Graduate QSEN Competencies

Click here for the AACN 2012 updated Graduate level Competencies


The overall goal for the Quality and Safety Education for Nurses (QSEN) project is to meet the challenge of preparing future nurses who will have the knowledge, skills and attitudes (KSAs) necessary to continuously improve the quality and safety of the healthcare systems within which they work.

Using the Institute of Medicine 1 competencies, QSEN faculty, a National Advisory Board, and 17 representatives from 11 professional organizations representing advanced nursing practice defined quality and safety competencies for nursing and proposed targets for the knowledge, skills, and attitudes to be developed in nursing graduate programs for each competency. These definitions are shared in the six tables below as a resource to serve as guides to curricular development for formal academic graduate programs and for use as criteria for certification and continuing education of advanced practice nurses 2.

For information on applying the competencies at a prelicensure level, see the Prelicensure KSAs page.

Note: This content is reprinted with permission from the “Quality and Safety Education for Nurses” article originally printed in Nursing Outlook Special Issue: Quality and Safety Education. For guidelines on use of this material, please read our terms and conditions.


Patient-centered Care

Definition: Recognize the patient or designee as the source of control and full partner in providing compassionate and coordinated care based on respect for patient’s preferences, values, and needs.
Knowledge Skills Attitudes

Analyze multiple dimensions of patient-centered care:
• patient/family/community preferences, values
• coordination and integration of care
• information, communication, and education
• physical comfort and emotional support
• involvement of family and friends
• transition and continuity

Analyze how diverse cultural, ethnic, spiritual and social backgrounds function as sources of patient, family, and community values

Analyze social, political, economic, and historical dimensions of patient care processes and the implications for patient-centered careIntegrate knowledge of psychological, spiritual, social, developmental and physiological models of pain and suffering

Elicit patient values, preferences and expressed needs as part of clinical interview, diagnosis, implementation of care plan and evaluation of care

Communicate patient values, preferences and expressed needs to other members of health care team

Provide patient-centered care with sensitivity, empathy, and respect for the diversity of human experience


Ensure that the systems within which one practices support patient-centered care for individuals and groups whose values differ from the majority or one’s own.

Assess and treat pain and suffering in light of patient values, preferences, and expressed needs

Value seeing health care situations ‘through patients’ eyes’

Respect and encourage individual expression of patient values, preferences and expressed needs

Value the patient’s expertise with own health and symptoms


Honor learning opportunities with patients who represent all aspects of human diversity

Seek to understand one’s personally held attitudes about working with patients from different ethnic, cultural and social backgrounds

Willingly support patient-centered care for individuals and groups whose values differ from own

Value cultural humility

Seek to understand one’s personally held values and beliefs about the management of pain or suffering

Analyze ethical and legal implications of patient-centered care

Describe the limits and boundaries of therapeutic patient-centered care

Respect the boundaries of therapeutic relationships

Acknowledge the tension that may exist between patient preferences and organizational and professional responsibilities for ethical careFacilitate informed patient consent for care

Value shared decision-making with empowered patients and families, even when conflicts occur

Analyze strategies that empower patients or families in all aspects of the health care process

Analyze features of physical facilities that support or pose barriers to patient-centered care

Analyze reasons for common barriers to active involvement of patients and families in their own health care processes

Engage patients or designated surrogates in active partnerships along the health illness continuum

Create or change organizational cultures so that patient and family preferences are assessed and supported

Assess level of patient’s decisional conflict and provide access to resources


Eliminate barriers to presence of families and other designated surrogates based on patient preferences

Respect patient preferences for degree of active engagement in care processHonor active partnerships with patients or designated surrogates in planning, implementation, and evaluation of care

Respect patient’s right to access to personal health records


Value system changes that support patient-centered care

Integrate principles of effective communication with knowledge of quality and safety competenciesAnalyze principles of consensus building and conflict resolution

Analyze advanced practice nursing roles in assuring coordination, integration, and continuity of care


Describe process of reflective practice

Continuously analyze and improve own level of communication skill in encounters with patients, families, and teams

