The Future of Nursing: Focus on Nursing Education report supported the need for a more educated nursing workforce and recommended an adequate number of nurses with the appropriate skills to overcome complexity barriers in health care (Institute of Medicine [IOM], 2010). In response to this recommendation, the Institute for Healthcare Improvement (IHI, 2012) issued a guide for curricular integration for a quality and safety certification divided into 13 modules based on evidence. The guide created the ideal opportunity for collaboration in achieving that recommendation in the Elmhurst College graduate nursing program.
Elmhurst College is a small, private institution in the midwestern region of the United States with both undergraduate and graduate-level degree options, including two points of entry for Master of Science in Nursing (MSN) students. The first point of entry is the traditional postbaccalaureate in nursing and the second point of entry is the master's entry in nursing practice (MENP). To strengthen the curricula around Quality and Safety Education for Nurses (QSEN) Competencies (American Association of Colleges of Nursing [AACN] Quality & Safety Education in Nursing Education Consortium, 2012), it was acknowledged that integrating the IHI Basic Quality and Safety Certification would allow supporting content to be delivered easily while augmenting achievement of program outcomes. To launch this innovation, Golde (2015) suggested that nursing faculty collaborate in the following areas: alignment of program and outcomes, building academic culture, and rethinking pedagogies. The institution desired increasing curricular alignment with current content between entry options, supporting the academic culture around quality and safety in nursing, and assisting students in having a profile that differentiated them from other job seekers postgraduation. According to IHI Best Practices (2012), the IHI Open School courses that are free to students and faculty have been vital in “bringing the skills of improvement, safety, system design, and leadership to the next generation of health care professionals” (p. 4).
Elmhurst College implemented the IHI Modules that include 13 courses to achieve basic certification in the master's entry student population initially. Master's entry students are second-degree students who enter a master's degree nursing program with an undergraduate degree in another area of study and have specific course prerequisites completed for admission to this type of program. Master's entry students enter with no experience in nursing and generally limited knowledge related to health care quality improvement and patient safety. To assist students in closing this gap, Webb and McKeon (2014) note that IHI Modules support master's entry students as well as program faculty.
With positive feedback and data, program leadership then collaborated to spread the integration to the alternative entry point in the master's program, the traditional MSN program. Courses shared between programs were focused on specifically for future efficiency of course offerings. Traditional MSN students present a different set of challenges; these students may have years of nursing experience. In the dynamic world of health care, quality and safety initiatives and trends may have been outdated from their baccalaureate education, oftentimes completed many years prior to admission to an MSN program (IOM, 2010). IHI Modules were strategically integrated within this program to ensure not only alignment with course content but also without regard to specialty concentration. Faculty desired to ensure that this certification could be obtained by all specialty concentrations within the traditional MSN program (nurse administrator, nurse educator, and clinical nurse leader).
The student population has not had prior experience with IHI modules, so both MENP and MSN curricula were analyzed by the Graduate Program Committee. Using horizontal integration, modules were embedded in courses aligning with course content (IHI, 2012). Didactic courses could offer points for module completion with point values at the professors' discretion. Grading for modules in clinical courses would be satisfactory or unsatisfactory to align with the college grading criteria, but completing modules were used as clinical time when completed outside the regular clinical day. The 13 modules, although distributed differently between entry points, were allocated based on student population and curricular alignment.
Qualitative data indicate that students appreciated the opportunity to enhance resumes, learn foundational knowledge, and earn clinical time for some modules. Students also noted that including IHI Modules enhanced and supported Clinical Nurse Leader certification examination review for that specialty concentration across both entry options.
Upon completion of the MSN program, 100% of the students earn certification, and 100% of the MENP students include this certification on their resumes. In the final semester, MENP students add this certification to their resumes to demonstrate specialized knowledge in the areas of quality and safety, thus differentiating them from others.
Graduate portfolios demonstrate the IHI integration assists students in achieving program outcomes. Faculty evaluate students' portfolio narratives to ensure differentiation between baccalaureate and master's level competencies. Portfolio analysis reveals that students have used IHI Modules as evidence of achieving six of eight program outcomes. Program completion surveys indicate higher scores for academic years 2017–2018 and 2018–2019 on a 4-point scale (Table 1).
Abbreviated Program Outcomes and Overall Student Satisfaction
Integrating the IHI Basic Quality and Safety Certification into the MSN program at Elmhurst College was an innovative way to strengthen the scaffolding of content in the program curricula for both the MSN and MENP entry options. By embedding evidence-based quality and safety content into the curriculum, faculty recognize the culture of safety is important and a priority for students' learning as evidenced by increased scores in achievement of program outcomes and overall satisfaction with the graduate program. By supporting the AACN Masters Essentials and QSEN guidelines for nursing education, the academic culture provides a foundation for quality and safety as priority areas in health care and nursing. The initiative was collaborative in nature and based on data in student achievement and student satisfaction, which can present a strong narrative for program improvement during an accreditation cycle for any educational institution.
- American Association of Colleges of Nursing Quality & Safety Education in Nursing Education Consortium. (2012). Graduate-level QSEN competencies: Knowledge, skills, and attitudes. http://www.aacnnursing.org/Portals/42/AcademicNursing/CurriculumGuidelines/Graduate-QSEN-Competencies.pdf
- Golde, C.M. (2015). The formation of scholars: Insights of the Carnegie initiative on the doctorate. GEOJournal, 80(2), 209–213.
- Institute for Healthcare Improvement. (2012). Basic certification in quality and safety. http://www.ihi.org/education/IHIOpenSchool/Courses/Pages/OpenSchoolCertificates.aspx
- Institute of Medicine. (2010). The future of nursing: Focus on nursing education. Washington, DC: National Academies Press.
- Webb, S. & McKeon, L. (2014). A model for preparing faculty to teach model C clinical nurse leader students. Journal of Nursing Education, 53(7), 421–425.
Abbreviated Program Outcomes and Overall Student Satisfaction
|Outcome||Scores per Academic Year|
|Critical thinking and decision making||3.62||3.86|
|Professional values and ethics||3.52||3.86|
|Accountability and professional development||3.48||3.76|
|Leadership within systems||3.59||3.79|
|Overall satisfaction with program||3.24||3.62|