Core Competencies for State and Quality Nursing Care
Core Competencies for Safe and Quality Nursing Care
Leadership in Nursing Practice
Role of the Nurse Leader
Every nurse acts as a leader regardless of formal title or position; leadership is demonstrated in daily practice, student organizations such as the Nurse Student Association (NSA, formerly SNA), and patient care environments.
Nursing leadership extends beyond administrative roles (such as Charge Nurse, Nurse Practitioner, Director of Nursing, or Chief Nursing Officer) to include bedside nurses, who serve as the primary coordinators of care.
Core leadership characteristics include listening, establishing principles, maintaining passion and purpose, setting core values, and empowering team members.
Key Leadership Principles & Quotations
Leadership effectiveness relies on empowering others rather than exercising power over them: "Leaders become great not because of their power, but because of their ability to empower others."
True leadership fosters autonomy and shared achievement: "A leader is best when people barely know they exist… When his work is done, his aim fulfilled, they will say, we did it ourselves."
Impact of Nursing Leadership
Nurse leadership directly impacts patients, families, the nursing profession, co-workers, interdisciplinary team members, and healthcare facility staff.
Nurses maintain a continuous presence in acute care environments ( coverage), whereas interdisciplinary team members—such as Physical Therapy (PT), Occupational Therapy (OT), and Medical Technologists (MT)—do not maintain continuous bedside presence.
Due to this constant presence, nurses serve as the primary hub of interdisciplinary communication and patient care delivery.
Self-Care Principle
Nurses must prioritize personal health and self-care first to possess the capacity to care effectively for patients and families.
QSEN and AACN Core Competencies
Framework Overview
The core competencies were originally established as Quality and Safety Education for Nurses (QSEN) competencies and have since been absorbed into the American Association of Colleges of Nursing (AACN) Essentials and sub-competencies.
Overarching Goal: Prepare future nurses with the knowledge, skills, and attitudes (KSAs) necessary to continuously improve the quality and safety of healthcare systems.
Each core competency begins with an active, action-oriented verb to emphasize active implementation rather than passive observation.
The Six Core Competencies
Provide Patient- and Family-Centered Care
Work in Interdisciplinary Teams (Teamwork and Collaboration)
Employ Evidence-Based Practice (EBP)
Apply Quality Improvement (QI)
Use Informatics
Create a Culture of Safety
Patient- and Family-Centered Care (Gap 1)
Core Components
Advocacy: Representing patients and families when they cannot speak for themselves or lack knowledge to navigate healthcare decisions. Aligns with the American Nurses Association (ANA) Code of Ethics.
Empowerment: Providing patients and families with direct access to information, resources, support, and decision-making opportunities.
Self-Management: Building the confidence and skills of patients and families to manage their own health conditions independently.
Health Literacy: Assisting patients and families in reading, understanding, and acting upon health information.
Cultural Competence: Respecting individual patient values, preferences, and expressed needs while meeting patients where they are socially and environment-wise.
Optimal Healing Environment: Creating a clean, safe, and private care space that addresses physical, mental, and spiritual needs (mind, body, and soul).
Health Literacy Standards & Writing Level
All patient education material, pamphlets, and written instructions must be written at a -grade reading level to ensure universal comprehension.
Case Study Example: At Arkansas Children's Hospital, a infant diagnosed with "failure to thrive" experienced repeated readmissions. The healthcare team discovered that the mother was illiterate and unable to read written instructions regarding formula mixing ratios as the child grew. Upon identifying this barrier, nurses marked physical feeding bottles visually to indicate fluid levels. Following this visual modification, the infant was successfully managed at home and was never readmitted.
Patient Portals & Self-Management
Federal and state regulations mandate providing patients direct, immediate electronic access to their health records via patient portals to support transparency and self-management.
Social Determinants of Health (SDOH)
Impact on Health Outcomes
Social Determinants of Health account for approximately of an individual's overall health outcomes.
Healthy People 2030 categorizes SDOH into five core domains (found on pages 11–12 of the textbook).
Key Assessment Domains
Access to reliable transportation.
Proximity and access to healthcare clinics and primary care providers.
Availability of home internet service and computing devices.
Financial stability and employment status.
Health literacy and community support networks.
Teamwork and Collaboration (Gap 2)
Care Coordination
Involves organizing components of the overall plan of care, implementing interventions, advocating, and documenting care.
Care coordination is legally recognized as an autonomous nursing function that nurses execute independently without requiring a physician's order or direct supervision.
