Early-Career Nurses Not Involved in QI Activities but Strive to Engage in Hand Hygiene

Nurses are the largest group of healthcare providers in the U.S., and healthcare leaders agree that engaging registered nurses in quality improvement (QI) efforts is essential to improving patient care. Unfortunately, despite studies demonstrating the value of nurse-led quality improvement efforts, far too few nurses are involved in these efforts, and the number is not growing, according to a study published in the Journal of Nursing Care Quality.

The studypart of the RN Work Project funded by the Robert Wood Johnson Foundation (RWJF)compared the participation levels for RNs who were first licensed between 2004 and 2005, and RNs first licensed between 2007 and 2008 in hospital QI activities. The research team found little difference in participation levels between the two cohorts for a variety of activities, including performance measurement, working to improve processes or systems of care, monitoring sustainability of improved practices, and efforts at performance improvement. The only exception was "use of appropriate strategies to improve handwashing compliance to reduce nosocomial infection rates." 

The research team included Maja Djukic, PhD, RN, assistant professor at the College of Nursing, New York University; Christine Kovner, PhD, RN, FAAN, professor at the College of Nursing, New York University; Carol Brewer, PhD, RN, FAAN, professor at the School of Nursing, University at Buffalo; and Ilya Bernstein, BS, RN, Langone Medical Center, New York University. Kovner and Brewer direct the RN Work Project.
 
We expected to find a greater variation in QI participation between the two groups, says Djukic. These 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 team noted that there has been an increase in the number of hospitals who participate in formal programs aimed at increasing nurses engagement in quality and safety initiatives since 2008. They 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 hospital Magnet Recognition Program, and the Quality and Safety Education for Nurses initiative (QSEN), funded by RWJF.
 
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 Centers Clinical Scene Investigator Academy in Kansas and Missouri. They also recommended better data systems for monitoring quality outcomes specific to nursing care, so that RNs receive timely feedback on their performance. 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 QSEN;
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; and
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 15 states: Alabama, Kentucky, Maryland, Michigan, North Carolina, New Jersey, Nevada, New York, Oklahoma, Oregon, Pennsylvania, South Carolina, Tennessee, Texas and West Virginia. The National Council of State Boards of Nursing Center for Regulatory Excellence provided funding for the study, in addition to the RWJF support.

The RN Work Project is a 10-year study of newly licensed registered nurses (NLRNs) that began in 2006. It is the only multi-state, longitudinal study of new nurses turnover rates, intentions and attitudesincluding intent, satisfaction, organizational commitment and preferences about work. The study draws on data from nurses in 34 states and the District of Columbia, covering 51 metropolitan areas and nine rural areas.