Provide leadership in building consensus or resolving conflict in the context of patient care

Communicate care provided and needed at each transition in care


Incorporate reflective practices into own repertoire

Value continuous improvement of own communication and conflict resolution skills

Value consensus

Value the process of reflective practice



Definition: Function effectively within nursing and inter-professional teams, fostering open communication, mutual respect, and shared decision-making to achieve quality patient care.
Knowledge Skills Attitudes

Analyze own strengths, limitations, and values as a member of a team

Analyze impact of own advanced practice role and its contributions to team functioning

Demonstrate awareness of own strengths and limitations as a team member

Continuously plan for improvement in use of self in effective team development and functioning

Act with integrity, consistency, and respect for differing views

Acknowledge own contributions to effective or ineffective team functioning

Describe scopes of practice and roles of all health care team members

Analyze strategies for identifying and managing overlaps in team member roles and accountabilities

Function competently within own scope of practice as a member of the health care team

Assume role of team member or leader based on the situation

Guide the team in managing areas of overlap in team member functioning


Solicit input from other team members to improve individual, as well as team, performance

Empower contributions of others who play a role in helping patients/families achieve health goals

Respect the unique attributes that members bring to a team, including variation in professional orientations, competencies and accountabilities

Respect the centrality of the patient/family as core members of any health care team

Analyze strategies that influence the ability to initiate and sustain effective partnerships with members of nursing and inter-professional teams

Analyze impact of cultural diversity on team functioning

Initiate and sustain effective health care teams

Communicate with team members, adapting own style of communicating to needs of the team and situation

Appreciate importance of inter-professional collaboration

Value collaboration with nurses and other members of the nursing team

Analyze differences in communication style preferences among patients and families, advanced practice nurses and other members of the health team

Describe impact of own communication style on others

Communicate respect for team member competence in communicationInitiate actions to resolve conflict Value different styles of communication

Describe examples of the impact of team functioning on safety and quality of care

Analyze authority gradients and their influence on teamwork and patient safety

Follow communication practices that minimize risks associated with handoffs among providers, and across transitions in care

Choose communication styles that diminish the risks associated with authority gradients among team members

Assert own position/perspective and supporting evidence in discussions about patient care

Appreciate the risks associated with handoffs among providers and across transitions in careValue the solutions obtained through systematic, inter-professional collaborative efforts

Identify system barriers and facilitators of effective team functioning

Examine strategies for improving systems to support team functioning

Lead or participate in the design and implementation of systems that support effective teamworkEngage in state and national policy initiatives aimed at improving teamwork and collaboration Value the influence of system solutions in achieving team functioning


Definition: Integrate best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health care.
Knowledge Skills Attitudes

Demonstrate knowledge of health research methods and processes

Describe evidence-based practice to include the components of research evidence, clinical expertise and patient/family values

Use health research methods and processes, alone or in partnership with scientists, to generate new knowledge for practice

Adhere to Institutional Review Board guidelinesRole model clinical decision making based on evidence, clinical expertise and patient/family preferences and values

Appreciate strengths and weaknesses of scientific bases for practice

Value the need for ethical conduct of research and quality improvement

Value all components of evidence-based practice

Identify efficient and effective search strategies to locate reliable sources of evidence Employ efficient and effective search strategies to answer focused clinical questions Value development of search skills for locating evidence for best practice

Identify principles that comprise the critical appraisal of research evidence

Summarize current evidence regarding major diagnostic and treatment actions within the practice specialty

Determine evidence gaps within the practice specialty

Critically appraise original research and evidence summaries related to area of practice

Exhibit contemporary knowledge of best evidence related to practice specialtyPromote research agenda for evidence that is needed in practice specialty


Initiate changes in approaches to care when new evidence warrants evaluation of other options for improving outcomes or decreasing adverse events

Value knowing the evidence base for practice specialty

Value public policies that support evidence-based practice

Analyze how the strength of available evidence influences the provision of care (assessment, diagnosis, treatment, and evaluation)Evaluate organizational cultures and structures that promote evidence-based practice

