QSEN and Magnet®: Incorporating System Thinking for Quality Care

Patient care errors with dire consequences have continued to threaten the health and safety of patients and erode trust among the public in our health care systems.  Recent studies have confirmed that the number and the percentage of preventable adverse patient events in United States (US) hospitals has been grossly underestimated (Sitterding, 2011).  One attempt to improve the safety and quality in the hospital setting has been the pursuit of Magnet ® status.  The Magnet ® framework for nursing excellence provides insight about essential roles needed to support a culture of patient safety in the hospital setting.  It could be argued that Magnet ® recognition is a marker of pre-existing quality pursued by hospitals before the recognition was obtained, however, research supports lower odds of mortality and lower odds of failure to rescue in Magnet ® facilities (McHugh, et al., 2013).  Although the number of Magnet ® recognized hospitals have grown (now 8% of hospitals nationally), only a slight improvement in patient safety and quality outcomes have been reported (Brady, 2011). 

Despite small gains in quality and safety indicators, nosocomial infections, falls, pressure ulcers, and many other preventable incidents continue to plague our healthcare systems.   Safety and quality issues identified in US healthcare system have triggered a mandate to transform nursing education into a new model that prepares graduates for interdisciplinary collaboration and system thinking to promote patient safety (Brady, 2011).  Responding to this call, the quality and safety education for nurses (QSEN) initiative was developed to integrate quality and safety competences into nursing education (Brady, 2011).  The relationship between nursing excellence and a culture of patient safety is well illustrated through the combining of QSEN with a Magnet ® environment.  QSEN competencies are patient centered care, teamwork, collaboration, evidence based practice, safety, quality improvement and informatics (Dolansky & Moore, 2013).  The Magnet ® model includes transformational leadership, structural empowerment, exemplary professional practice, new knowledge, innovations and improvements, and empirical outcomes (ANCC, 2013).  Integrating system thinking into the QSEN and Magnet ® environment offers promise for developing a culture that fosters patient safety.  Dolansky and Moore (2013) suggest that system thinking is vital to heighten awareness of the interdependencies needed to provide safety and quality care. They further indicate that events occur as part of a chain in the system, rather than isolated occurrences.   Most systems have deep layers of complexity in which patient care is delivered requiring nurses to recognize patterns and processes that are barriers to patient safety. How nurses view themselves and the quality of their work is informed by the systems in which they provide care.  Nursing excellence must include the ability to understand systems and apply system thinking skills to create an environment that ensure patient safety.