The 2011 Quality and Safety Education for Nurses (QSEN) conference in Milwaukee, Wisconsin, was an eye opener for many nurses.  Most Americans and nurses had been shocked by the 2000 Institute of Medicine report,  “To Err Is Human: Building a Safer Health System”, where experts estimated that as many as 98,000 people die in any given year from medical errors that occur in hospitals.  The three co-editors were sure that neither we nor any of the nurses or other health care providers that we knew had contributed to that number.  The Milwaukee QSEN conference raised our consciousness on the need for nurses and other health care providers to pay more attention to quality and safety.  The idea for a new book, Introduction to Quality and Safety Education for Nurses: Core Competencies, was born.

The book’s three co-editors, Patricia Kelly from Illinois, Dr. Beth Vottero from Indiana, and Dr. Carolyn McAuliffe from New York have long been involved with quality and safety.  Their  collective backgrounds include working as staff nurses, nursing faculty of ADN, BSN, and MSN nursing education programs, faculty for several QSEN conferences, faculty for quality improvement seminars for The Joint Commission, Director of Nursing Quality at a large university hospital,  Magnet Program Director, Clinical Researcher,  Family Nurse Practitioner, and Regional Co-lead of the New York State Action Coalition to advance the Future of Nursing: Campaign for Action in nurse training, education, professional leadership, and work force policy.

The three co-editors brainstormed what the book’s thirteen chapter topics would be.  In separate chapters, we decided to address each of the six QSEN competencies:

  1. Quality improvement
  2. Safety
  3. Evidence-based practice
  4. Informatics
  5. Teamwork and collaboration
  6. Patient-centered care

The other chapters would be on topics related to the QSEN competencies, e.g., overview of the health care system, overview of QSEN, ensuring highly reliable quality and safety in health care organizations, benchmarking, tools of quality Improvement, literature search strategies, and the future of quality and safety in health care.

The chapters explore various quality and safety strategies, including using Donabedian’s structure, process, and outcome model to improve patient care.  Many other quality and safety strategies are discussed in the book, e.g., root cause analysis; TEAMSTEPPS; Crew Resource Management; culture of safety; rapid response teams, and the use of standardized evidence-based practice guidelines to assure reliable, high quality patient care, e.g. the guidelines for elimination of ventilator-associated pneumonia (VAP).  The use of protocols to improve quality and safety are also highlighted, e.g., Plan, Do, Study, Act (PDCA); Situation, Background, Assessment, Recommendation, Response (SBARR); and the Patient/Population, Intervention, Comparison, Outcome (PICO) Model.  PowerPoints for each chapter are available for faculty use with the book.

There are three appendixes in the book:

  • Tables of  linkages between the original QSEN knowledge, skills, and attitudes competencies to the content in the book
  • List of key Institute of Medicine Reports that have influenced quality and safety  in health care today
  • Additional student activities

We identified chapter contributors from various areas of the United States to develop the chapters.  We asked several QSEN consultants (Dr. Gerry Altmiller from La Salle University in Philadelphia PA; and Dr. Gail Armstrong and Dr. Amy Barton from the University of Colorado College of Nursing in Aurora CO) to contribute chapters to the book.  Dr. Gerry Altmiller and Dr. Ronda Hughes (author, Patient Safety and Quality: An Evidence-Based Handbook for Nurses) wrote the book’s preface.  We encouraged chapter contributors to refer readers to the QSEN website with its many faculty and student resources and invite input from physicians, patients, librarians, psychologists, and other health care team members.  This would assure that the text represented a broad picture of quality and safety.  We encouraged all chapter contributors to use many student-friendly activities to build knowledge of quality and safety competencies quickly.  We wanted nurse educators, students and all health care providers to understand quality and safety best practices, theories, methods, and evaluation.   Today, more than ever, we believe that all nurses are key players in assuring patient care quality and safety.  This text helps nurses fulfill that role, now and in the future.



National Research Council. To Err Is Human: Building a Safer Health System. Washington, DC: The National Academies Press, 2000.

Quality and Safety Education in Nursing (QSEN). Accessed March 18, 2014 from

Hughes, Ronda G.  Patient Safety and Quality: An Evidence-Based Handbook for Nurses. (2008). AHRQ Publication No. 08-0043. Agency for Healthcare Research and Quality, Rockville, MD.