N108: Transition to the Registered Professional Nurse Role Study Guide hospitals began collecting data on standardized or core performance measures. In 2004, The Joint Commission and the Centers for Medicare and Medicaid Services (CMS) began working together to align measures common to both organizations. These standardized common measures are referred to as Hospital Quality Measures and are integral to improving the quality of care provided to hospital patients and bringing value to stakeholders by focusing on the actual results. 3.5 The RN’s Role in Quality Improvement In the Quality and Safety Education in Nursing (QSEN) competency “safety” dictates that nursing education should emphasize minimizing the risk of harm to patients and providers through both system effectiveness and individual performance. This pre-licensure competency involves understanding designs set in place to prevent errors and how unsafe practices, such as work arounds, endanger patient safety. New RN graduates should be able to describe factors that create a culture of safety in health care and the processes used to understand the causes of error. They must have knowledge of national patient safety resources, initiatives, and regulations. In summary, they should be able to delineate common causes of errors, knowwhat the system can do to prevent errors, identify what they can do as individual nurses to prevent errors, and understand the institutional and national responses to error. Nurses are the largest deliverer of health care in the U.S. and as hospital participation in quality improvement activities increases, so does the role of nursing. Nurses are essential on the front lines of quality improvement because they spend the most time close to the patient and, therefore, are in the best position to affect the care patients receive during a hospital stay. Nurses are at the bedside, real time, catching medication errors, catching patient falls, recognizing when a patient is in need of something, and avoiding failure to rescue. As vital members of the quality improvement team, nurses are able to understand and explain the patient experience and, because they know first-hand how the system works, they know what needs to be changed, what is working well, and how all of it affects patient care. Quality Indicators Related to Nursing Care Nursing Sensitive Quality Improvement Indicators (NDNQI) In 1998, the National Database of Nursing Quality Indicators was established by ANA so that ANA could continue to collect and build on data obtained from earlier studies, and further develop nursing's body of knowledge related to factors which influence the quality of nursing care. More than 2,000 U.S. hospitals and 98% of Magnet recognized facilities participate in the NDNQI program to measure nursing quality, improve nurse satisfaction, strengthen the nursing work environment, assess staffing levels, and improve reimbursement under current pay for performance policies. They monitor relationships between quality indicators and outcomes. Structural indicators include the supply of nursing staff, skill level of nursing staff, and education and certification levels of nursing staff. Methods of patient assessment, nursing interventions, and nursing job satisfaction are process indicators. Outcome indicators reflect patient outcomes that are nursing-sensitive because they depend upon the quantity or quality of nursing care, such as pressure ulcers and falls.