Quality and Safety Education for Nurses


The overall goal for the Quality and Safety Education for Nurses (QSEN) project is to meet the challenge of preparing future nurses who will have the knowledge, skills and attitudes (KSAs) necessary to continuously improve the quality and safety of the healthcare systems within which they work.

Using the Institute of Medicine 1 competencies, QSEN faculty, a National Advisory Board, and 17 representatives from 11 professional organizations representing advanced nursing practice defined quality and safety competencies for nursing and proposed targets for the knowledge, skills, and attitudes to be developed in nursing graduate programs for each competency. These definitions are shared in the six tables below as a resource to serve as guides to curricular development for formal academic graduate programs and for use as criteria for certification and continuing education of advanced practice nurses 2.

For information on applying the competencies at a prelicensure level, see the Prelicensure KSAs page.

[box type=”shadow”]Note: This content is reprinted with permission from the “Quality and Safety Education for Nurses” article originally printed in Nursing Outlook Special Issue: Quality and Safety Education. For guidelines on use of this material, please read our terms and conditions.[/box]


  • Patient-centered Care
  • Teamwork and Collaboration
  • Evidence-based Practice (EBP)
  • Quality Improvement (QI)
  • Safety
  • Informatics

Patient-centered Care

Definition: Recognize the patient or designee as the source of control and full partner in providing compassionate and coordinated care based on respect for patient’s preferences, values, and needs.
Knowledge Skills Attitudes
Analyze multiple dimensions of patient centered care:
• patient/family/community preferences, values
• coordination and integration of care
• information, communication, and education
• physical comfort and emotional support
• involvement of family and friends
• transition and continuityAnalyze how diverse cultural, ethnic, spiritual and social backgrounds function as sources of patient, family, and community valuesAnalyze social, political, economic, and historical dimensions of patient care processes and the implications for patient-centered careIntegrate knowledge of psychological, spiritual, social, developmental and physiological models of pain and suffering
Elicit patient values, preferences and expressed needs as part of clinical interview, diagnosis, implementation of care plan and evaluation of careCommunicate patient values, preferences and expressed needs to other members of health care teamProvide patient-centered care with sensitivity, empathy and respect for the diversity of human experienceEnsure that the systems within which one practices support patient-centered care for individuals and groups whose values differ from the majority or one’s own.

Assess and treat pain and suffering in light of patient values, preferences, and expressed needs

Value seeing health care situations ‘through patients’ eyes’Respect and encourage individual expression of patient values, preferences and expressed needsValue the patient’s expertise with own health and symptomsHonor learning opportunities with patients who represent all aspects of human diversity

Seek to understand one’s personally held attitudes about working with patients from different ethnic, cultural and social backgrounds

Willingly support patient-centered care for individuals and groups whose values differ from own

Value cultural humility

Seek to understand one’s personally held values and beliefs about the management of pain or suffering

Analyze ethical and legal implications of patient-centered careDescribe the limits and boundaries of therapeutic patient-centered care Respect the boundaries of therapeutic relationshipsAcknowledge the tension that may exist between patient preferences and organizational and professional responsibilities for ethical careFacilitate informed patient consent for care Value shared decision-making with empowered patients and families, even when conflicts occur
Analyze strategies that empower patients or families in all aspects of the health care processAnalyze features of physical facilities that support or pose barriers to patient-centered careAnalyze reasons for common barriers to active involvement of patients and families in their own health care processes Engage patients or designated surrogates in active partnerships along the health illness continuumCreate or change organizational cultures so that patient and family preferences are assessed and supportedAssess level of patient’s decisional conflict and provide access to resourcesEliminate barriers to presence of families and other designated surrogates based on patient preferences Respect patient preferences for degree of active engagement in care processHonor active partnerships with patients or designated surrogates in planning, implementation, and evaluation of careRespect patient’s right to access to personal health recordsValue system changes that support patient-centered care
Integrate principles of effective communication with knowledge of quality and safety competenciesAnalyze principles of consensus building and conflict resolutionAnalyze advanced practice nursing roles in assuring coordination, integration, and continuity of careDescribe process of reflective practice Continuously analyze and improve own level of communication skill in encounters with patients, families, and teamsProvide leadership in building consensus or resolving conflict in the context of patient careCommunicate care provided and needed at each transition in careIncorporate reflective practices into own repertoire Value continuous improvement of own communication and conflict resolution skillsValue consensusValue the process of reflective practice


Definition: Function effectively within nursing and inter-professional teams, fostering open communication, mutual respect, and shared decision-making to achieve quality patient care.
Knowledge Skills Attitudes
Analyze own strengths, limitations and values as a member of a teamAnalyze impact of own advanced practice role and its contributions to team functioning Demonstrate awareness of own strengths and limitations as a team memberContinuously plan for improvement in use of self in effective team development and functioningAct with integrity, consistency and respect for differing views Acknowledge own contributions to effective or ineffective team functioning
Describe scopes of practice and roles of all health care team membersAnalyze strategies for identifying and managing overlaps in team member roles and accountabilities Function competently within own scope of practice as a member of the health care teamAssume role of team member or leader based on the situationGuide the team in managing areas of overlap in team member functioningSolicit input from other team members to improve individual, as well as team, performance

