Amy Barton, Ph.D., R.N., describes the Robert Wood Johnson Foundation’s Quality and Safety Education for Nurses project (QSEN) as a way to bridge the gap between her current position in nursing education, and her previous one, in nursing practice. The participation in QSEN by the University of Colorado Denver, College of Nursing, where she is an associate professor and the associate dean for clinical and community affairs, has allowed Barton, serving as project director, and colleagues to initiate dramatic changes in the methods used to teach the next generation of nurses.
The core competencies at the heart of the QSEN project:
“When I left my hospital-based position to come teach, some of my colleagues warned me not to turn into ‘one of them’—one of those ivory tower professors disconnected from the actual practice of nursing,” she remembers with a laugh. “But for us, QSEN has been about getting educators and nurses on the same page, getting them to use the same language about the system of care. I think we’re producing a different type of graduate as a result, men and women who are more comfortable in the systems aspect of nursing care as they go into their first jobs.”
The curricular changes at the college have been built on the six core competencies at the heart of the QSEN project: patient-centered care, teamwork and collaboration, evidence-based practice, quality improvement, informatics and safety. “We completely restructured our clinical education,” she explains. “Our lab has been reformulated, so that it’s no longer just a skills lab, and is now a true clinical education center. It provides students with learning opportunities anchored in the six QSEN competencies, and incorporates a clinical component that is new to us. In our previous model, students were in the lab for six hours a week during their first two clinical blocks. Now it’s four hours per week over eight weeks, and a two-day clinical experience in ambulatory care to help them develop skills related to patient-centered care and communication. It’s made a big difference in their understanding of how care is actually delivered.”
“Our staffing has changed dramatically, as well,” Barton says. “We started with a model consisting of a part-time lab coordinator and a team of teaching assistants in the lab. Each lab course would have seven sections, each with a different instructor and they would often leave after one or two semesters. Now we have a coordinator who is a nurse practitioner, and two clinical nurse specialists with expertise in emergency and critical care. That core team now instructs all our students in the lab. So we’ve enhanced the clinical expertise of our faculty, and created more continuity in the instruction.”
The changes reflect Barton’s and her colleagues’ shared view that traditional nursing curricular models are inadequate to prepare students for the complexity of health care systems they’ll work in after graduation. She points out that nurses serve not just as care providers, but as care designers, managers, coordinators of care and as members of inter-professional health care teams. She sees the QSEN core competencies as a road map for redesigning curricula to address a systems approach to safety and quality in nursing.
“We had a real ‘aha!’ moment a while ago, when one of our team members shared with students a story about an incident that had occurred on her shift. One of the students raised his hand and said, ‘Can you tell me how the system responded to that adverse event?’ That’s when we knew that our messages about systems and quality were getting through. Systems issues haven’t always been a part of students’ education or thinking. That training always came on the job, and usually by osmosis. But it’s too important to be so casual about it. We need to teach it here, so that our nurses are ready for it when they’re caring for patients in the context of the broader system of care.”
Dean Linda Cronenwett, Ph.D., R.N., F.A.A.N., of the University of North Carolina-Chapel Hill School of Nursing and principal investigator for the QSEN project, applauds Barton and her colleagues’ role in the broader QSEN effort. The college was one of 15 pilot schools around the country, testing new approaches and sharing its results. “QSEN leaders were particularly grateful to the University of Colorado team—Amy Barton, and her colleagues Gail Armstrong and Gayle Preheim—for their thoughtful work to plan the sequence of quality and safety competency development across the curriculum. Their contributions ranged from a playful ‘Where’s QSEN?’—in the ‘Where’s Waldo?’ mode—approach to curriculum mapping to a rigorous Delphi study involving national experts. And Amy Barton’s colleague, Gail Armstrong, emerged as a leader among the QSEN Collaborative participants in generating ideas about how to fundamentally rethink ‘nursing fundamentals.’ They’ve also taken real leadership to spread QSEN ideas across Colorado and elsewhere.”
Indeed, as Barton and her colleagues have worked to share the QSEN approach with colleagues at other institutions, they’re applying some of the same techniques they use with students. “As we work to help other schools integrate the competencies, we’ve found that the more specific we can be with suggestions of learning activities, the more effective it will be,” she says. “We’ve realized that we really need to catalog specific activities for a handful of the QSEN knowledge, skills and attitudes within each of the core competencies.”
That approach—paying attention to how well lessons are learned, and how well that learning prepares students for what they’ll actually be called on to do—is as applicable for curriculum developers and educators as it is for students.
In addition to her work with the QSEN Project, Amy Barton is a member of the 2005 cohort of the Robert Wood Johnson Foundation Executive Nurse Fellows Program, an advanced leadership program for nurses in senior executive roles in health services, public health and nursing education who aspire to help lead and shape the U.S. health care system. Read more about Quality Safety and Education for Nurses at http://www.qsen.org/.