continued innovation in the development and evaluation of methods to elicit and assess student learning of the knowledge, skills, and attitudes of the six IOM/QSEN competencies and the widespread sharing of those innovations.2 Develop the faculty expertise necessary to assist the learning and assessment of achievement of quality and safety competencies in all types of nursing programs.
3 Create mechanisms to sustain the will to change among all programs through the content of textbooks, accreditation and certification standards, licensure exams, and continued competence requirements.
Thus began a three‐year intensive effort to develop faculty expertise for integrating QSEN competency development in curricula throughout the country.
Phase III Impact Factors
One of the Phase III factors that we believe assisted forward progress in faculty development was the following multimodal approach that was taken across two major grants using one steering committee:
For prospective faculty (pre‐ and postdoctoral scholars) with an interest in quality improvement science, the VAQS initiative provided a unique opportunity for interprofessional learning and development of scholars in an area of science that was new to nursing.
Faculty members worldwide could seek their own self‐development opportunities on the QSEN website, through teaching strategies submitted from the field at large and through learning modules developed with expert editorial support from Pamela Ironside.
For schools that wanted to contract with one or more consultants to conduct faculty development activities with entire faculties on their own campuses, descriptions of QSEN facilitators were accessible through the QSEN website.
For schools that wished to send QSEN champions to train‐the‐trainer opportunities, nine conferences were held in regions across the country (sold out for each one held to date). These early adopters received extensive resources for themselves and for educating colleagues at home.
For innovator faculty members who were experimenting with new curricula, pedagogies, and clinical and simulation teaching, the opportunity to submit their work for peer review and presentation at QSEN National Forums was provided.
In sum, a faculty development opportunity was in reach of anyone, anywhere. Furthermore, the impact of each faculty development method was potentiated by others. Website learning opportunities were mentioned at conferences, and conferences were advertised on the website. QSEN facilitators presented and moderated panels at the national forums, thus increasing their visibility and subsequent solicitation as consultants. Through the generosity of RWJF, this multimodal, multigrant approach was possible. Add to that the 2009 special issues of Nursing Outlook and Journal of Nursing Education, and QSEN was everywhere.
Another important factor was a conscious focus on what would be needed to support the execution phase of improving quality and safety education for faculty, regardless of whether they were innovators, early adopters, or late adopters. Innovators needed to be able to get together and stimulate each other’s creativity and motivation to persist in innovating for the field. The QSEN Pilot School Collaborative, QSEN facilitators group, VAQS program, and QSEN National Forums were designed for these purposes.
Early adopters needed faculty development and consultation opportunities that could bring QSEN ideas to them and their schools without requiring everyone to “reinvent the wheel” from KSA learning objectives alone. QSEN website resources, train‐the‐trainer regional conferences, and QSEN facilitators, along with this group’s publications and presentations, all served to support early adopters.
In spite of the enthusiasm of innovators and early adopters, there remains a large group of faculties who either have never heard of the QSEN competencies (in IOM or QSEN terms) or do not appreciate the fact that accomplishing improvements in this domain requires the knowledgeable support of every faculty member in every school. For those faculty members not innately attracted to or unaware of the work, changing standards for licensure and certification (and continuing competency in both domains) and changing standards for accreditation of nursing education programs are important tools for encouraging continuous improvement.
Another strategy for late adopters was changing the content of the textbooks used in courses. We had expected to have to push in this area. Instead we were (and still are) being pulled into the processes of change. Textbook authors, working on next editions of more than 20 textbooks, have requested assistance or authorship of sections related to QSEN competency development. Others are undoubtedly making these changes without our knowledge or assistance. One major publisher of nursing textbooks currently requires authors to document the manner in which they are addressing each QSEN competency. Finally, after many calls for a “QSEN Textbook,” Drs. Sherwood and Barnsteiner agreed to co‐edit the book in which this chapter appears.
QSEN and Beyond Phase III
In May 2011, our RWJF program manager, MaryJoan Ladden, invited Dr. Bednash and me to submit proposals for one final QSEN phase. The Interprofessional Education Collaborative (IPEC), which is sponsored by six professional organizations that represent those who educate allopathic and osteopathic physicians, nurses, pharmacists, dentists, and public health, published (2011) a monograph that calls upon the health professions to prepare graduates with interprofessional team and team‐based care competencies. The four competencies (values/ethics for interprofessional practice, roles/responsibilities for collaborative practice, interprofessional communication, and interprofessional teamwork and team‐based care) and their learning objectives overlap significantly with QSEN competency definitions and KSAs. We hope that QSEN has prepared nursing faculty with ideas and resources that will increase the quality of their contributions to this important initiative.
What should we expect to see over time if QSEN’s impact, along with other national initiatives, “changes the world”? Initially, curricula have to change so that students develop their professional identity assuming that to be a good nurse means being competent in patient‐centered care, teamwork and collaboration, evidence‐based practice, quality improvement, safety, and informatics. Using a sample of new nurses who graduated August 2004 to July 2005, Kovner et al. (2010) reported analyses of data from a 2008 survey where 39% of the nurses thought they were “poorly” or “very poorly” prepared about or had “never heard of” quality improvement. Fortunately, Drs. Kovner and Brewer, also funded by RWJF, will follow more recent cohorts of newly licensed nurses during their 10‐year study, enriching the assessments and analyses of outcomes pertaining to development of quality and safety competencies. We hope that over time we will be able to answer the question posed in Gregory et al.’s (2007) research brief “Patient safety: Where is nursing education?”
In the end, however, returning to Batalden and Foster’s (2012) triangle, we will hopefully find health professionals who, as part of their daily work, care for individual patients while simultaneously improving population health, system performance, and professional development. To be successful, we will need to discover ways to support nursing faculty as key contributors to the interprofessional work of continuous quality improvement, so that they are role models as well as guides for what it means to be a good nurse. If we succeed in reaching these lofty aims and QSEN has been one of the optimistic catalysts for this magnitude of change, it will be a legacy of which to be proud.
QSEN: 2012–2017
The pioneering work begun in early 2000 has continued at the same fast pace and with broadened dissemination and
