Teaching Quality Improvement to Baccalaureate Nursing Students: Strategies That Work!

Thursday, 27 July 2017: 3:50 PM

Laurie Bladen, PhD, MBA/HCM
School of Nursing and Health Sciences, Clarion University of Pennslyvania, Clarion, PA, USA


The purpose of this presentation is to describe strategies that work in teaching quality improvement to baccalaureate nursing students. According to American Association of Colleges of Nursing (AACN) (2015) expected outcomes for graduates of baccalaureate nursing programs include scholarship for evidence-based practice, leadership, and the ability to promote health. Baccalaureate nurses are expected to use data and methods to continuously improve quality and safety of patient care (Dolansky & Moore, 2013; Phillips & Cullen, 2014; Quality Safety and Education for Nurses (QSEN), 2014). The mission of the Quality and Safety Education for Nursing is to address the challenge of assuring that nurses have the knowledge, skills and attitudes (KSA) necessary to improve the quality and safety of their patients in the world. According to the World Health Organization (WHO) (2011) as cited in White, Clark Lewis and Robson (2016) change management principles should be used to incorporate quality improvement practices in nursing education. A challenge for nurse educators is to identify instructional methods to promote success of these outcomes and to prepare graduates with the necessary quality improvement skills (Dotson & Lewis, 2013).

 Clarion University of Pennsylvania in the United States offers students an opportunity to earn a baccalaureate degree in the RN to BSN online program that traditional is a 15 week or semester course. A pilot program for the RN to BSN program is offered to teach the same content in a 7-5 week term. Student learning outcomes and the delivery method for these courses are identical. The purpose of this quantitative study was to examine the knowledge, skills, and attitudes (KSAP) gap of students enrolled in a leadership course. This study was approved by Clarion University of Pennsylvania IRB#34-15-16.

 A course revision in the RN to BSN program created an opportunity to provide students with an opportunity to learn the quality improvement process developing nursing vigilance. Nursing vigilance combines nursing knowledge, evidenced-based practice, and critical thinking that enable BSN graduates to engage in safety and quality care. Quality improvement teaching strategies should be part of a global nursing curriculum to help students recognize how to develop solutions to nursing practice and to avoid devastating safety errors. Application assignments empower nursing students to experience solving a nursing problem (Murray, Douglas, Girdley, & Jarzemsky, 2010). This presentation is designed to provide information on teaching strategies to enable faculty to teach quality improvement in a baccalaureate online program. Information on the difference found between teaching quality improvement in a 15 week program versus a 7-5 week program will be presented. Challenges to teaching quality improvement in an online program will be discussed.


 In the beginning of a 15-week (full semester) and a 7.5-week (accelerated term) course of NURS.457 Leadership in Nursing, students will be provided in the classroom and through email an introductory letter, which provides an explanation of the study. If students are interested in participating in the study, they are asked to email the researcher. The students who volunteer to be a participant will be emailed an informed consent and the modified QulSKA. Permission from the author of the QulSKA has provided permission to use and modify the instrument.

The QulSKA is a 73-item survey that measures knowledge, skills and attitude across the six core QSEN domains (patient-centered care, teamwork and collaboration, evidence-based practice, quality improvement, safety, and informatics) (Dycus & McKeon, 2009). The results from the survey were expected to inform faculty of the development of targeted educational strategies focusing on the cognitive, behavioral, and affective needs of students in their understanding of the knowledge, skills, and attitudes of the QSEN core competencies in the Leadership in Nursing Class.

The students are asked to read and sign the informed consent. The signature on the informed consent can be electronically signed or it can be an ink signature. The researchers contact information is provided to the potential participants through e-mail and on the informed consent in case the participants had questions concerning the study or wish to withdraw. Participants will be assured that their participation in this study is voluntary; they can withdraw from the study at any time by contacting the researcher at the phone number or email listed on the informed consent. The potential participants will be informed that whether they participate or do not participate in this study it does not affect their grade in the class.

A four-digit code number will be assigned to each participant’s informed consent and corresponding pretest and posttest. The pretest was given in the beginning of each course and the post-test will be given during the last weeks of each individual course. The participant’s identity and the assigned four-digit code will be placed on a separate code sheet. Only the researcher had access to the code sheet that links the four-digit code to the individual participants. The code sheet is located on a different flash drive stored in a locked office in a locked drawer and only the researcher has the key. This code sheet is the only document t that links the code to the participant. Following this process allows identification in case the participant chooses to withdraw from the study and allows the researcher to match the participant’s individual survey to the informed consent.


 The results of this study revealed that students showed a significant difference for evidence-based practice, informatics, and quality (the QSEN core competencies) after taking the NURS 457 Leadership class. There is no significant difference in students learning the QSEN competencies between a class that is 15 weeks in length versus a class that is 7.5 weeks in length.

Although the 15 week mean score for safety, teamwork and collaboration was slightly higher; they were only significant at the .10 alpha level. Quality was the only core domain that was significant higher between the 15 week pretest and 7 week pretest.


The teaching strategy for having students develop a process improvement (PI) proposal for a nursing problem at their employment during a leadership class enables students to learn and design new processes using the QSEN competencies. The existence of gaps in the curriculum related to the QSEN competencies of evidence, based practice, informatics, and quality are now removed with the existence of the process improvement project. As a result of this study the RN-BSN nursing faculty is currently reviewing the curriculum courses to determine the student learning outcomes and practice experience assignments. A limitation to this study is the amount of students who participated in this study. There was a potential of 70 participants and 40 participated for a response rate of 57%.