New nurses' views of quality improvement education

Background: Quality improvement (QI) is a focus of hospital managers and policymakers. The role of registered nurses (RNs) in QI in hospitals is vital because most hospital-based RNs provide direct care to patients. QI skills are necessary to identify gaps between current care and best practice and to design, implement, test, and evaluate changes and are essential for R.N.s to participate effectively in QI. Newly licensed registered nurses' (new nurses') positions as direct caregivers could have an impact on QI if nurses lack sufficient knowledge, concepts, and tools required for QI. Methods: Data came from the 436 respondents (69.4% response rate) to a 2008 eight-page mailed survey to participants in a nationally representative panel survey of new nurses who graduated between August 1, 2004, and July 31, 2005. Results: Overall, 159 (38.6%) of new nurses thought that they were "poorly" or "very poorly" prepared about or had "never heard of" QI. Their perceptions of preparation varied widely by the specific topic. Baccalaureate (B.S.) graduates reported significantly higher levels of preparation than associate degree (A.D.) graduates in evidence-based practice; assessing gaps in practice, teamwork, and collaboration; and many of the research-type skills such as data collection, analysis, measurement, and measuring resulting changes. Discussion: Registered-nurse educational programs need to improve education about and application of QI concepts and to consider focusing QI content into a separate course to have some confidence that faculty will teach it. Despite the strong focus on QI in hospitals, new nurses do not see the connection between QI education and successfully performing their hospital jobs. Both nursing programs and hospitals should help new nurses make the connection.