Empower contributions of others who play a role in helping patients/families achieve health goals

Respect the unique attributes that members bring to a team, including variation in professional orientations, competencies and accountabilitiesRespect the centrality of the patient/family as core members of any health care team
Analyze strategies that influence the ability to initiate and sustain effective partnerships with members of nursing and inter-professional teamsAnalyze impact of cultural diversity on team functioning Initiate and sustain effective health care teamsCommunicate with team members, adapting own style of communicating to needs of the team and situation Appreciate importance of inter-professional collaborationValue collaboration with nurses and other members of the nursing team
Analyze differences in communication style preferences among patients and families, advanced practice nurses and other members of the health teamDescribe impact of own communication style on others Communicate respect for team member competence in communicationInitiate actions to resolve conflict Value different styles of communication
Describe examples of the impact of team functioning on safety and quality of careAnalyze authority gradients and their influence on teamwork and patient safety Follow communication practices that minimize risks associated with handoffs among providers, and across transitions in careChoose communication styles that diminish the risks associated with authority gradients among team membersAssert own position/perspective and supporting evidence in discussions about patient care Appreciate the risks associated with handoffs among providers and across transitions in careValue the solutions obtained through systematic, inter-professional collaborative efforts
Identify system barriers and facilitators of effective team functioningExamine strategies for improving systems to support team functioning Lead or participate in the design and implementation of systems that support effective teamworkEngage in state and national policy initiatives aimed at improving teamwork and collaboration Value the influence of system solutions in achieving team functioning


Definition: Integrate best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health care.
Knowledge Skills Attitudes
Demonstrate knowledge of health research methods and processesDescribe evidence-based practice to include the components of research evidence, clinical expertise and patient/family values Use health research methods and processes, alone or in partnership with scientists, to generate new knowledge for practiceAdhere to Institutional Review Board guidelinesRole model clinical decision making based on evidence, clinical expertise and patient/family preferences and values Appreciate strengths and weaknesses of scientific bases for practiceValue the need for ethical conduct of research and quality improvementValue all components of evidence-based practice
Identify efficient and effective search strategies to locate reliable sources of evidence Employ efficient and effective search strategies to answer focused clinical questions Value development of search skills for locating evidence for best practice
Identify principles that comprise the critical appraisal of research evidenceSummarize current evidence regarding major diagnostic and treatment actions within the practice specialtyDetermine evidence gaps within the practice specialty Critically appraise original research and evidence summaries related to area of practiceExhibit contemporary knowledge of best evidence related to practice specialtyPromote research agenda for evidence that is needed in practice specialtyInitiate changes in approaches to care when new evidence warrants evaluation of other options for improving outcomes or decreasing adverse events Value knowing the evidence base for practice specialtyValue public policies that support evidence-based practice
Analyze how the strength of available evidence influences the provision of care (assessment, diagnosis, treatment and evaluation)Evaluate organizational cultures and structures that promote evidence-based practice Develop guidelines for clinical decision making regarding departure from established protocols/standards of careParticipate in designing systems that support evidence-based practice Acknowledge own limitations in knowledge and clinical expertise before determining when to deviate from evidence-based best practicesValue the need for continuous improvement in clinical practice based on new knowledge


Definition: Use data to monitor the outcomes of care processes and use improvement methods to design and test changes to continuously improve the quality and safety of health care systems.
Knowledge Skills Attitudes
Describe strategies for improving outcomes of care in the setting in which one is engaged in clinical practiceAnalyze the impact of context (such as, access, cost or team functioning) on improvement efforts Use a variety of sources of information to review outcomes of care and identify potential areas for improvementPropose appropriate aims for quality improvement effortsAssert leadership in shaping the dialogue about and providing leadership for the introduction of best practices Appreciate that continuous quality improvement is an essential part of the daily work of all health professionals
Analyze ethical issues associated with quality improvementDescribe features of quality improvement projects that overlap sufficiently with research, thereby requiring IRB oversight Assure ethical oversight of quality improvement projectsMaintain confidentiality of any patient information used to determine outcomes of quality improvement efforts Value the need for ethical conduct of quality improvement
Describe the benefits and limitations of quality improvement data sources, and measurement and data analysis strategies Design and use databases as sources of information for improving patient careSelect and use relevant benchmarks Appreciate the importance of data that allows one to estimate the quality of local care
Explain common causes of variation in outcomes of care in the practice specialty Select and use tools (such as control charts and run charts) that are helpful for understanding variationIdentify gaps between local and best practice Appreciate how unwanted variation affects outcomes of care processes
Describe common quality measures in the practice specialty Use findings from root cause analyses to design and implement system improvementsSelect and use quality measures to understand performance Value measurement and its role in good patient care
Analyze the differences between micro-system and macro-system changeUnderstand principles of change managementAnalyze the strengths and limitations of common quality improvement methods Use principles of change management to implement and evaluate care processes at the micro-system levelDesign, implement and evaluate tests of change in daily work (using an experiential learning method such as Plan-Do-Study-Act)Align the aims, measures and changes involved in improving careUse measures to evaluate the effect of change

