Running head: IMPACT OF QUALITY AND SAFETY IN NURSING AND THE 1

Impact of Quality and Safety in Nursing and the Educator's Role

Angela Purgiel

Ferris State University

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Abstract

With the recent introduction of the Affordable Care Act influencing the Center for Medicare and

Medicaid and the American Nursing Association it is important for nursing educators to

incorporate these organization’s safety initiatives into the curriculum of nursing students. One of

the goals of these organizations is to reduce hospital acquired infections by 40%. Nursing

educators can easily incorporate this safety initiative into the course work by having students

observe and research specific hospital unit’s quality metrics and presenting it to the other

members of the group within the clinical setting. This will integrate foundational nursing

techniques with exposure to future nursing content and allow the students to make ties between

how to perform these tasks and why it is important to adhere to these organization’s

recommendations for safe patient outcomes.

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Impact of Quality and Safety in Nursing and the Educator's Role

Anyone that has stepped into a hospital in recent years can speak to the effect of quality

and safety initiatives and the impact they have had on health care in the United States. With the

government creating ties between reimbursement and quality and safety metrics it is important

for nurses to be educated on relevant quality and safety topics, such as hospital acquired

infections along with many other preventable diseases a hospital may cause (Centers for

Medicare & Medicaid Services, n.d.). It is also vital for the nurse educators, in the hospital

setting and also in the academic setting, to incorporate these initiatives into the education of

future nurses and provide them with current evidence based practice techniques to ensure the

overall safety of the patients cared for. The purpose of the paper is to outline specific instructions

and associated assignments needed to provide nursing students with the education needed to

meet quality and safety benchmarks presented by the Center for Medicare and Medicaid and the

American Nurses Association as influenced by the Affordable Health Care act related to catheter

associated urinary tract infections (CAUTIs).

Quality and Safety Initiative Identified and Discussed

According to the Center for Disease Control and Prevention (CDC) “between 15-25% of

hospitalized patients receive urinary catheters during their hospital stay and among urinary tract

infections (UTIs) acquired in the hospital, approximately 75% are associated with a urinary

catheter” (Center for Disease Control and Prevention, 2015, p. 1). “UTIs are the most common

type of healthcare-associated infection reported to the National Healthcare Safety Network

(NHSN)” with the most important risk factor associated with UTIs as being prolonged use of the

catheter(Center for Disease Control and Prevention, 2015, p. 1). It is important for early removal

of the catheter and should be an important goal of UTI reduction (Center for Disease Control and
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Prevention, 2015). There are several organizations that have made this safety initiative a priority

including the CDC, the American Nurses Association (ANA), and the Center for Medicare and

Medicaid (CMS). All of these organizations provide nurses and nurse educators with valuable

resources that will aid in the overall reduction of hospital acquired infections.

Changing Healthcare Environment

In an effort to reduce the occurrence of hospital acquired infections the American Nurses

Association (ANA) and the Centers for Medicare and Medicaid Services (CMS) as influenced by

the Affordable Health Care Act have partnered together to reduce avoidable hospital acquired

infections by 40% (American Nurses Association, n.d.). Not only do these infections lead to

extended hospital stays, increased health care costs, and patient morbidity and mortality but the

CMS is tying payment and offering incentives for providers that deliver high quality care.

According to the ANA nurses play an important role and can aid in the overall reduction of UTIs

by “prevention of inappropriate short-term catheter use, nurse-driven timely removal of urinary

catheters, and urinary catheter care during placement” (American Nurses Association, n.d., p. 1).

This means that nurses have an important role to adhere to these guidelines and to provide proper

techniques as provided by these organizations. It is equally important for nurse educators to

incorporate these safety initiatives into the education of nursing students.

Impact on Nursing Education

According to Teaching in Nursing: A Guide For Faculty Nursing Educators, educators

need to not only incorporate foundational nursing education into the curriculum, but also need to

make them relevant to tomorrow’s practice of nursing including evidence based practice and care

outcomes (Billings & Halstead, 2012). Educators have to teach the proper sterile technique for

catheter insertion and it has to be relevant to the future of nursing by integrating quality metrics
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and has to meet the needs of the ANA, and CMS. This type of education fits into both the

classroom setting and can be transitioned into the clinical setting where they quality metrics will

be present.

