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I recently designed a quality improvement (QI) program for my facility, but staff nurses complain they are too busy. How can I get staff nurses involved and interested in the process of improvement?


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 It is critical that nurses at the bedside are engaged in QI, carrying out the bundles, protocols, and other processes designed to improve quality and safety. Yet getting direct-care nurses involved in QI is difficult in many hospitals, as bedside nurses complain they are already too busy, they do not have enough staff members to carry out complex QI processes, or they do not feel QI is in the scope of the nursing practice.

To engage direct-care nurses, nurse leaders need to follow four basic rules:

  • Be transparent with your staff at all times. Information and knowledge are crucial to staff engagement, strong performance and efficiency, and in meeting the strategic goals of the healthcare institution. Nurse managers should share information on operating and capital budgets, market share, and labor costs, strategic goals for their institution, and performance on key clinical and business metrics.
  • Make accountability for improvement at the unit and staff nurse levels. Leaders must establish a culture that reinforces that QI is not some other department’s responsibility, but rather is every nurse’s job. Strategies may include surveying unit nurses, creating unit QI councils, or defining accountability for quality outcomes in the yearly performance appraisals of staff members.
  • Give your staff the tools to succeed. Bedside staff nurses will not become engaged In QI unless nurse leaders educate them on the basic pieces of QI. QI and quality management information must be basic, geared toward nursing, and reinforced with practical examples.
  • Reward and recognize improvement. One of the easiest ways to engage staff members in QI is positive reinforcement through reward and recognition of their efforts. Publicize all QI projects and outcomes, or encourage a friendly competition between units and reward with food, small gifts, etc.


Cynthia Barnard, MBA, MSJS, CPHQ


(September 2010)