Passing the Baton: After Seven Highly Successful Years, A New Start and A New Institute for QSEN

    • May 31, 2012

After seven years under the leadership of Linda Cronenwett, PhD, RN, FAAN, and her team at the University of North Carolina (UNC) at Chapel Hill School of Nursing, the Robert Wood Johnson Foundation's Quality and Safety Education for Nurses (QSEN) project transitions this summer to the Frances Payne Bolton School of Nursing at Case Western Reserve University, under the leadership of Mary A. Dolansky, PhD, RN.

The transition marks the successful completion of the first four phases of the project, which launched at UNC in 2005. Each phase was supported by Robert Wood Johnson Foundation (RWJF) grants. The overall goal of the project was, and remains, to prepare nurses who have the knowledge, skills, and attitudes necessary to continuously improve the quality and safety of the health care systems in which they work.

In the early years of the project, Cronenwett and her UNC team worked with QSEN faculty—experts drawn from institutions across the nation—to define a comprehensive set of quality and safety competencies for nurses. QSEN faculty then surveyed nursing programs to gauge the extent to which these competencies were already included in curricula, whether faculty were sufficiently expert to teach them, and how well nursing students were learning them. That effort also included an 18-month learning collaborative of 15 nursing programs around the nation whose faculties generated strategies for fostering learning of the six QSEN competencies: patient-centered care; teamwork and collaboration; evidence-based practice; quality improvement; safety; and informatics.

Beginning in 2009, Cronenwett, co-investigator Gwen Sherwood, PhD, RN, FAAN, and their colleagues at UNC partnered with the American Association of Colleges of Nursing (AACN) to focus on developing the faculty expertise needed at the nation's nursing schools to teach the QSEN core competencies. They also worked to instill those competencies in textbooks, licensing, accreditation and certification, and to promote continued innovation in teaching them.

The final phase of QSEN at UNC culminated in the publication of a new textbook, Quality and Safety in Nursing: A Competency Approach to Improving Outcomes, edited by Sherwood and Jane Barnsteiner, PhD, RN, FAAN. It features chapter contributions from a distinguished roster of experts, including several members of the QSEN Faculty and Advisory Board.

The QSEN Institute

Under Dolansky's leadership, Case Western Reserve will continue the QSEN work and will launch a QSEN Institute. The Institute will make the significant and growing QSEN knowledge base, including teaching strategies, journal articles, curricular materials and more, available online for use by nursing educators around the nation as they adopt the QSEN model into their schools' curricula. In addition, Case Western Reserve will take charge of hosting the immensely popular QSEN National Forum series, at which nursing educators and other experts gather annually to share and discuss new developments in the field.

The announcement of the transition from UNC to Case Western Reserve came at this year's QSEN National Forum in Tucson, Ariz., a three-day conference that began on May 30.

QSEN’s work will continue, not just through the new Case Western Reserve QSEN Institute, but through AACN, which will continue its work with nursing school faculty. From 2009 to early 2012, AACN hosted eight regional faculty-development institutes designed to prepare nurse faculty in undergraduate programs to teach quality and safety content. AACN's effort will now focus chiefly on graduate education programs, providing educational resources and training to enhance the ability of faculty in master's and doctoral nursing programs to teach the program's quality and safety competencies. This next wave of AACN QSEN faculty development workshops will begin in early 2013, again with RWJF support. Materials created during the initiative will be disseminated to all graduate schools of nursing through webinars, journal articles, and web resources, as well as other communication channels.

Cronenwett Reflects on Seven Years of Rapid Accomplishment

As the transition approached, Cronenwett reflected on QSEN's accomplishments. "We tried with QSEN to do several things," she says. "First, we set out to build the will to change nursing education, and then we focused on generating and sharing the ideas that educators could use in their curricula. Finally, we tried to support the execution of the work by seeding it in nursing schools around the nation, by developing a textbook that embodied the QSEN approach, and by creating a large group of experts who made themselves available to consult with nursing programs as they went about revising their curricula."

"At its core," she continues, "our work was aimed at altering professional identity-formation so that a new type of nursing graduate would be developed—someone who would come into the workforce with knowledge about how to create and continuously improve systems of care."

How did QSEN's achievements measure up to the original vision? "You know, we didn't have a grand vision when we began," she says. "We had some critical elements that we knew would make a difference. But like the nurses we hoped would be the product of the project, we treated ourselves as a learning group. Then once we had a pilot school collaborative, we learned along with them. No one had done this before, so we had to figure it out as we went along. We knew what our goals were, but we had to learn how best to teach them. We knew texts and accreditation standards needed to change, but we had to figure out what all that should look like.

"To their great credit," she continues, "our program officers at RWJF encouraged us to seek multiple paths for change, rather than locking into just one grand vision on day one. That was the wisest advice we could possibly have had, and it let us make decisions every 18 months or so about what needed to come next."

Cronenwett also stresses the important role that collaboration played in the project. "One thing that made a huge difference early on," she explains, "is that we had the leaders at our pilot schools bring in partners—clinical partners, a classroom teacher, and a simulation teacher. And the four of them became a strong, unified voice affecting curriculum in their schools, in a cross-cutting way. We had incredible leadership at the schools, and they continue to be leaders in their institutions."

Looking Ahead

"We've inherited a dynamic and profession-altering project, thanks to the work led by Dr. Cronenwett and Dr. Sherwood at UNC," Dolansky said. "Much of the work of the last few years has been sharing with colleagues around the nation innovative ways to deliver quality and safety education. That's exactly what we're going to continue doing at Case Western Reserve, making it as easy as we can for educators, faculty leaders, and clinicians across the nation—the globe for that matter—to access the materials."

"Dr. Cronenwett and the QSEN project have made an extraordinary contribution to the profession of nursing, and to the health care that Americans receive today and into the future," said RWJF Senior Adviser for Nursing Susan B. Hassmiller, PhD, RN, FAAN. "In the seven years that the Foundation has supported the project at UNC, Dr. Cronenwett and her colleagues have literally rewritten the textbook on nursing education, helping to create a generation of nurses trained both to deliver care to patients and to contribute to the continuous process of increasing the safety, reliability and quality of care."