Nursing Care Quality at NQF

New! Nurses, as the principal caregivers in any healthcare system, directly and profoundly affect the lives of patients and are critical to the quality of care patients receive.  However, patient acuity and shorter lengths of stay, the nursing shortage, changing technology, expansion of public and community health services, and higher patient expectations have produced a greater demand for care, mounted financial pressure, and limited nursing resources.  Today’s nurses practice in a constrained environment that tests the core of their contribution to quality.

NQF is leading an effort to understand more fully the extent to which nurses contribute to improved patient safety and healthcare outcomes and promote nursing care quality.  This site provides an overview of NQF activities in this area and supports a growing community of stakeholders—including healthcare professionals, researchers, consumers, public and private purchasers, employers, health plans, accrediting bodies, labor organizations, and organizations involved in healthcare research or quality improvement—that are interested in collaborating in this endeavor.

NQF-endorsed™ National Voluntary Consensus Standards for Nursing-Sensitive Care  

Recognizing nurses’ contribution to patient safety and quality outcomes, NQF embarked on the ‘Nursing Care Performance Measures’ project in February 2003 to: 

  • identify a framework for how to measure nursing care performance, with particular attention to the performance of nurses as teams and their contributions to the overall healthcare team;
  • endorse a set of voluntary consensus standards for evaluating the quality of nursing care (including designating consensus standards that are appropriate for public reporting); and
  • identify and prioritize unresolved issues regarding nursing care performance measurement and research needs. 

This project, known as the ‘Nursing Care Performance Measures’ project, resulted in 15 NQF-endorsedTM consensus standards for nursing-sensitive care.  As “nursing-sensitive,” these consensus standards include measures of processes and outcomes—and structural proxies for these processes and outcomes (e.g., skill mix, nurse staffing hours)—that are affected, provided, and/or influenced by nursing personnel—but for which nursing is not exclusively responsible. 

These consensus standards are intended for use by the public and other healthcare stakeholders to evaluate the extent to and ways in which nurses in acute care hospitals contribute to patient safety, healthcare quality, and a professional work environment.

A report of this consensus project was published in 2004, describing the 15 NQF-endorsed voluntary consensus standards for nursing-sensitive care and the process that lead to their endorsement.

View the rosters of the project’s Steering Committee and Technical Advisory Panel (TAP), that were convened to make recommendations to NQF Members in this area. 

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Do you or do you plan to implement the NQF-endorsed consensus standards for nursing-sensitive care? 

If so, please share your experience with NQF.

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NQF Statement on ‘Nurses Educational Preparation’ as a Determinant of Quality.

NQF recognizes the contribution of nurses to patient safety and healthcare outcomes.  While measurable outcomes have been associated with higher levels of education* it is difficult to determine the extent that variations in earnings, perception of health, smoking rates, voting patterns, and other outcomes  are solely attributable to education and how much to other factors.  This is no exception when it comes to the conceptual basis for the education-quality relationship among nurses.  During consensus development, NQF considered the extent that nurses with bachelor of science in nursing (BSNs) or higher degrees contribute to improved healthcare.  At the time of consideration, NQF did not endorse it because of the limited (albeit emerging) evidence base linking it as an independent variable to patient outcomes.  However, in an effort to support the potential relationship between nursing educational preparation and quality healthcare, NQF sought the advice of key stakeholders and drafted a paper that summarizes the evidence on this topic.  Nurses’ Educational Preparation and Patient Outcomes in Acute Care:  A Case for Quality* summarizes the current research in this area, creates a context for NQF’s associated research and data system recommendations, and articulates the significant effects of nursing education on outcomes and patient safety.  

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Tracking the Implementation of the NQF-endorsed™  Consensus Standards

Since NQF’s endorsement, the nursing-sensitive consensus standards have been used by many organizations in a variety of ways.  To understand more fully the penetration and diffusion of these consensus standards, to identify the successes and challenges experienced by users of them (including factors that influence the voluntary collection and reporting of them), and to identify technical issues that are barriers to uniform implementation, NQF has received support from the Robert Wood Johnson Foundation to track the implementation of its endorsed consensus standards for nursing-sensitive care.

Patient-centered Outcome Measures:

  1. Death among surgical inpatients with treatable serious complications (failure to rescue): The percentage of major surgical inpatients who experience a hospital-acquired complication and die.
  2. Pressure ulcer prevalence: Percentage of inpatients who have a hospital acquired pressure ulcer.
  3. Falls prevalence: Number of inpatient falls per inpatient days.
  4. Falls with injury: Number of inpatient falls with injuries per inpatient days.
  5. Restraint prevalence: Percentage of inpatients who have a vest or limb restraint.
  6. Urinary catheter-associated urinary tract infection for intensive care unit (ICU) patients: Rate of urinary track infections associated with use of urinary catheters for ICU patients.
  7. Central line catheter-associated blood stream infection rate for ICU and high-risk nursery patients: Rate of blood stream infections associated with use of central line catheters for ICU and high-risk nursery patients.
  8. Ventilator-associated pneumonia for ICU and high-risk nursery patients: Rate of pneumonia associated with use of ventilators for ICU and high-risk nursery patients.

Nursing-centered Intervention Measures:

  1. Smoking cessation counseling for acute myocardial infarction.
  2. Smoking cessation counseling for heart failure.
  3. Smoking cessation counseling for pneumonia.

Each measures the percentage of patients with a history of smoking within the past year who received smoking cessation advice or counseling during hospitalization.

System-centered Measures:

  1. Skill mix: Percentage of registered nurse, licensed vocational/practical nurse, unlicensed assistive personnel, and contracted nurse care hours to total nursing care hours.
  2. Nursing care hours per patient day: Number of registered nurses per patient day and number of nursing staff hours (registered nurse, licensed vocational/practical nurse, and unlicensed assistive personnel) per patient day.
  3. Practice Environment Scale ― Nursing Work Index: Composite score and scores for five subscales: (1) nurse participation in hospital affairs; (2) nursing foundations for quality of care; (3) nurse manager ability, leadership and support of nurses; (4) staffing and resource adequacy; and (5) collegiality of nurse-physician relations.
  4. Voluntary turnover: Number of voluntary uncontrolled separations during the month by category (RNs, APNs, LVN/LPNs, NAs).
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Other Activities and Relevant Links

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Robert Wood Johnson Foundation Logo

This project is supported by a grant from
the Robert Wood Johnson Foundation.