Quality improvement engagement and competence: A comparison between frontline nurses and nurse leaders

Dana Tschannen, Catherine Alexander, Sarah Taylor, Elizabeth G. Tovar, Bidisha Ghosh, Cindy Zellefrow, Kerry A. Milner

Research output: Contribution to journalArticlepeer-review

6 Scopus citations


Background: Nurses play a pivotal role in improving patient care. To maximize nurses’ impact on quality, nurses must have quality improvement (QI) competence and engage fully in QI initiatives. Purpose: To describe QI competence (knowledge, skills, and attitudes) among frontline nurses and leaders; and compare variations in competence among nursing roles, experience, and specialty areas. Methods: A total of 681 nurses at one heath system fully completed the Nursing Quality Improvement Practice tool electronically. Findings: Half of the respondents reported QI engagement (53.6%). Mean knowledge scores were 5.08 (SD 1.16, 7 items). Skill proficiency was low (M = 2.82, SD = 1.03; range 1–6) although QI attitudes were favorable (M = 3.76, SD = 0.63; range 1–5). Significant differences in skills and attitudes were identified by role. QI competence among nurses employed in various specialty areas were similar. Discussion: Strategies for increasing QI competence and engagement of nurses must be created and deployed in order to improve quality and safety.

Original languageEnglish
Pages (from-to)836-847
Number of pages12
JournalNursing Outlook
Issue number5
StatePublished - Sep 1 2021

Bibliographical note

Funding Information:
In 2005, nursing leaders initiated the Quality and Safety in Nursing (QSEN) movement funded by the Robert Wood Johnson Foundation. The goal of this movement was to identify competencies needed to improve the quality and safety in our health care system ( Cronenwett et al., 2007 ). Phase I consisted of defining the KSAs for prelicensure education aligned with six competencies: quality improvement, patient centered care, safety, teamwork and collaboration, informatics, and evidence-based practice ( Cronenwett et al., 2007 ). Subsequent work has included development of competencies for graduate level education, training of academic leaders through the QSEN Institute, and the development of numerous resources for faculty engaged in educating the next generation of nurses (e.g., teaching strategies, workshops, conferences)( Cronenwett et al., 2009 ). Through integration of the QSEN KSAs in nursing schools across the country and the establishment of collaborative partnerships with other organizations to deploy education and training into the practice setting, the QSEN project has laid the foundation for improved competency of frontline nurses to play a pivotal role in improving health care quality and safety ( Olds & Dolansky, 2017 ; QSEN, n.d. ). Yet, the level of competence among frontline staff and the subsequent use of these competencies through engagement in QI initiatives remain unclear and require further study.

Publisher Copyright:
© 2021 Elsevier Inc.


  • Attitudes
  • Competence
  • Front line nurses
  • Knowledge
  • Leadership
  • Nurse engagement
  • Quality improvement
  • Skills

ASJC Scopus subject areas

  • Nursing (all)


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