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Study highlights lack of nurse-led QI activities


Despite studies that have demonstrated the value of nurse-led quality improvement initiatives, few nurses are involved in such efforts and the number is not growing, according to a study.

In the study — part of the RN Work Project, funded by the Robert Wood Johnson Foundation — nurse researchers with New York University and the University at Buffalo compared the participation levels in hospital QI activities of RNs who were licensed in 2004 and 2005 with those of RNs licensed in 2007 and 2008.

The researchers noted an increase since 2008 in the number of hospitals that participate in formal programs aimed at increasing nurses’ engagement in quality and safety initiatives. They had expected that trend would increase the likelihood of participation in QI activities for the later cohort. Among those initiatives are Transforming Care at the Bedside, National Database of Nursing Quality Indicators Program, the Magnet Recognition Program and the Quality and Safety Education for Nurses initiative, funded by RWJF.

Instead, the researchers found little difference in participation levels between the two cohorts for 13 of 14 activities, including performance measurement, working to improve processes or systems of care, monitoring sustainability of improved practices and efforts at performance improvement.

The lone exception was “use of appropriate strategies to improve hand-washing compliance to reduce nosocomial infection rates,” the researchers reported in a study scheduled for publication in the Journal of Nursing Care Quality.

“We expected to find a greater variation in QI participation between the two groups,” Maja Djukic, RN, PhD, a study investigator and assistant professor at the College of Nursing, New York University, said in a news release. “The findings underscore the need for hospitals to collaborate with nursing schools to develop effective strategies to ensure that RNs expect and are prepared to engage in QI activities. Nurses are an important resource in efforts to improve care and patient outcomes, and right now that resource is too often being underutilized.”

The research team cited several promising programs for engaging staff RNs in QI activities, including the Integrated Nurse Leadership Program in California and the Bi-State Nursing Workforce Innovation Center’s Clinical Scene Investigator Academy in Kansas and Missouri. They also recommended better data systems for monitoring quality outcomes specific to nursing care, allowing RNs to receive timely feedback on their performances.

Other recommendations for hospital leadership include:

• Subscribing to programs that allow RNs to complete self-directed online modules to learn about QI, such as the Institute for Health Care Improvement Open School for Health Professions and the Quality and Safety Education for Nurses initiative;

• Having more experienced colleagues guide early-career RNs in translating newly acquired QI knowledge into action;

• Ensuring that staffing levels are high enough and that RNs have sufficient release time to participate in QI activities;

• Ensuring RNs have access to an information technology infrastructure that provides meaningful, timely and actionable QI data.

The study was based on surveys of 539 RNs who work in hospitals in Alabama, Kentucky, Maryland, Michigan, Nevada, New Jersey, New York, North Carolina, Oklahoma, Oregon, Pennsylvania, South Carolina, Tennessee, Texas and West Virginia. The National Council of State Boards of Nursing Center for Regulatory Excellence provided additional funding for the study.

The RN Work Project ( is a 10-year study of newly licensed registered nurses that began in 2006. It is described as the only multi-state, longitudinal study of new nurses’ turnover rates, intentions and attitudes — including intent, satisfaction, organizational commitment and preferences about work. The study draws on data from nurses in 34 states and Washington, D.C., covering 51 metropolitan areas and nine rural areas.

Christine Kovner, RN, PhD, FAAN, professor at the College of Nursing, New York University, and Carol Brewer, RN, PhD, FAAN, professor at the School of Nursing, University at Buffalo, direct the RN Work Project and were part of the research team for the latest study.

The study abstract is available at


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