Quality improvement engagement and competence: A comparison between frontline nurses and nurse leaders


      • As the largest, most consistent provider of care, nurses play a pivotal role in improving care and patient outcomes at the frontline.
      • The Nursing Quality Improvement in Practice tool can be used to determine current levels of QI competence (e.g. knowledge, skills, and attitudes) and engagement of nurses in QI.
      • Strategies for increasing QI competence and engagement of nurses must be created and deployed in order to improve quality and safety.



      Nurses play a pivotal role in improving patient care. To maximize nurses’ impact on quality, nurses must have quality improvement (QI) competence and engage fully in QI initiatives.


      To describe QI competence (knowledge, skills, and attitudes) among frontline nurses and leaders; and compare variations in competence among nursing roles, experience, and specialty areas.


      A total of 681 nurses at one heath system fully completed the Nursing Quality Improvement Practice tool electronically.


      Half of the respondents reported QI engagement (53.6%). Mean knowledge scores were 5.08 (SD 1.16, 7 items). Skill proficiency was low (M = 2.82, SD = 1.03; range 1–6) although QI attitudes were favorable (M = 3.76, SD = 0.63; range 1–5). Significant differences in skills and attitudes were identified by role. QI competence among nurses employed in various specialty areas were similar.


      Strategies for increasing QI competence and engagement of nurses must be created and deployed in order to improve quality and safety.


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