Educating Next Generation Nursing Leaders and Enhancing Education-Practice Partnerships: The Role of Quality Improvement Projects

The healthcare crisis in the United States requires new approaches and continuous improvement.  Nursing has the unique opportunity to champion grassroots efforts to enact change through their immersion in and direct influence on patient care.  As educators, our job is to prepare the newest members of the profession with the tools, skills, and motivation to carry out these efforts.  Indeed, fundamental nursing skills are expanding to include quality improvement, interprofessional teamwork, and systems thinking (Irondside & McNelis, 2011).  The acquisition of these essential skills requires, however, developing didactic and experiential learning opportunities that bridge the classroom and practice contexts.  Service learning, built upon strong academic-practice partnerships, provides the mechanism for successful implementation (Voss et al., 2015).  The purpose of this research project is to examine the impact of an educational innovation bringing pre-licensure nursing students and practice partners together to execute a quality improvement project using a service-learning framework.

Lean quality improvement projects were incorporated into the senior-level nursing leadership course at a large Midwestern university.  In the classroom, students are introduced to the Define, Measure, Analyze, Improve, and Control (DMAIC) framework for identifying systems, waste, gaps, and problems.  They employ this framework, in collaboration with practice partners, to complete real-world projects that tackle system problems, provide deliverables that improve the systems of interest, and address systematic policy gaps.  Projects are solicited from practice partners and represent a host of real-world issues they are currently facing.  Examples include expediting the transfer of ER patients admitted to a unit in a critical access hospital, designing a protocol for individualizing alarm settings to reduce alarm fatigue, developing training materials about safe bed-to-chair patient transfer, and increasing efficiency of the discharge process to enhance patient/family satisfaction and improve resource utilization.

A mixed methods approach is used to evaluate the students’, practice partners’, and stakeholders’ perspectives of quality improvement projects.  Surveys with both quantitative and qualitative items were developed and distributed.  For the quantitative items, traditional statistical methods are used to describe the perspectives and compare differences across three cohorts of students and between students and other stakeholders.  Thematic analysis is being conducted on the qualitative responses. 

Data analysis is ongoing.  Initial results suggest that the majority of students find this learning opportunity challenging, yet at the same time relevant to their future success.  Constructive feedback has been used to adjust the didactic component.  Specifically, the DMAIC framework is presented during the first four weeks of the semester, rather than distributed throughout the term as it was originally designed.  Practice partners and stakeholders enthusiastically support the skills gained by our pre-licensure nurses in quality improvement and systems thinking. 

This initial work demonstrates the efficacy of our approach, particularly with respect to empowering the next generation of nursing leaders to enact change.  Further research is needed to quantify (1) the effects of our approach on the acquisition of team and quality improvement skills, (2) the benefits to students and practice partners of this collaborative experience, and (3) the impact on long-term professional engagement and identity.