Providing the highest quality of care to clients, and keeping them safe, is a priority for all nurses. This chapter presents an evolving case scenario that will follow a nurse's exploration of quality and safety on her patient care unit. It helps the reader to define quality improvement and safety in healthcare. The chapter describes approaches that nurses can take to evaluate the quality of care through measurement and benchmarking. It helps the reader to explain the influence of variation on the quality of care and apply a framework to improve reliability. The chapter differentiates prepatient events, safety events, and serious safety events and describes how human factors contribute to events of harm. It defines the culture of safety and its elements, including event reporting, event disclosure, and accountability in a just culture. The chapter finally explains the process for determining actual and potential failures in processes.

Healthcare in the United States in the 21st century is influenced and challenged by a multitude of factors, including legislation, public policy, and consumer mandates. Healthcare leaders must identify new priorities not only for healthcare delivery but to improve the work life of the members of the healthcare team. This chapter helps the reader to understand current challenges driving healthcare delivery in the United States, describe the Quadruple Aim, understand healthcare teams and models, and identify challenges related to health literacy. It distinguishes a variety of environments and setting for healthcare leadership and examines productivity, effectiveness, and safety and their impact on quality care. The chapter also describes the unique role of the APRN in leading initiatives in primary care to address the need to improve outcomes across settings and articulates the importance of social determinants of health.

This chapter focuses on one of the areas of human diversity—socioeconomic class—more specifically it examines poverty and its impact on health. Socioeconomic status has been identified as one of the major determinants of health. Therefore, nurses and other healthcare providers must attempt to find ways to minimize the impact of low income on healthcare access to reduce healthcare disparities in the United States. Despite nurses’ desire to give optimum care to all patients, the socioeconomic status of the patient can sometimes interfere with nurses’ and other healthcare workers’ best efforts to positively influence the quality of healthcare the patient receives. The chapter describes health-related problems encountered by the poor and uninsured. It examines homelessness and its impact on health, and discusses the intersection of cultural differences, language barriers, and poverty and its impact on healthcare access.

Competency-based education (CBE) is becoming the new curriculum model in healthcare for several reasons: Need for greater practitioner accountability; Increased social expectations for quality care; and Need for educational systems that can readily adapt to change. This chapter delves into the specifics of revising or developing a nursing curriculum using a CBE model. Curriculum revision or development must consider many variables including the educational mission, the competencies identified as needed, the framework, and the constraints encountered in traditional educational systems. The chapter discusses the development of CBE curricula. It compares CBE to traditional curriculum models and helps the reader to identify leadership attributes needed to develop or revise curricula. A curriculum framework organizes content and competencies. Milestones are built in to ensure logical succession of competency achievement. Assessment and evaluation of competency achievement is completed along the way to ensure student success in reaching program outcomes.

The Americans with Disabilities Act (ADA) defines disability in terms of the person’s physical, mental, or emotional functioning problems that coexist with his or her levels of participation in the activities required to be integrated into the social world. This chapter describes the various types of disabilities found in American society and discusses the impact of discrimination or bias on persons with disabilities. It examines the demographics found among persons with disabilities. The chapter helps the reader to identify groups and organizations that may be used as resources when caring for persons with disabilities and to explore common attitudes of healthcare providers toward persons with disabilities. It also helps the reader to recognize the implications for nurses when caring for persons with disabilities and to determine strategies and intervention to enhance the quality of care for persons with disabilities.

Digital health is an overarching category including mHealth, health information technology, wearable devices, telehealth and telemedicine, and personalized medicine. Healthcare providers and other stakeholders use digital health to improve access, reduce costs, improve efficiency and quality, and make care more personalized. Healthcare providers use digital healthcare technologies to deliver care transcending time and distance. Patients and healthcare consumers use digital health to manage and track their health and wellness. Health systems managers use digital interventions to improve quality of care and to help with state and federal regulatory compliance and reporting. Data services interventions entail crosscutting functionality necessary for data collection, management, use, and exchange. This chapter provides the definitions of mHealth, telehealth, telemedicine, and wearables. It details the benefits of use of healthcare technologies and the challenges and pitfalls for patients and providers relating to health information technologies. It concludes with a discussion of the future direction of mHealth, telehealth, and wearables.

Nurses enrolled in graduate programs must be prepared for their new roles when they complete their programs of study. Competency is what is needed to safely care for patients. “Although competency is defined in different ways, there is a common goal; to ensure nurses have he knowledge, skills, and abilities expected and required for their practice settings”. In competency-based education, the nursing student must reach certain learning outcomes before advancing in their program. Competency-based education (CBE) is aligned with the call for improved quality and safety in healthcare. This chapter defines competency and CBE and discusses how competencies have been integrated into graduate nursing curricular requirements. It describes the use of CBE in a Doctor of Nursing Practice (DNP) nursing curricula. Since practice-based DNP programs are already required to meet core competencies for accreditation, it becomes a natural fit for these programs to employ competency-based education in accomplishing this goal.

Data standardization supports the goals of nursing to improve direct patient care and healthcare safety and quality. By allowing comparison of patients across healthcare systems and settings, data standardization has the potential to enhance the evidence basis for nursing practice and to improve clinical outcomes. Data standardization has the potential to decrease the costs of healthcare to patients and organizations by improving reimbursement, decreasing unnecessary testing, and streamlining the processes like nursing and physician documentation, giving providers more time to care for patients directly. Professional nurses with knowledge of data standardization are empowered to advocate on behalf of the discipline and patients to improve machine readability of nursing documentation and to improve care. This chapter helps the reader to define data standardization, and discuss the rationale for standardizing nursing-generated data and the differences and applications for standardized nursing nomenclatures.

Obtaining a master’s degree does not end the need for lifelong learning. One will continue to need to explore healthcare research and keep abreast of the new knowledge in our profession. Lifelong learning can be accomplished through several avenues, including formal and informal paths. Lifelong learning entails the learner setting goals and choosing methods to acquire the knowledge and skills required to meet those goals. Lifelong learning is an essential part of every level of nursing. It is important that we stay informed of the latest updates in our discipline to provide the safest and highest quality of care for our patients. Lifelong learning can be accomplished through formal and informal pathways, depending on the type of knowledge and skills needed. As a master’s-prepared nurse, it will be necessary for you to continue your learning through many avenues for years to come.

The clinical nurse leader (CNL) role is the first new nursing role in over 30 years. The Institute of Medicine (IOM) brought attention to critical healthcare concerns in 1999 that triggered the American Association of Colleges of Nursing (AACN) to address safety and quality gaps in care. The CNL role can provide a great deal of opportunity for a unit to not only improve patient outcomes and reduce costs but also develop new nurses and provide an environment for innovation. Careful planning must go into the implementation and all stakeholders must be supportive in the process and offer continued support throughout implementation. The CNL has the knowledge and tools to respond to the demand to improve the quality of healthcare; it is the support within the macro- and microsystems that can ultimately influence the role and its desired outcomes.