Advancing the Culture of Competency to Improve Patient Outcomes and Drive Patient Safety

Monday, 22 July 2013: 1:30 PM

Stephanie Mearns, MN, BSN, RN1
Allen J. Orsi, PhD, RN1
Anastasia Fisher, PhD, MN, BSN2
(1)San Francisco Bay Area Hospital, Daly City, CA
(2)School of Nursing, San Francisco State University, Oakland, CA

Learning Objective 1: Identify strategies to build faculty-scholar programs within the community

Learning Objective 2: Develop strategies to improve clinical judgement that improve patient safety

Purpose: Expectations that nurses be competent have always been a part of professional codes and standards, licensing and accreditation requirements and, are a key component of the profession’s social contract. The purpose of this presentation is to describe the preliminary results of our project exploring ways to assess and document professional nursing competencies to assure safe, quality nursing practice.  The QSEN (Quality Safety Education in Nursing) competencies were used as a guiding framework

Methods: Current staff nurse competencies were assessed using two strategies: 1) a written assessment and 2) an observed standardized patient clinical scenario.   Both written assessment and observed clinical scenario were developed using QSEN and assessed core knowledge, ability to analyze and synthesize information and make an appropriate clinical judgment.  The written assessment consisted of 50 questions developed using the QSEN competencies with a possible score of 0-50 and the scenario assessed 63 behaviors and attitudes with a possible score of 0-63.

Results: The mean on the written assessment (37 + 4) and the observed standardized clinical scenario (mean 39 + 3)) was surprisingly low.  Further analyses of the subscales show the lowest scores in quality improvement/safety (mean=24.5 + 2) with the safe medication administration performance lower than the other areas.  Nurses performed better in patient-centered care (mean= 37.5 + 2) and evidence based practice (mean=40+ 3).     


Nurse competencies were below expected level particularly in areas that impact patient safety such as medication administration.  The leadership team has identified the low performers and in collaboration with the advanced practice nurses developed an on-line learning module to increase critical thinking and clinical judgment in medication administration.  Reassessment is currently in progress to ensure patient safety in medication administration.  Individual nurse’s results were analyzed and themes related to the nursing interventions are currently being initiated for higher-level competencies.