Rueckert-Hartman College for Health Professions
Doctor of Nursing Practice
Loretto Heights School of Nursing
Thesis - Open Access
Number of Pages
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
© Dana Lusk
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Lusk, Dana, "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" (2016). Regis University Student Publications. 840.