Teaching the Culture of Safety

Jane Barnsteiner, PhD, RN, FAAN


Online J Issues Nurs. 2011;16(3) 

In This Article

What Students Need to Know About a Culture of Safety

The Quality and Safety Education for Nurses (QSEN) was developed to identify the competencies pre-licensure and graduate students need for safe practice (Cronenwett et al., 2007, Cronenwett et al., 2009). QSEN defines safety as minimize(ing) risk of harm to patients and providers through both system effectiveness and individual performance (Cronenwett, et al., 2007, p. 128). With funding from the Robert Wood Johnson Foundation a group of experts, with consultation and input from multiple accrediting agencies and professional groups, identified the needed safety competencies and disseminated them via publications (Cronenwett et al., 2007; Cronenwett et al., 2009), a website, www.qsen.org national forums, and 'train the trainer' workshops for faculty. Didactic, simulation laboratory, and clinical fieldwork teaching strategies have been developed to assist faculty to incorporate a culture of safety into the curriculum.

Traditionally education has focused on the care of individual patients/families, with an understanding of the complexity of care delivery systems being notably absent. The QSEN project places considerable emphasis on helping students understand the complexity of care delivery systems.

Faculty are urged to incorporate the QSEN competencies into their teaching about patient and provider safety. One of the QSEN concepts, patient-centered care, ensures the patient is involved in decision making and understands the plan of care thus preventing errors from occurring. Evidence-based practice guides clinicians in using up-to-date science, in addition to considering clinical expertise and patient values, in designing a plan of care. Teamwork and collaboration assist the healthcare team to communicate and work together effectively, using shared decision making to achieve safe, high quality care. Quality improvement provides for trending and analysis of data to be able to benchmark with comparable organizations and identify system vulnerabilities needing correction. Informatics assists clinicians in using information and technology to communicate, access knowledge, and support decision making. The QSEN project has separated quality and safety into two separate competencies to more comprehensively address the science underlying each of the two and to better describe the knowledge, skills, and attitudes necessary for effective practice.

The QSEN competency for safety lists the knowledge, skills, and attitudes students need to know to practice safely. Table 2 lists the components of the competency, including the elements of a culture of safety, types of healthcare errors, why errors occur, and how to make care safer. This article will focus on the QSEN safety competencies.


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