Nursing teams must actively avoid working in "silos" (isolated organizational units) and maintain open interprofessional collaboration.
Core action verbs: Organize, Coordinate, Implement, Advocate.
Interprofessional Communication
Effective communication encompasses both verbal and non-verbal modes.
Deficits in communication represent a primary root cause of healthcare errors; systematic communication pathways must be maintained across shifts and departments.
Evidence-Based Practice (Gap 3)
Integration of Research and Clinical Guidelines
Evidence-Based Practice (EBP) integrates current empirical research, clinical expertise, and patient values to address clinical questions and solve clinical problems.
Requires evaluating workflow, establishing progress benchmarks, and appraising published scientific literature to refine clinical practice guidelines.
Historical Practice Example: Practice guidelines previously required aspirating prior to administering intramuscular (IM) injections to check for blood vessel entry; this standard was subsequently discontinued based on updated clinical research and evidence.
Evidence-Based Management
Involves adopting managerial and operational policies that are directly supported by rigorous empirical research.
Primary Barrier to EBP: Challenges in real-world implementation and continuous monitoring of updated clinical guidelines.
Quality Improvement (Gap 4)
Three Dimensions of Quality Improvement
Structured Care Environment (The Where): Evaluates the setting in which care is provided, including physical facility layout, specialized equipment, staffing ratios, unit culture, and formal organizational policies and procedures.
Care Process (The How): Evaluates the specific processes of care delivery, workflow mechanics, and active nursing operations.
Outcomes of Care (The Results): Evaluates the measurable outcomes of nursing care to determine the overall clinical effectiveness of implemented nursing actions.
Nursing Informatics (Gap 5)
Link to the Nursing Process
Informatics leverages information technology to collect, analyze, monitor, summarize, and communicate healthcare data.
Direct connection to the standard Nursing Process cycle:
The Next Generation NCLEX examination focuses directly on clinical judgment and application of the nursing process rather than rote knowledge memorization.
Documentation Requirements
Complete documentation of all patient interactions, assessments, interventions, evaluations, and clinical outcomes within the electronic health record (EHR) is mandatory to support continuity of care and patient portal access.
Culture of Safety and Human Factors (Gap 6)
Human Error & Safety Dynamics
Although complete elimination of healthcare errors is impossible due to human involvement, strict adherence to safety protocols reduces risk to a manageable level.
Act of Omission: An error resulting from a failure to perform a necessary action or omitting a required safety check.
Act of Commission: An error resulting from performing an incorrect action or executing a procedure improperly.
Legal & Professional Implications
Case Example: A nurse in Memphis, Tennessee was stripped of her nursing license and convicted of a felony following a fatal medication administration error. The conviction occurred because the nurse repeatedly bypassed, overrode, and ignored established software and hardware safety controls prior to the patient's death.
Five Principles of a Safety Culture
Provide Leadership: Primary principle driving safety culture across an organization.
Respect Human Limits: Design protocols, systems, and shift schedules that account for natural human physiological and cognitive limitations.
Promote Effective Team Functioning: Facilitate interprofessional teamwork and clear breakdown-free communication.
Anticipate the Unexpected: Proactively design contingency plans for potential systems failures or unexpected clinical events.
Establish a Continuous Learning Environment: Encourage transparent error reporting without immediate punitive retaliation to improve operating systems.
Examination Application & Practice Questions
Exam Format & Focus
Leadership examinations assess higher-level application and analysis of clinical concepts rather than simple facts or memorized definitions.
Sample Scenario 1: Evidence-Based Practice
Question: What is the first step a nurse leader should take when integrating evidence-based practice to solve an operational unit issue?
Correct Answer: Collaborate with researchers and staff to clearly identify and define the specific clinical problem.
Sample Scenario 2: Assessing Nurse Leadership Outcomes
Question: A nurse leader knows that patient- and family-centered care has been effectively integrated when unit staff express which perspective?
Correct Answer: Staff state: "I have access to information and resources, I have the opportunity to learn and grow, and I have all the support necessary to deliver high-quality care."
Sample Scenario 3: Social Determinants of Health at Discharge
Question: A nurse is preparing to discharge a patient following a surgical procedure. Which Social Determinants of Health (SDOH) should the nurse prioritize assessing to ensure a successful transition of care?
Correct Answers:
Patient health literacy.
Access to reliable transportation.
Employment status and economic stability.