The Jigsaw Teaching Strategy: Maximizing Opportunities for Students to Explore QSEN Competencies Across Clinical Sites

Submitter Information

Author: David Foley, PhD, MSN, RN-BC, MPA
Title: Assistant Professor and Director of Faculty Development
Institution: Case Western Reserve University Frances Payne Bolton School of Nursing

Competency Category(s)
Evidence-Based Practice, Patient-Centered Care, Quality Improvement, Teamwork and Collaboration

Learner Level(s)
Pre-Licensure ADN/Diploma, Pre-Licensure BSN

Learner Setting(s)
Clinical Setting

Strategy Type
General Strategy

Learning Objectives

Through participation in this Jigsaw Clinical Exercise the student will individually and collectively:
• Identify QSEN competencies observed within their assigned clinical settings and provide example(s) of each
• During post-conference discussions, use systems thinking to identify themes and patterns in QSEN competencies across clinical sites, especially in terms of patient-centered care, evidence-based practice, safety, and quality improvement
• Affirm the importance of teamwork and collaboration in these robust post-conference discussions

Strategy Overview

Strategy Overview: A typical early-intermediate didactic nursing course is divided into clinical groups of approximately 6-8 students, with each clinical group typically assigned to a specific clinical location or unit within each location. Although students are often assigned to only one clinical unit during their clinical experience, opportunities to rotate students to other units for direct patient care or observational experiences are often available. As the opportunity arises, each clinical group, or individual member(s) of a clinical group, are assigned 1-2 QSEN competencies and asked to note examples of that competency during their clinical experience. Alternatively, students may also be asked to gather examples of unit policies or related performance improvement initiatives that highlight any QSEN competency. Each clinical group or individual student(s) must gather information related to their QSEN competencies and related policies and be prepared to discuss it with their classmates during post-conference discussion.

This pedagogical tool, known as a Jigsaw Learning Strategy, places great emphasis on cooperation and shared responsibility within groups and thus illustrates a valuable opportunity for teamwork and collaboration. As the success of each group depends on the participation of each individual in completing their task, nursing faculty must provide very clear instructions and swift feedback throughout the clinical day in order for the Jigsaw Learning Strategy to be executed effectively.

The Jigsaw Learning Strategy for students assigned within the same unit at the clinical location: Clinical faculty assign each student 1 or more QSEN competencies as an area of focus for the day’s activities. Students note evidence of the competency through passive observation, discussion with other nurses, participation in interdisciplinary meetings, and by researching the unit’s policies, if available. Students reconvene for post conference and present their findings to the group. At the conclusion of the post conference, a number of QSEN competencies have been reviewed from the perspective of several students as well as the culture of their clinical units, thus leveraging opportunities for learning. Over the course of several weeks, the QSEN competencies can be rotated between students and after several weeks a complex mosaic of student observations and perspectives has been reviewed.

Students dispersed to various clinical units at the same clinical location: (note: appropriate permission should be sought per established guidelines for clinical placement as agreed upon by the clinical site and the school of nursing). Clinical faculty assign each student 1-2 QSEN competencies as an area of focus for the semester’s. Students note evidence of the competency(ies) through passive observation, discussion with other nurses, participation in interdisciplinary meetings, and by researching the unit’s policies, if available. Over the course of several weeks, each student will rotate through the various units and become the clinical group’s ‘expert’ on that QSEN competency. Over the course of the semester an in-depth review of the clinical site’s mastery—or opportunities for improvement—on a QSEN competency will be achieved.

• As with any assigned clinical activity, the Jigsaw learning strategy is planned in accordance with the clinical day’s goals, reviewed carefully at the clinical day’s preconference, and monitored by clinical faculty throughout the day.
o Students are required to document on the Jigsaw Learning Form, review their findings with their peers, and submit to faculty for focused review at the end of the clinical day.
o Faculty reviews the form for effective documentation of QSEN competencies and then returns to students, who will retain them for additional analysis at future clinical pre-/post-conferences or for discussion in the didactic classroom.
o If possible, and with permission of students, faculty may post the collection of student observations in an approved location within the clinical site to spur interest in the QSEN competencies among staff.

A Jigsaw Meta-Analysis of QSEN Competencies
Toward the end of the semester, the didactic instructor can leverage the opportunity of having students from all clinical groups in the same classroom by having representatives from each clinical site present their observations on individual QSEN competencies. Starting with Safety, a representative from each clinical group can be asked to present a brief overview of the clinical site and findings related to that QSEN competency to the class. Students can write their findings in bulleted format on flip-charts then affix them to a classroom wall, if possible. The result is an impressive, although literal, representation of the Jigsaw teaching strategy. Students have been known to photograph the collage with their cell phones for future reference. For larger classes, a discussion board within the course’s learning management system can be created with a section for each QSEN competency.
Jigsaw Learning is an example of a teaching strategy that promotes dynamic, meaningful clinical pre- and post-conference discussions. Reactions from students, clinical instructors, and clinical site staff has been quite favorable. Given today’s healthcare climate where safety, quality improvement, teamwork and collaboration, and other QSEN competencies lend themselves to the Magnet Status healthcare workplace. Feedback from floor nursing staff has especially been overwhelmingly positive. In fact, a number of the floor staff, especially from clinical sites espousing a shared governance model, have asked to attend post-conferences to learn more about the QSEN Competencies. Students have been overwhelmingly favorable in their response, especially given their strong preference for immediate application of didactic classroom knowledge.
Following the clinical day, students are asked to reflect and submit their written reflection to faculty using the Critical Reflection Journal Template. This document asks students to relate their experience identifying QSEN strategies as related to one of the course objectives, classroom content, their daily goal, and future nursing practice. These reflective journals provide students with a suitable outlet to communicate their concerns to faculty, who can in turn provide constructive feedback and guidance.


With careful planning and supervision, the Jigsaw Teaching Method can be applied to nursing clinicals as a means to maximize students’ opportunities to individually and collectively identify and analyze QSEN competencies across settings. Post conference discussions allow students the opportunity to collectively share what they learned individually and thus magnify the learning potential of each clinical day.

Submitted Materials


Additional Materials

Evaluation Description

1). Critical Reflection Journal
2). Informal feedback from students and floor staff
3). Review of artifacts (i.e. policies) retrieved by students