1. Mangold, Kara DNP, RN-BC, CCTN, CNE
  2. Pearson, Jocelyn MSN, RN, ACNS-BC


Developing the capability to interpret nursing-sensitive quality indicators and other outcome data can be a challenge for registered nurses. An interactive, facilitator-led learning activity effectively addressed this issue in one organization. Registered nurses identified solutions to quality measures in an environment that engaged all levels of Benner's novice-to-expert continuum. The activity had positive outcomes, and learning was shown after the activity.


Article Content

Nursing-sensitive quality indicators (NSQIs), such as pressure ulcers and falls, reflect patient outcomes impacted by nursing care (Owens & Koch, 2015). When one institution sets a goal to identify opportunities and create action plans to improve NSQIs, a learning needs assessment survey revealed that only 62% of clinical registered nurses (RNs) were aware of NSQIs that applied to their nursing care. Observation at staff meetings confirmed a knowledge gap related to NSQIs: RNs were unable to locate, discuss, or analyze unit-specific data. These findings were congruent with issues identified in the literature related to quality initiatives: engaging nurses and bridging the knowledge gap (Draper, Felland, Liebhaber, & Melichar, 2008).



The challenge faced was a multifaceted professional practice gap: Foundational knowledge was needed, but the ultimate goal was to analyze and apply data to patient care. An additional challenge was engaging nurses in NSQIs. The nursing professional development practitioner (NPDP) created an interactive educational activity to address these challenges. An outline of the activity is presented in Table 1. Multiple learning experiences and networking activities were developed. The content included the significance of improving patient care and learning approaches encouraged each participant to provide input.

Table 1 - Click to enlarge in new windowTABLE 1


The resources needed for this activity included classroom space that could accommodate each RN having a laptop with the organization's intranet to access nursing data, a template for recording information, and a NPDP to facilitate the activity. The template assisted learners in analyzing the data and included two questions: (a) "Why is the quality indicator important?" and (b) "What is one nursing intervention that could be implemented at the point of care to positively influence this patient outcome?".



Stakeholders included nursing leadership and clinical RNs. Leadership supported this learning activity to address the knowledge gap, and allocated RN time and compensation for the activity. The clinical RNs were diverse and crossed all levels of Benner's novice-to-expert continuum (Benner, 1984). Optimal learning methods for each stage were incorporated into the activity to enhance participation (see Table 1). The learner engagement strategy for novice learners was instruction, for advanced beginner and competent learners was networking, for competent and proficient learners was application, and for proficient and expert learners was mentoring (Smith, 2013).



The outcomes of the RN education were to accurately interpret nursing quality data and generate targeted solutions to apply at the point of care. The evaluation data supported that these outcomes were met. The evaluation data align with the Kirkpatrick (2016) Model for training evaluation ( Reaction evaluation was assessed through participant survey: 97% of the individuals rated the learning activity as positive and reported that it met expectations. Written comments indicated that the interactive nature of the activity enhanced learning and provided an opportunity to understand and analyze a variety of nursing quality measures. Evaluation of learning was conducted through a National Database of Nursing Quality Indicators Nursing Satisfaction survey taken after the activity. Results indicated that 96.97% of the RNs were aware of the unit's quality results and described understanding of the results as 3.03 on a 1- to 4-point scale (1 = poor understanding to 4 = excellent understanding). These results were greater than the survey mean for the benchmark and indicated an improvement from the initial learning needs assessment. Learning retention was confirmed when participants were able to locate and discuss the data during meetings 1 and 3 months after the activity. Behavior evaluation was evidenced by accurate participant interpretation of the data and generation of action plans with thoughtful, realistic solutions. These solutions could then be incorporated into nursing practice at the point of care to positively impact patient outcomes. Future evaluation could assess if quality measures were improved or sustained after the activity.



The level of participation was both a risk and an obstacle. When designing the activity, the level of staff engagement and required facilitator assistance were unknown. However, participants were highly engaged in the activity and it was necessary for the NPDP to monitor time for all groups to share their work during the allotted 45 minutes. The mentoring and networking in the groups made it feasible to have only one NPDP present during the activity. Leadership engagement and support for the activity, availability of reliable technology to assist the learners, and presentation of data in a consistent format to ease analysis enhanced learning effectiveness.



For this endeavor to be effective, RNs must be able to utilize the data outside the classroom. The facilitator-led interactive activity promoted increased knowledge of NSQIs and other data impacted by nursing care. RNs learned from each other and retained the ability to evaluate the data after the learning activity. This pilot activity was replicated by others in the organization. The NPDP can leverage this activity to develop foundational knowledge so that teams can identify opportunities and create action plans for improving patient outcomes.




Benner P. (1984). From novice to expert: Excellence and power in clinical practice. Menlo Park, CA: Addison-Wesley. [Context Link]


Draper D. A., Felland L. E., Liebhaber A., Melichar L. (2008). The role of nurses in hospital quality improvement. Washington, DC: Center for Studying Healthcare System Change. Retrieved from[Context Link]


Kirkpatrick D. (2016). Kirkpatrick Partners Web site. Retrieved from


Owens L. D., Koch R. W. (2015). Understanding quality patient care and the role of the practicing nurse. Nursing Clinics of North America, 50(1), 33-43. [Context Link]


Smith C. M. (2013). Teaching learning methodologies. In Bruce S. L. (Ed.), Core curriculum for nursing professional development (4th ed. pp. 233-236). Chicago, IL: Association for Nursing Professional Development. [Context Link]