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Many New Nurses Don't Connect Job Performance with Quality Improvement

doi: 10.1097/01.NNE.0000334849.34145.2d
Departments: News, Notes and Tips

Novice nurses report being "poorly" or "very poorly" prepared in their nursing education programs to implement quality improvement (QI). Some even stated that they "had never heard" of the term QI. New Nurses Views of Quality Improvement Education, published in the January 2010 issue of The Joint Commission Journal on Safety and Patient Quality, explains that despite the strong focus on quality improvement in hospitals, 38.6% of novice nurses questioned reported the deficiencies noted above in their educational programs.

With support from the Robert Wood Johnson Foundation, the researchers analyzed the survey responses from 436 newly licensed RNs from 34 states and the District of Columbia (69.4% response rate). While many nurses may observe problems and understand the need for quality improvement, many others reported feeling unprepared to undertake the actions necessary to do so.

The views of survey participants related to their QI preparation varied dramatically, depending on the specific content area. For example, a majority felt they were "very prepared" in patient-centered care. However, half of the participants felt they were "not at all prepared" to use specific QI techniques, such as root cause analysis.

Respondents with a Baccalaureate degree reported significantly higher levels of preparation than Associate Degree program graduates in evidence-based practice, assessing gaps in practice, teamwork and collaboration. The BSN graduates also reported being better prepared to incorporate research skills such as data collection, analysis, measurement, and measuring resulting changes into their novice practice.

Accrediting bodies are key players in QI, and the study's findings are certainly in contrast to their expectations. The American Association of Colleges of Nursing, for example, requires that graduates demonstrate an understanding of the basic elements of research and models for applying evidence to clinical practice. Hospital nurses provide direct care to patients, making their attention to QI critical to an organization's success. The study calls on leaders in hospitals, nurse education programs, and nursing program accrediting organizations to make QI education their highest priority.

Still, many novice nurses did not perceive their QI training from their employers as helpful either, prompting the study authors to suggest that this finding required additional study. The authors also recommend that nurse educators partner with hospitals to implement more effective QI education, jointly introducing students to the methods that health care organizations use and make specific QI projects a requirement for graduation.

Co-principal investigators of the study are Carol S. Brewer, professor, School of Nursing at the University at Buffalo and Christine Kovner, professor, New York University's College of Nursing and author of the study.

Source: Press Release, December 17, 2009. GYMR Public Relations. For more information, contact Anne Marie Borrego at

Submitted by: Robin Pattillo, PhD, RN, News Editor at

© 2010 Lippincott Williams & Wilkins, Inc.