Quality and Safety in Nursing. Группа авторов
Cleveland, OH, USA
Carol F. Durham, EdD, RN, ANEF, FSSH, FAAN Professor Director, QSEN Regional Center UNC‐Chapel Hill School of Nursing Chapel Hill, NC, USA
Margo A. Halm, PhD, RN, NEA‐BC Associate Chief Nurse Executive, Nursing Research & Evidence‐Based Practice VA Portland Health Care System Portland, OR, USA
Pamela M. Ironside, PhD, RN, FAAN, ANEF Professor Emerita Prairie du Sac, WI, USA
Jean Johnson, PhD, RN, FAAN Emerita Dean and Professor George Washington University School of Nursing Washington, DC, USA
Joan Kavanagh, PhD, RN, NEA‐BC Associate Chief Nursing Officer Education and Professional Development Cleveland Clinic Health System Cleveland, OH, USA
Ellen Luebbers, MD VA Quality Scholars Fellow Louis Stokes Cleveland VA Medical Center Case Western Reserve University School of Medicine Cleveland, OH, USA
Shirley M. Moore, PhD, RN, FAAN Professor Emerita Frances Payne Bolton School of Nursing Case Western Reserve University Cleveland, OH, USA
Bethany Robertson, DNP, CNM, FNAP Associate Professor, Clinical Emory University Nell Hodgson Woodruff School of Nursing Atlanta, GA, USA
Mary Jean Schumann, DNP, MBA, RN, CPNP‐PC, FAAN Associate Professor of Nursing George Washington University School of Nursing Washington, DC, USA
Mamta K. Singh, MD, MS Associate Professor of Medicine Case Western Reserve University School of Medicine Louis Stokes Cleveland Veterans Affairs Medical Center Cleveland, OH, USA
Nancy Spector, PhD, RN, FAAN Director of Regulatory Innovations National Council of State Boards of Nursing Chicago, IL, USA
Mary Fran Tracy, PhD, RN, APRN, CNS, FCNS, FAAN Associate Professor University of Minnesota School of Nursing University of Minnesota Medical Center Minneapolis, MN, USA
Judith J. Warren, PhD, RN, BC, FAAN, FACMI Consultant, Warren Associates, LLC Plattsmouth, NE, USA
Amy Hagedorn Wonder, PhD, RN Assistant Professor Indiana University School of Nursing Bloomington, IN, USA Meg Zomorodi, PhD, RN, FAAN, ANEF Assistant Provost and Director Office of Interprofessional Education and Practice Professor UNC‐Chapel Hill School of Nursing Chapel Hill, NC, USA
Foreword
Twenty years ago, the groundbreaking report To Err Is Human spotlighted the failure of the US health care system to protect patients from preventable harm. The report called for sweeping recommendations to improve patient safety and quality, including viewing medical errors as systemic problems, rather than individual mistakes. Nurse leaders responded to the urgent call to improve patient safety, and in 2005, the Robert Wood Johnson Foundation’s Quality and Safety Education in Nursing (QSEN) program was born. QSEN sought to intentionally integrate specific quality and safety concepts into nursing and other health profession curricula to prepare new nurses to improve quality and safety where they work. While initially focused on educating faculty to teach students competencies for use in hospital settings, QSEN expanded its focus to educating practicing nurses to use the competencies as the framework for practice, professional development, promotion, and evaluation across all types of care settings.
The award‐winning Quality and Safety Education in Nursing: A Competency Approach to Improving Outcomes was the first nursing textbook dedicated to widely sharing the QSEN competencies in order to improve patient safety and quality. As the third edition goes to press, health care leaders once again are grappling with irrefutable evidence of the shortcomings and systemic failures of the US health care system. The COVID‐19 pandemic has taken a devastating toll on the front‐line health care workforce and exposed the fractures within the systems that have a responsibility to protect nurses and other health care workers (Ulrich et al., 2020). Family members were not allowed to visit their loved ones, making it difficult for health care workers to incorporate patient engagement strategies, which have been shown to improve patient safety and quality (Hassmiller and Bilazarian, 2018). The pandemic has also laid bare long‐existing health inequities that have persisted for generations. As of June 2021, more than 600,000 people have died from COVID—a disproportionate number of whom have been people of color (APM Research Lab, 2021). Health care leaders are faced with a choice: to maintain the status quo, or to commit to a more just future.
Quality care starts with equitable care. Health is greatly influenced by nonmedical factors that affect communities, such as access to jobs that pay a living wage, safe housing, reliable transportation, walkable neighborhoods, good schools, fresh food, and adequate green spaces. Factors like our race and ethnicity, income level, sexual orientation, disabilities, and the conditions where we live—including in rural and remote areas—predict whether we are more likely to suffer from preventable, costly medical conditions and live shorter lives. Structural racism—defined as a system in which public policies, institutional practices, cultural representations, and other norms work in various, often reinforcing ways to perpetuate racial group inequity—directly prevents many from receiving safe and equitable care. For example, low‐income patients on Medicaid or without insurance in Los Angeles were more likely during the pandemic to receive care in overcrowded safety‐net hospitals, in spite of available room in nearby teaching hospitals with adequate staffing and more lifesaving technology. According to a New York Times article, 86% of COVID‐19 patients who had been intubated at Martin Luther King Jr. Community Hospital in Los Angeles died—a significantly higher number than at nearby teaching hospitals (Fink, 2021). The vast majority were Latino.
The pandemic has underscored the urgency of creating a future that gives everyone a fairer and more just opportunity for health. The National Academy of Medicine’s long‐anticipated report The Future of Nursing 2020–2030: Charting a Path to Achieve Health Equity, released in May 2021, contains a series of recommendations that are designed to unleash the potential for nurses to achieve health equity (NAM, 2021). The following key takeaways from the report are critical to eliminating preventable harm:
Fully support nurses. The report calls on nursing education programs, employers, nursing leaders, licensing boards, and nursing organizations to implement structures, systems, and evidence‐based interventions to promote nurses’ health and well‐being. The report recognizes that structural and cultural changes are needed to prioritize nurse well‐being. When nurses experience poor well‐being, they are more likely to make medical errors (Melnyk et al., 2018).
Permanently remove nurse practice barriers. The report recommends that nurses be allowed to practice to the full extent of their education and training in order to prevent significant and preventable gaps in access to care. For many people, delays in obtaining care lead to worsening of symptoms and disease progression, and to greater costs when they do receive care. Quality care starts with people being able to access care when they need it.
Value nurses’ contributions. The report calls on payment systems to explicitly value nurses’ contributions that improve quality and advance health equity. Examples include case management, care coordination, and team‐based care, which have all been shown to improve quality.
Prepare nurses to tackle health equity. The report calls on nursing education programs to ensure that nurses are prepared to address the social and economic drivers of health and achieve health equity. This includes dismantling structural racism and becoming aware of implicit biases to help nurses provide safer care to everyone.
The pandemic has underscored the importance of prioritizing equity to improve the quality of the care nurses provide locally and globally. As you read this textbook, I urge you to think about how you can use the QSEN competencies to recognize and address inequities in health care.
Susan B. Hassmiller, PhD, RN, FAAN