Appreciate the value of what individuals and teams can to do to improve careValue local systems improvement (in individual practice, team practice on a unit, or in the macro-system) and its role in professional job satisfactionAppreciate that all improvement is change but not all change is improvement


Definition: Minimizes risk of harm to patients and providers through both system effectiveness and individual performance.
Knowledge Skills Attitudes
Describe human factors and other basic safety design principles as well as commonly used unsafe practices (such as workarounds and dangerous abbreviations)Describe the benefits and limitations of selected safety-enhancing technologies (such as barcodes, Computer Provider Order Entry, and electronic prescribing)Evaluate effective strategies to reduce reliance on memory Participate as a team member to design, promote and model effective use of technology and standardized practices that support safety and qualityParticipate as a team member to design, promote and model effective use of strategies to reduce risk of harm to self and others.Promote a practice culture conducive to highly reliable processes built on human factors researchUse appropriate strategies to reduce reliance on memory (such as forcing functions, checklists) Value the contributions of standardization and reliability to safetyAppreciate the importance of being a safety mentor and role modelAppreciate the cognitive and physical limits of human performance
Delineate general categories of errors and hazards in careIdentify best practices for organizational responses to errorDescribe factors that create a just culture and culture of safetyDescribe best practices that promote patient and provider safety in the practice specialty Communicate observations or concerns related to hazards and errors to patients, families and the health care team.Identify and correct system failures and hazards in careDesign and implement micro-system changes in response to identified hazards and errorsEngage in a systems focus rather than blaming individuals when errors or near misses occur

Report errors and support members of the healthcare team to be forthcoming about errors and near misses

Value own role in reporting and preventing errorsValue systems approaches to improving patient safety in lieu of blaming individualsValue the use of organizational error reporting systems
Describe processes used to analyze causes of error and allocation of responsibility and accountability (such as root cause analysis and failure mode effects analysis) Participate appropriately in analyzing errors and designing, implementing and evaluating system improvements Value vigilance and monitoring of care, including one’s own performance, by patients, families and other members of the health care team
Describe methods of identifying and preventing verbal, physical and psychological harm to patients and staff Prevent escalation of conflictRespond appropriately to aggressive behavior Value prevention of assaults and loss of dignity for patients, staff, and aggressors
Analyze potential and actual impact of national patient safety resources, initiatives and regulations Use national patient safety resources:
• for own professional development
• to focus attention on safety in care settings
• to design and implement improvements in practice
Value relationship between national patient safety campaigns and implementation in local practices and practice settings


Definition: Use information and technology to communicate, manage knowledge, mitigate error, and support decision making.
Knowledge Skills Attitudes
Contrast benefits and limitations of common information technology strategies used in the delivery of patient careEvaluate the strengths and weaknesses of information systems used in patient care Participate in the selection, design, implementation and evaluation of information systemsCommunicate the integral role of information technology in nurses’ workModel behaviors that support implementation and appropriate use of electronic health recordsAssist team members to adopt information technology by piloting and evaluating proposed technologies Value the use of information and communication technologies in patient care
Formulate essential information that must be available in a common database to support patient care in the practice specialtyEvaluate benefits and limitations of different communication technologies and their impact on safety and quality Promote access to patient care information for all professionals who provide care to patientsServe as a resource for how to document nursing care at basic and advanced levelsDevelop safeguards for protected health informationChampion communication technologies that support clinical decision-making, error prevention, care coordination, and protection of patient privacy Appreciate the need for consensus and collaboration in developing systems to manage information for patient careValue the confidentiality and security of all patient records
Describe and critique taxonomic and terminology systems used in national efforts to enhance interoperability of information systems and knowledge management systems Access and evaluate high quality electronic sources of healthcare informationParticipate in the design of clinical decision-making supports and alertsSearch, retrieve, and manage data to make decisions using information and knowledge management systemsAnticipate unintended consequences of new technology Value the importance of standardized terminologies in conducting searches for patient informationAppreciate the contribution of technological alert systemsAppreciate the time, effort, and skill required for computers, databases and other technologies to become reliable and effective tools for patient care


1 Institute of Medicine. Health professions education: A bridge to quality. Washington DC: National Academies Press; 2003.

2 Cronenwett, L., Sherwood, G., Pohl, J., Barnsteiner, J., Moore, S., Sullivan, D., Ward, D., Warren, J. (2009). Quality and safety education for advanced nursing practice.
Nursing Outlook 57(6), 338-348.

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