Measures and indicators of quality care—such as the Healthcare Effectiveness Data and Information Set, and those developed by the Agency for Healthcare Research and Quality—inform consumers, practitioners and policy-makers about the quality of patient care. Other measures, such as those developed by the National Quality Forum, define quality by using nurse-sensitive patient outcomes. But even these measures do not capture some important aspects of quality nursing care in hospitals.

In order to inform more nursing-specific indicators of quality, researchers asked early-career (less than four years experience) registered nurses (RNs) what they thought constituted high-quality nursing. Three themes emerged as integral to quality nursing care:

1. RN presence—being present with the patient at the bedside; having the time and flexibility to spend time with patients; and having a workload that facilitates both.
2. Developing relationships—trust between RNs and their patients; focusing on the patient; treating the patient as if he or she were family; and being an advocate for the patient.
3. Facilitating the flow of knowledge and information—informed by an evidence base; RN education and competence; and teamwork and communication.

Quality indicators need to include process measures in order to reflect the complexity of bedside nursing care.