Dana Lusk

First Advisor

Patricia Cullen


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

150 pages


Executive Summary

Comparing the Knowledge, Skills and Attitudes of Newly Hired Nursing Staff Before and After

Implementation of a Quality and Safety Competency-Based Nursing Orientation Program


There was a lack of content regarding quality and patient safety in an urban Veterans

Administration (VA) health care system nursing orientation program. A Department of Veterans

Affairs culture of safety survey indicated frontline VA nursing staff scored lower in the safety

culture dimensions compared to other VA health care professionals. Developing a curriculum

for nursing orientation incorporating the six Quality and Safety Education for Nurses (QSEN)

competencies and utilizing a trans-theoretical approach guided by Marilyn Ray’s theory of

bureaucratic caring and Albert Bandura’s self-efficacy theory was developed to offer a solution.


The purpose of this project is to determine if a theory-guided, competency-based, nursing

orientation program will increase the self-reported self-efficacy of the knowledge, skills and

attitudes associated with the six QSEN competencies and learner satisfaction of newly hired

nursing staff within an urban, Veterans Administration health care system.


The goals of this project are to redesign the nursing orientation program to increase

quality and safety content in the nursing orientation curriculum; increase learner satisfaction of

nursing orientation; and ensure compliance with the VA and Office of the Inspector General

standards regarding competency validation of nursing competency, and improve the facility

culture of safety.


The objectives of this project are to develop a nursing orientation program within the

framework of the existing orientation program; develop a QSEN competency validation form;

administer the Nursing Quality and Safety Self-Inventory (NQSSI) as a pre and posttest of the

participants in nursing orientation and a post Utilization-Focused Evaluation before and after

implementation to compare for any differences in the self-efficacy or learner satisfaction of

newly hired nursing staff.


Causal-comparative/case control design with a comparative group using interrupted time

series pretest, posttest and approximately 30 day post-posttest.

Outcomes and Result

Results of the NQSSI found no significant difference in all of the KSAs of the six QSEN

competencies between the control and intervention groups except for post-posttest results for

Knowledge in the Quality Improvement competency. Significantly higher satisfaction is found

in the intervention group who had the Quality and Safety Competency-Based Nursing

Orientation compared to the control group with usual nursing orientation in all areas except for

the classroom being conducive to learning. Differences were found in some of the results of the

NQSSI regarding years of experience and having had QSEN in nursing school. Those with 0-3

years of experience or had QSEN in nursing school scored lower in some of the KSAs than those

with more experience or those who did not have QSEN or were not sure. There are no

significant differences regarding level of nursing education and NQSSI results.

Date of Award

Winter 2016

Location (Creation)

Colorado (state); Denver (county); Denver (inhabited place)

Rights Statement

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