1 Members of QSEN Advisory Board
QSEN leaders were familiar with the Institute for Health Care Improvement's (IHI) use of learning collaboratives to inspire innovation and quality improvement (IHI, 2003) and decided to test the use of that model to accomplish Phase II goals for prelicensure education. Proposals to participate in the QSEN Pilot School Collaborative required that applicants describe curricular changes, faculty development strategies, and other activities that they would conduct within their specific nursing education programs. Cross‐collaborative learning was an expectation as well, with attendance at two meetings required of all school teams, which comprised clinical, classroom, and simulation lab faculty members plus a clinical partner (Cronenwett et al., 2009a).
For the work related to education for advanced practice registered nurse (APRN) roles, we added APRN leaders to both the QSEN faculty (Ward) and advisory board (Pohl), and invited the input of multiple organizations involved in setting standards for licensure, certification, or accreditation of APRN education programs. Representatives of 13 organizations (see Table 3.2) participated in the generation and organizational reviews of KSA learning objectives for graduate education (Cronenwett et al., 2009b).
Phase II Impact Factors
As in Phase I, linking QSEN with professional organizations potentiated the ideas generated by thought leaders and early innovators. Advisory board members participated fully in both the Pilot School Collaborative and APRN education work and built on this work from the perspectives of their own organizations. For example, the National Council of State Boards of Nursing (2011) began building a Transition to Practice model (QSEN link—Jane Barnsteiner) that required attention to QSEN competency development (now in its pilot phase in three states). The AACN (QSEN links—Polly Bednash and MaryJoan Ladden) created new standards for accreditation of baccalaureate (AACN, 2008) and clinical doctoral education (AACN, 2006) that included quality and safety competencies. The National League for Nursing (2010; QSEN links—Gwen Sherwood and Elaine Tagliareni) developed its education competencies model with a quality and safety thread. The National Organization of Nurse Practitioner Faculties (NONPF; QSEN links—Linda Cronenwett and Joanne Pohl) engaged in analyses of core and practice doctorate competencies for evidence of inclusion of the QSEN graduate KSAs (Pohl et al., 2009). The 12 QSEN faculty experts had wide professional networks and were invited to speak at numerous professional conferences, but the efforts of these few alone could not have produced the spread of QSEN‐related work throughout the profession. As the major professional organizations associated with licensure and accreditation standards demonstrated the need for and will to change, the momentum for innovation grew.
With that momentum came a need for growing the pool of nursing faculty who could provide consultation among peers in classroom, clinical, and simulation/skills laboratory teaching. A total of 53 schools applied for membership in the QSEN collaborative, and we suspect that the act of applying stimulated attention to improving quality and safety education, even though only 15 schools could be funded. Once again, we used DSS values and methods with 45 expert teachers, and they exceeded our expectations in terms of the breadth and quality of the innovative teaching strategies they developed.
We achieved our goal to end Phase II with at least 40 people who could join the QSEN faculty ranks and provide consultation for associate degree, diploma, and university programs in geographic areas around the country. In addition, a group of collaborative members conducted and published a Delphi study to assist faculties with determining the logical progression of quality and safety competency development across curricula (Barton et al., 2009). We also populated the QSEN website with teaching strategies that became available for faculty throughout the world to use. QSEN leader Pamela Ironside served as co‐editor for a special edition (December 2009) of the Journal of Nursing Education, where numerous innovative ideas for developing QSEN competencies (many from collaborative members) were published.
Another influential factor in this phase was our commitment to linking QSEN to practice. Pilot schools were expected to bring clinical partners to the QSEN meetings, and those participants enriched the discussions of both the problem and potential solutions. Many of the teaching innovations required access to root cause analyses, quality improvement project data, methods of error reporting, or electronic health records. Without the common goal of improving quality and safety education for the next generation of nursing graduates, clinical settings often prevented faculty and student access to these learning opportunities. In evaluating their participation in the QSEN collaborative, faculty participants often commented that a valuable and important outcome had been the extent to which their work on QSEN had strengthened academic–clinical partnerships.
Another potential explanation is that clinical partners helped keep nursing faculty aware of the rationale for the need to change our approaches to nursing professional identity formation. Batalden and Foster (2012) proposed that creating an environment in which people generate never‐ending improvement of the quality–safety–value of health care requires a commitment that holds three aims together: (a) better outcomes of care; (b) better system performance; and (c) better professional formation and development. Indeed, QSEN leaders noted that faculty responded with energy and commitment when it was clear how the work we were asking them to do was linked to the needs of patients, families, and communities. Apart from this link, the call for curricular change to accommodate a paradigm shift in thinking about quality and safety may not have found fertile ground.
Embedding New Competencies: Phase III
As Phase II entered its final months, QSEN relationships shifted in preparation for a major faculty development initiative. Program manager Rosemary Gibson resigned her position at RWJF, and we worried about the impact the loss of this long‐term partner would have on QSEN work. By some good fortune, QSEN advisory board member MaryJoan Ladden was hired by RWJF shortly thereafter and was appointed our new program manager and spokesperson within the foundation. Her intimate knowledge and support for the work of QSEN were crucial during the downturn in the economy (and foundation resources) that occurred as Phase III began (November 2008–November 2011 [UNC]; February 2009–February 2012 [AACN]).
In another shift in relationship, Geraldine (Polly) Bednash, the executive director of the AACN, moved from QSEN advisory board member to principal investigator of the train‐the‐trainer faculty development initiative portion of Phase III. Three QSEN faculty members (Barnsteiner, Disch, and Johnson) joined Dr. Bednash to develop the resources and lead the teaching of the regional conferences sponsored by the AACN Phase III grant. Three other QSEN faculty members (Ironside, Moore, and co‐investigator Sherwood) worked with me on UNC‐based initiatives. Collectively, we made up the steering committee, which oversaw the incredible investment that RWJF made (see Textbox 3.1 and Figure 3.2).
Finally, Paul Batalden and Mark Splaine, another DSS community member and head of the Veterans Administration Quality Scholars (VAQS) program, suggested that we explore the possibility of making VAQS, until then a program for physicians only, into an interprofessional program that would include nursing pre‐ and postdoctoral scholars. The Veterans Administration (VA) had mechanisms for paying nursing scholars, but since nursing faculties were not employed by the VA in the way medical faculties were, they had no way to pay faculty members for mentoring VAQS nursing scholars. I met with Dr. Hassmiller to explore the possibility of additional RWJF support for this purpose, and she was enthusiastic about the possibility of partnering with the VA to educate the first quality improvement scholars in nursing. Shirley Moore, a QSEN faculty member, proceeded to work with Dr. Splaine to co‐direct this new interprofessional VAQS program.
