Ask the expert: Understanding nursing roles in quality improvement

Nurse Leader Insider, April 5, 2010

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This week, Cynthia Barnard, MBA, MSJS, CPHQ, discusses how to understand and distinguish the different nursing roles in quality improvement.

Q: My facility has put an emphasis on quality improvement over the past few months. How can I identify the roles of nurses at every level in the quality improvement initiative?

A: The role of professional nurses in quality improvement (QI) is twofold: to carry out interdisciplinary processes to meet organizational QI goals and to measure, improve, and control nursing-sensitive indicators (NSI) affecting patient outcomes specific to nursing practices. All levels of nurses, from the direct care bedside nurse to the chief nursing officer (CNO), play a part in promoting QI within the healthcare provider organization.

Here is an explanation of the involvement each level of nurse should have in promoting QI:

The CNO: CNOs set the tone for the nursing department's participation in QI. As a member of administrative leadership, the CNO must integrate nursing practices into the organizational goals for excellence in patient outcomes through communication of strategic goals to all levels of staff.

The nurse manager (NM) or nursing director: The NM or nursing director is responsible for communicating and operationalizing the organization's QI goals and processes to the bedside nurse, identifying specific NSIs that need improvement according to his or her particular patient population, and coordinating QI processes to improve these at the unit level.

The direct care nurse: The direct care bedside nurse is the key to quality patient outcomes, carrying out the protocols and standards of care shown by evidence to improve patient care.

To read additional ways to help improve communication between physicians and nurses, click here.

Editor’s note: Do you have a question for our experts? E-mail your queries to Editorial Assistant Sarah Kearns at and see your name in print next week! In the meantime, head over to our Web site and view a growing collection of advice from our experts.

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