and safe care, throughout their nursing education. 

In response to patient safety concerns in hospitals, nursing leaders launched Quality and Safety Education for Nurses (QSEN) in 2005. The initiative addressed findings from the Institute of Medicine report “To Err is Human: Building a Safer Health System.” According to the report, medical errors were causing up to 98,000 preventable hospital deaths annually.

By the early 2000s, modern healthcare had grown more complex, and it was time to examine the systems and structures that allowed human errors to occur. The report prompted other long-standing patient safety initiatives, including The Joint Commission’s National Patient Safety Goals^® in 2003.

Recognizing that nurses play a key role in patient safety, leaders established six core competencies to shape nursing knowledge, skills and attitudes (KSAs) toward care. Elements of the framework encourage nurses to think critically about the “why” behind their clinical decisions and interactions — whether with patients, families or healthcare team members.

By integrating the competencies into nursing curricula and clinical practice, nurses at all levels are trained to prioritize quality and safety in their daily work. QSEN seeks to:

• Reduce preventable errors in complex healthcare environments
• Prepare nurses to seek continuous improvement in the healthcare setting
• Standardize nursing education by integrating quality and safety standards into learning materials, testing and licensure preparation

In nursing education, quality and safety competencies are woven throughout curricula, from clinical practicum to population health sources. For instance, instructors might assess a student’s safety practices during a simulated sterile dressing change. The rubric would evaluate adherence to protocols like maintaining a sterile field and following a step-by-step method to complete the procedure. By building this foundation in nursing school, nurses should instinctively incorporate a best-practice mindset in professional practice. 

Each of the six QSEN core competencies encompasses specific KSAs that nurses must develop to prioritize safety and quality in patient care.

Patient-centered care involves partnering with patients and families as active participants in decision-making. Nurses apply a nursing model of care that respects patients’ personal and cultural preferences while prioritizing dignity and comfort. Patient-centered care encourages nurses to view care decisions from the patient’s perspective rather than a one-size-fits-all approach. 

Teamwork and collaboration emphasize effective communication and mutual respect within multidisciplinary teams. Nurses adapt their communication styles to work effectively with diverse team members, and they seek to remediate any limitations through one another’s strengths. Establishing strong working relationships builds trust among the team and supports a culture of transparency.

Evidence-based practice requires nurses to ground their clinical decisions in current research rather than tradition alone. This means consulting peer-reviewed journals when questions arise and engaging in ongoing learning to bring the latest evidence into practice. Nurses incorporate evidence-based practice in patient education by providing quality resources for health information.

To improve quality of care, nurses must focus on systematically identifying and addressing gaps in care. Recognizing their role as change agents in enhancing patient outcomes, nurses participate in unit-based quality improvement projects. For example, nurses may create task forces to lead initiatives such as reducing central line infection rates or promoting early postoperative ambulation. 

To improve quality of care, nurses must focus on systematically identifying and addressing gaps in care. Recognizing their role as change agents in enhancing patient outcomes, nurses participate in unit-based quality improvement projects. For example, nurses may create task forces to lead initiatives such as reducing central line infection rates or promoting early postoperative ambulation. 

Informatics involves using information and technology to communicate, manage knowledge and support decision-making, thus enhancing patient safety. Nurses use electronic health records, barcode medication administration systems and clinical alerts to prevent errors. This competency also includes evaluating technology’s effectiveness while identifying potential risks such as distractions and alarm fatigue.

Educational programs typically integrate QSEN into course syllabi and learning objectives. For example, a fundamentals course might include objectives such as “the student nurse will deliver compassionate patient-centered care in diverse settings when caring for the older adult.” By anchoring objectives to the core competencies, educators can connect specific nursing skills to broader professional values. This can help students integrate quality and safety standards into every task, setting their intentions beyond skill proficiency.

The QSEN framework is used to measure safety and readiness during clinical evaluation and assessment. Clinical evaluation tools track students’ progress throughout a nursing program. Nursing students and instructors alike use them to measure a student’s abilities by providing examples of how a student incorporates each competency into practice.

Using the tools for self-evaluation allows a student to reflect on their approach to care and decision-making patterns in the clinical setting. Instructors may use these tools to provide feedback on what students should work on as they build clinical practice. For example, an instructor might identify a need for more effective communication during patient education. The student would then take this feedback and provide more thorough patient teaching in future clinical rotations.

In addition to clinical evaluations, students may reflect on their clinical experiences through a quality and safety perspective. A reflective assignment may involve relating a specific learning opportunity in clinicals to a competency like teamwork and collaboration.

The reflections bridge the gap between classroom theory and clinical practice, helping students recognize the core competencies in action and consider how they could handle similar situations differently. This cultivates the habit of continuous self-evaluation, which is necessary in professional nursing practice.

Students are expected to apply the foundation for quality and safety competencies in their nursing education program, which continues throughout their professional practice. QSEN-framed nursing education programs for professional nurses may translate to measurable benefits. When healthcare organizations provide ongoing QSEN education, they can help foster a culture of continuous learning and quality improvement. Educational interventions can improve nursing competency, which may ultimately enhance staff satisfaction and patient safety. 

By applying systems thinking in clinical practice, nurses are better prepared to:

• Enhance problem-solving and decision-making
• Improve priority-setting and delegation
• Engage in more effective interactions with colleagues and patients

The nursing profession could benefit from nurses whose education is grounded in QSEN competencies. University of Phoenix offers online nursing degrees at the bachelor’s, master’s and doctoral levels. For more information, contact University of Phoenix.