The Journal of Continuing Education in Nursing

Guest Editorial Free

Why Quality and Safety Education for Nurses (QSEN) Matters in Practice

Gerry Altmiller, EdD, APRN, ACNS-BC, FAAN; Loraine Hopkins-Pepe, MSN, RN, CCRN-K

The Quality and Safety Education for Nurses (QSEN) Collaboration formed in response to the call from the Institute of Medicine (now the National Academy of Medicine) to improve the quality and safety of health care. That call to action identified five competencies required by all health care providers to transform the health care system, shifting the emphasis to include patient-centered care, teamwork and collaboration, use of evidence-based practice, quality improvement skills, and the integrated use of informatics in the care provided for patients (Institute of Medicine, 2003). Shortly afterward in 2005, the QSEN collaboration, funded by the Robert Wood Johnson Foundation and led by Linda Cronenwett, adopted those five requisites, added safety as a sixth competency, and the newly developed QSEN competencies became the blueprint for nurse educators working to re-channel the focus of formal nursing education programs (Cronenwett et al., 2007). The QSEN competencies provided a clear structure designed to change the identity of nursing from that of a task-oriented role to one driven by the knowledge, skills, and attitudes (KSA) that underpin quality and safety concepts.

What followed was 13 years of transformation as the QSEN competencies were integrated into curriculum plans and accreditation standards for schools of nursing. QSEN provided resources and partnered with national nursing organizations to support the implementation of the competencies in nursing academia. In 2009, graduate-level QSEN competencies that demonstrated enhanced leadership KSAs were developed, but through all this, practice was slow to embrace the QSEN competencies. During this same time, practice saw the introduction of the Hospital Value-Based Purchasing program implemented by the Centers for Medicare & Medicaid Services (2018). This program reimbursed hospitals based on quality of care rather than quantity, thus driving efforts to improve quality and safety within health care systems. The Joint Commission Accreditation Standards supported hospitals in meeting the regulatory requirements and Magnet® standards drove excellence. Through it all, the aims have always been congruent between nursing practice and academia, but the two have not always shared a common language or understanding.

The work of Lyle-Edrosolo and Waxman (2016) has been significant in bridging academia and practice. Using crosswalk methodology, they aligned the six QSEN competencies, the Magnet® standards, and the Joint Commission Accreditation Standards. This work demonstrates the relationship among these three driving forces and how nursing education framed in quality and safety aligns with expectations for excellence in nursing practice. Although the QSEN competencies were originally designed for nursing education, this work validates the QSEN competencies as an effective framework to drive excellence and buttress the lifelong learning required by nursing professionals to ensure that the best care is provided to those who access the health care system.

Nurses are the linchpin in achieving quality and safety outcomes, and they are frequently viewed as the last defense between the patient and potential errors (Sherwood & Zomorodi, 2014). In order to champion for safer health care for patients and to make an appreciable difference, nurses need to be informed and educated about quality and safety competencies (Sherwood & Zomorodi, 2014). QSEN competencies serve as an appropriate framework for education to address common issues confronting nursing practice, such as medication errors, pressure injuries, and falls.

Continuing education and professional development educators play a vital role in enhancing quality and safety in the practice setting. To improve care delivery and achieve quality and safety goals, continuing education programs for nurses must be transformed to include expanded content focused on quality and safety competencies (Sherwood, 2017). Integrating the QSEN competencies into educational initiatives provides a standardized structure for content development and clearly delineates objectives to enhance the clarity of the material delivered. The QSEN competencies provide an effective foundation for nurses to influence and promote high-quality safe care.

QSEN competencies have served as the underpinning of transition-to-practice programs but why not as the framework for continuing education? Integrating the QSEN competencies enables continuing education and professional development educators to emphasize the “why” behind nursing interventions while also highlighting the evidence driving care. Additionally, framing educational offerings in the QSEN competencies allows all educators to promote the universal language of quality and safety.

Finally, and perhaps most significantly, integrating the QSEN competencies into practice-based education programs challenges educators to update and revitalize course content. Continuing education and professional development educators are often tasked with repeatedly teaching the same required courses containing content that becomes stagnant over time. By critically evaluating existing courses and revising them to integrate the QSEN competencies, these educators may begin teaching from a different lens, shifting their focus from teaching tasks to teaching concepts about how to influence and promote high-quality safe care. Continuing education and professional development educators are influential in enhancing the quality and safety of care delivery, and The Journal of Continuing Education in Nursing will support QSEN competency implementation in practice through the Teaching Tips column, beginning with this issue, by sharing strategies and ideas with educators so that they may perform this work effectively. Reframing continuing education programs in the QSEN competencies supports the work of continuing education and professional development educators as they work to better highlight the critical impact of the nursing profession on quality care and patient outcomes.


  • Center for Medicare & Medicaid Services. (2018). Hospital value-based purchasing. Retrieved from
  • Cronenwett, L., Sherwood, G., Barnsteiner, J., Disch, J., Johnson, J., Mitchell, P. & Warren, J. (2007). Quality and safety education for nurses. Nursing Outlook, 55, 122–131. doi:10.1016/j.outlook.2007.02.006 [CrossRef]
  • Institute of Medicine. (2003). Health professions education: A bridge to quality. Washington, DC: National Academies Press.
  • Lyle-Eldrosolo, G.L. & Waxman, K.T. (2016). Aligning healthcare safety and quality competencies: Quality and Safety Education for Nurses (QSEN), The Joint Commission, and American Nurses Credentialing Center (ANCC) Magnet® Standards Crosswalk. Nurse Leader, 14, 70–75. doi:10.1016/j.mnl.2015.08.005 [CrossRef]
  • Sherwood, G. (2017). Driving forces for quality and safety: Changing mindsets to improve health care. In Sherwood, G. & Barnsteiner, J. (Eds.), Quality and safety in nursing: A competency approach to improving outcomes (2nd ed., pp. 1–20). Hoboken, NJ: Wiley Blackwell.
  • Sherwood, G. & Zomorodi, M. (2014). A new mindset for quality and safety: The QSEN competencies redefine nurses' roles in practice. Nephrology Nursing Journal, 41, 15–22.

Editor's Note: This special guest editorial is presented as a beginning to a series in the Teaching Tips column that focuses on QSEN (Quality and Safety Education for Nurses). This new emphasis is designed to support nurses in practice as they enrich their knowledge, skills, and attitudes in addressing quality and safety issues.

As The Journal of Continuing Education in Nursing celebrates our next half-century of editorial excellence, we welcome manuscripts that describe the ways continuing education/professional development educators prepare nurses with competencies for ensuring quality and safety in nursing care and demonstrate the link to improved patient outcomes.

∼ Patricia S. Yoder-Wise, RN, EdD, NEA-BC, ANEF, FANOL, FAAN


Dr. Altmiller is Professor, Director of Quality and Safety Education for Nurses (QSEN) Institute Regional Center at The College of New Jersey, Ewing, New Jersey; and Ms. Hopkins-Pepe is Director, Nursing Education and Professional Development, Einstein Healthcare Network, Philadelphia, Pennsylvania.

The authors have disclosed no potential conflicts of interest, financial or otherwise.

Address correspondence to Gerry Altmiller, EdD, APRN, ACNS-BC, FAAN, Professor, Director of Quality and Safety Education for Nurses (QSEN) Institute Regional Center at The College of New Jersey, 2000 Pennington Road, Ewing, NJ 08628; e-mail:


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