Standard 10. Quality of Practice
Brenda L. Lyon PhD, CNS, FAAN
Standard 10. Quality of Practice. The registered nurse contributes to quality nursing practice.
Definition and Explanation of the Standard
The registered nurse (RN) contributes to quality nursing practice by assuring that patients receive evidence-based care that is patient-centered, safe, effective, timely, efficient, and equitable (IOM, 2001). The word quality has many usages in health care, both as an adjective and a noun, but those uses are grounded in the dictionary sense of the word: a peculiar or essential character, a degree of excellence, or a distinguishing attribute (Merriam-Webster, 2012). The following definition from the current edition of Nursing: Scope and Standards of Practice (ANA, 2010, p. 67) is nurse-sensitive:
Quality. The degree to which health services for patients, families, groups, communities, or populations increase the likelihood of desired outcomes and are consistent with current professional knowledge.
Nurses at all levels have a pivotal role in quality health care. The Institute of Medicine (IOM) report, Keeping Patients Safe: Transforming the Work Environment of Nurses (IOM, 2004), makes recommendations for healthcare organizations to improve the quality of care in hospitals, nursing homes, and other healthcare organization work environments that threaten patient safety through their effect on nursing care.
The IOM (2003, 2011) identified core competencies necessary for all healthcare professionals, regardless of discipline, to ensure quality healthcare outcomes. Those competencies include knowledge and skills in the following:
Provide patient-centered care that encompasses the uniqueness of each patient.
Work on interdisciplinary teams to integrate care, thereby ensuring that care is continuous and reliable.
Use evidence-based practice that integrates research evidence with clinical expertise and patient preference.
Apply quality improvement principles and strategies to change patient care processes and systems of care.
Use informatics to communicate and support decision-making to reduce errors.
Quality is everyone’s responsibility in health care; however, Standard 10 identifies the nurses’ responsibility in ensuring quality of care. Because of their clinical expertise and direct position at the point of care with healthcare consumers, nurses have individual responsibility and accountability for quality care. Those contributions to ensuring quality care occur directly through clinical practice activities as well as indirectly through the practice environment when quality care is made a priority. Nurses have embraced this priority and have traditionally been involved in interprofessional quality improvement efforts. Nurses have provided care that meets appropriate standards and have been involved in continuous quality improvement to improve nursing services and health care for their patients. Nurses are engaged every day in identifying areas for improvement, for monitoring, for measuring, and for reporting quality.
Quality nursing care is essential to cost-effective patient care that achieves desired outcomes (Lee et al., 1999; Aiken, 2008). The advanced practice registered nurse (APRN) contributes to quality nursing practice by leading the design and implementation of quality improvements in patient care processes and procedures, by designing and evaluating innovations in practice to improve health outcomes, by bringing research evidence to the point of care, by generating research questions pertinent to quality healthcare outcomes, and by leading healthcare system changes targeting the improvement of care. As part of the larger interprofessional team, nurses at all levels of practice
formulate recommendations for improvement and design innovations, and they sustain improvements in quality and safety to enhance healthcare delivery and nursing practice.
formulate recommendations for improvement and design innovations, and they sustain improvements in quality and safety to enhance healthcare delivery and nursing practice.
Through quality improvement efforts, nurses—as the key caregivers in hospitals—significantly influence the quality of care provided and, ultimately, the effectiveness of treatment and patient outcomes. To be eligible for Magnet® designation, hospital organizations must promote quality that supports a professional practice environment and that encourages nurses to express concerns about the practice environment. Moreover, a Magnet organization must lead initiatives to improve the practice environment.
Application of the Standard to Practice
Education
Educators design curricula that help nursing students acquire the competencies required to contribute to quality nursing care. To that end, students attain the requisite knowledge about nursing’s unique contribution to patient care. They do so through a systematic approach to nursing care using the nursing process. Nursing students learn to accurately assess and diagnose patient problems amenable to and requiring nursing intervention and therapeutics. To do so, they learn the identification of etiologies that determine the nursing interventions needed (Lyon, 2009) so that they achieve the desired nursesensitive outcomes (Doran, 2010). Learning experiences are structured so that students recognize the importance of evidence-based care and tracking of the quality indicators of nursing care as explicated in the American Nurses Association’s National Database of Nursing Quality Indicators® (NDNQI®, 2011). Students also become knowledgeable about other policy groups such as The Joint Commission (2011), Agency for Healthcare Research and Quality (AHRQ, 2011), Institute for Healthcare Improvement (IHI, 2011), and National Quality Forum (2011), all of which influence the national standards for quality patient outcomes.
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