Innovation in Practice: A QSEN Framework for Redesigning a Clinical Advancement Program for Nurses

The Institute of Medicine recommendations to address quality and safety provided the spark for the Quality Safety Education for Nurses (QSEN) movement. This spark has also been felt within the practice setting. QSEN now serves as the cornerstone for building competency-based practice focusing on the six domains of nursing practice.  

Healthcare reform is a driving force in the practice setting. Nursing executives value competency as the driver of quality, patient safety and cost of care. Improving nursing competency and advancing the profession are the goals of a clinical advancement program. 

This presentation will describe how a large academic healthcare system used QSEN competencies to redesign a clinical advancement program for registered nurses.  A twelve step process was used to build a competency-focused, clinical advancement program, or clinical ladder.

The first step was recognition and support from nursing leaders, the Nursing Credentialing Review Board (NCRB) and human resources.  Step two was involvement of nurses at all levels in subcommittees to lead the design and process work. Step three was completion of literature review and benchmarking for current clinical ladders in healthcare. Step four was drafting the ladder in a categorized, competency-focused framework or “QSENizing” the design. Of note, graduate level competencies were used for higher levels within the ladder and an additional leadership competency was added. Step five was redesigning the process for applications and credentialing within the NCRB. Step six was to gain approval of the new ladder and process through various decision-making committees. Step seven was the completion of a comprehensive market evaluation for compensation practices with the new ladder. Step eight was building an education plan for rollout. Step nine was building the infrastructure for the electronic submission process of credentialing through portfolios. Step ten was educating leadership and nursing staff on the competency focused clinical ladder. Step eleven was building professional portfolios for over 500 nurses and step twelve was building new registered nurse job descriptions based on the clinical ladder.

Using QSEN as the framework helped to define the domains of nursing practice and now serves to provide definitions of higher levels of nursing professionalism within the practice setting.