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Measuring Nurses’ Impact on Health Care Quality: Progress, Challenges, and Future Directions

Beck, Susan L. PhD, APRN, AOCN, FAAN*; Weiss, Marianne E. DNSc, RN; Ryan-Wenger, Nancy PhD, RN, CPNP, FAAN; Donaldson, Nancy E. DNSc, RN, FAAN§; Aydin, Carolyn PhD; Towsley, Gail L. PhD*; Gardner, William PhD¶,#

doi: 10.1097/MLR.0b013e3182802e8b
Original Articles

Background: Quality measurement is central in efforts to improve health care delivery and financing. The Interdisciplinary Nursing Quality Research Initiative supported interdisciplinary research teams to address gaps in measuring the contributions of nursing to quality care.

Objective: To summarize the research of 4 interdisciplinary teams funded by The Interdisciplinary Nursing Quality Research Initiative and reflect on challenges and future directions to improving quality measurement.

Methods: Each team summarized their work including the targeted gap in measurement, the methods used, key results, and next steps. The authors discussed key challenges and recommended future directions.

Results: These exemplar projects addressed cross-cutting issues related to quality; developed measures of patient experience; tested new ways to model the important relationships between structure, process, and outcome; measured care across the continuum; focused on positive aspects of care; examined the relationship of nursing care with outcomes; and measured both nursing and interdisciplinary care.

Discussion: Challenges include: measuring care delivery from multiple perspectives; determining the dose of care delivered; and measuring the entire care process. Meaningful measures that are simple, feasible, affordable, and integrated into the care delivery system and electronic health record are needed. Advances in health information systems create opportunities to advance quality measurement in innovative ways.

Conclusions: These findings and products add to the robust set of measures needed to measure nurses’ contributions to the care of hospitalized patients. The implementation of these projects has been rich with lessons about the ongoing challenges related to quality measurement.

*University of Utah College of Nursing, Salt Lake City, UT

Marquette University College of Nursing, Milwaukee, WI

Nursing Research, Nationwide Children’s Hospital, Columbus, OH

§University of California San Francisco Centre for Evidence-Based Quality Improvement A JBI Affiliate Centre, San Francisco

Cedars-Sinai Medical Center and Burns & Allen Research Institute, Los Angeles, CA

Department of Pediatrics, Psychology, & Psychiatry, The Ohio State University, Columbus, OH

#Department of Obstetrics & Gynaecology, Pediatrics, & Epidemiology, Dalhousie University, Halifax, NS, Canada

Funded by the Robert Wood Johnson Foundation as part of the Interdisciplinary Nursing Quality Research Initiative.

The authors declare no conflict of interest.

Reprints: Susan L. Beck, PhD, APRN, AOCN, FAAN, University of Utah College of Nursing, 10 South 2000 East, Salt Lake City, UT 84112. E-mail:

© 2013 Lippincott Williams & Wilkins, Inc.