First Advisor

Barbara Berg

Second Advisor

Lora Claywell


Rueckert-Hartman College for Health Professions

Degree Name

Doctor of Nursing Practice


Loretto Heights School of Nursing

Document Type

Thesis - Open Access

Number of Pages

272 pages


Healthcare quality and safety carries the burden of perfection in a complex, imperfect practice environment. Healthcare has identified quality and safety as a priority (Institute of Medicine, 1999; Institute of Medicine, 2011).Currently, application of Quality Safety Education for Nurses (QSEN) competencies is seen primarily within academic settings and has been studied in one segment of practicing nurses - pediatric oncology nurses (Dycus & McKeon, 2009). Practicing nurses should be able to identify and demonstrate the competencies of knowledge, skills and attitudes within the six domains of QSEN. Purpose: This three prong study measured the knowledge, skills and attitudes of practicing nurses compared to QSEN competencies; conducted psychometric evaluation of a tool to measure translation of QSEN into practice; and provided feedback to community academic partners about QSEN competencies in the practice setting.

Methodology: In January 2012, nurses at four acute care facilities were invited to participate in a survey study utilizing the Quality Improvement Knowledge, Skills and Attitudes (QUISKA2) tool (n = 2060). This descriptive survey study replicated and expanded the work of Dycus and McKeon (2009) by changing participants to nurses in various acute care clinical settings and organizational roles. Descriptive statistics and correlation between nursing role, academic degree, certification, unit of work, previous quality improvement education and years from nursing education and the QSEN domains were conducted. Pearson’s r for interval data of skills and MANOVA for comparison of three groups of leadership responses were completed. Psychometric tests included correlation between the various roles of nurses in the acute care setting in the expected competencies, frequencies of the items, internal consistency using Cronbach’s alpha, and an inter-item correlation coefficient.

Results: The QUISKA2 is a valid and reliable tool for measuring the knowledge, skills, and attitudes of practicing nurses at the three levels of nurses in the acute care practice setting. There is statistically higher scores and proficiency dependent upon the nursing role (p < 0.001), academic degree (p < 0.001), certification (p = 0.015) and the presence of previous QI training (p < 0.001). Nurses within the acute care setting are most familiar with QSEN domains of Patient Centered Care (5.5) and Teamwork and Collaboration (4.9) and less familiar with Quality Improvement (3.4) and Evidenced Based Practice (3.3) based on a scale of 1 to 6.

Practice Implications: Identification of quality safety outcomes benefits patients, practicing nurses and healthcare facilities through standardized assessment of nursing competencies. This work builds the foundation for translation of QSEN into the practice setting in partnership with community academic institutions. Future research is planned for 2013 to expand applicability of the QUISKA2 tool in other practice settings. A common quality safety competency language grounded in theory, research and practice elevates the discipline.

Date of Award

Spring 2012

Location (Creation)

Denver, Colorado

Rights Statement

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