This changes the way nursing educators will have to prepare students in the future, not

only will general nursing content have to be presented and influenced by the Commission on

Collegiate Nursing Education but it will have to be guided by CMS and ANA guidelines as it is

outline in the Affordable Care Act. Nursing educators will have to be stay current on CMS

guidelines and also maintain accreditation standards in order to ensure a student is well prepared

for the nursing field. Along with the guidelines provided by these organizations there are

valuable tools, practice standards, and educational materials. These learning materials can be

easily integrated into the education of nursing students as the bulk of the materials are already

prepared for nursing educators.

Incorporation into Instructional Design, Assessment, and Evaluation

There are several creative ways this safety initiative can be incorporated into nursing

school curriculum, fitting both into the clinical setting and also in the skills lab. The foundational

knowledge is gained in the skills lab where students learn the proper technique for catheter

insertion. This skill is then transitioned into the clinical setting where students gain a better

understanding of the proper technique and gain experience in performing this skill properly.

Once transitioned into the clinical setting many of the organizations that students attend for their

clinical experience have poster boards located in common areas that have the units quality

metrics displayed. Most students do not take the time to review them mostly because they may

not understand the context of the documents. One way to include these metrics and to also

engage the student in the overall improvement of the safety initiative would be to assign them a
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group project related to the safety initiative presented on the unit’s poster and include the unit’s

metrics in the presentation of initiative. There are several posted initiatives but specifically

metrics related to CAUTIs. This project would be presented at one of the post conference

sessions and students could work in groups. Time would be allotted during the clinical day for

students to prepare and research the topic. Also included in the presentation would be the unit’s

poster content and also content from certain governmental agencies including the CDC, CMS,

and the ANA. This will in turn help the student understand the relationship between all of these

organizations and show how these specific initiatives directly impact the nurse. Another

important piece of the project would be to include practice changes the unit is including in order

to meet their unit’s objective. This would expose the students to proper techniques and specific

things they can do to aid in the overall improvement of the outcome and allow them to be active

participants in meeting this unit’s outcome.

Assessment of the safety initiative would come in the form of a pre-assignment

discussion. Some of the questions that would be discussed would be what is the meaning of the

poster, how does it related to the unit, why is this information important to the overall care of the

patient, and what are some ways nurses can help in the overall improvement of this safety

initiative. Evaluation would be represented in two different ways including a group evaluation on

the content of the presentation and also an evaluation of the assignment and benefit. Some

discussion topics would be whether the students found this beneficial and if they felt better

prepared on how they as students could aid in the overall improvement of this safety initiative.

Projects like these should be incorporated throughout the entire duration of the course work for

several reasons. Not only will it provide the students with any updated information related to
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CMS and ANA guidelines but it will also expose them to several different topics related to these

organizations and will ultimately provide them with the completion of that objective.

Conclusion

The health care environment is constantly changing and new quality and safety initiatives

are introduced frequently. Nurse educators play and important role in preparing students and

nurses for the current state of nursing and also preparing them for the future state of nursing.

With the reduction in hospital acquired infections being a very important quality and safety

initiative and with the recent introduction of the Affordable Care Act linking reimbursement to

quality standards, nurse educators have to instruct nursing students on the proper techniques but

they also have to provide them with exposure to CMS and ANA guidelines which direct the care

needed to provide safe patient outcomes. There are many ways an educator can incorporate these

topics into the nursing curriculum and an example of this would be to have the student present

information of a unit’s quality metrics at a post conference session. This would tie the proper

technique with the reasons why it is important to the overall wellbeing of the organization

financial health and the patient’s health. As nurses educators prepare students for the work world

intergration of CMS, and ANA guidelines are important and should help guide the educational

material used in preparing the students.

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References

American Nurses Association. (n.d.). ANA CAUTI Prevention Tool. Retrieved from

http://nursingworld.org/ANA-CAUTI-Prevention-Tool

Billings, D. M., & Halstead, J. A. (2012). Teaching in Nursing (4th ed.). St. Louis, Missouri:

Elsevier Saunders.

Center for Disease Control and Prevention. (2015). Catheter-associated Urinary Tract Infections

(CAUTI). Retrieved from http://www.cdc.gov/HAI/ca_uti/uti.html

Centers for Medicare & Medicaid Services. (n.d.). Quality of Care Patient Safety. Retrieved from

http://www.medicaid.gov/medicaid-chip-program-information/by-topics/quality-of-

care/quality-of-care-patient-safety.html