Develop guidelines for clinical decision making regarding departure from established protocols/standards of care

Participate in designing systems that support evidence-based practice

Acknowledge own limitations in knowledge and clinical expertise before determining when to deviate from evidence-based best practices

Value the need for continuous improvement in clinical practice based on new knowledge



Definition: Use data to monitor the outcomes of care processes and use improvement methods to design and test changes to continuously improve the quality and safety of health care systems.
Knowledge Skills Attitudes

Describe strategies for improving outcomes of care in the setting in which one is engaged in clinical practice

Analyze the impact of context (such as access, cost or team functioning) on improvement efforts

Use a variety of sources of information to review outcomes of care and identify potential areas for improvement

Propose appropriate aims for quality improvement effortsAssert leadership in shaping the dialogue about and providing leadership for the introduction of best practices

Appreciate that continuous quality improvement is an essential part of the daily work of all health professionals

Analyze ethical issues associated with quality improvement

Describe features of quality improvement projects that overlap sufficiently with research, thereby requiring IRB oversight

Assure ethical oversight of quality improvement projects

Maintain confidentiality of any patient information used to determine outcomes of quality improvement efforts

Value the need for ethical conduct of quality improvement
Describe the benefits and limitations of quality improvement data sources, and measurement and data analysis strategies

Design and use databases as sources of information for improving patient care

Select and use relevant benchmarks

Appreciate the importance of data that allows one to estimate the quality of local care
Explain common causes of variation in outcomes of care in the practice specialty Select and use tools (such as control charts and run charts) that are helpful for understanding variationIdentify gaps between local and best practice Appreciate how unwanted variation affects outcomes of care processes
Describe common quality measures in the practice specialty

Use findings from root cause analyses to design and implement system improvements

Select and use quality measures to understand performance

Value measurement and its role in good patient care

Analyze the differences between micro-system and macro-system change

Understand principles of change management

Analyze the strengths and limitations of common quality improvement methods

Use principles of change management to implement and evaluate care processes at the micro-system level

Design, implement and evaluate tests of change in daily work (using an experiential learning method such as Plan-Do-Study-Act)Align the aims, measures, and changes involved in improving care


Use measures to evaluate the effect of change

Appreciate the value of what individuals and teams can to do to improve care

Value local systems improvement (in individual practice, team practice on a unit, or in the macro-system) and its role in professional job satisfaction

Appreciate that all improvement is change but not all change is improvement



Definition: Minimizes risk of harm to patients and providers through both system effectiveness and individual performance.
Knowledge Skills Attitudes

Describe human factors and other basic safety design principles, as well as commonly used unsafe practices (such as workarounds and dangerous abbreviations)

Describe the benefits and limitations of selected safety-enhancing technologies (such as barcodes, Computer Provider Order Entry, and electronic prescribing)

Evaluate effective strategies to reduce reliance on memory

Participate as a team member to design, promote and model effective use of technology and standardized practices that support safety and quality

Participate as a team member to design, promote, and model effective use of strategies to reduce risk of harm to self and others.

Promote a practice culture conducive to highly reliable processes built on human factors research


Use appropriate strategies to reduce reliance on memory (such as forcing functions, checklists)

Value the contributions of standardization and reliability to safety

Appreciate the importance of being a safety mentor and role model

Appreciate the cognitive and physical limits of human performance

Delineate general categories of errors and hazards in care

Identify best practices for organizational responses to errorDescribe factors that create a just culture and culture of safety


Describe best practices that promote patient and provider safety in the practice specialty

Communicate observations or concerns related to hazards and errors to patients, families, and the health care team.

Identify and correct system failures and hazards in care

Design and implement micro-system changes in response to identified hazards and errors


Engage in a systems focus rather than blaming individuals when errors or near misses occur

Report errors and support members of the healthcare team to be forthcoming about errors and near misses

Value own role in reporting and preventing errors

Value systems approaches to improving patient safety in lieu of blaming individuals

Value the use of organizational error reporting systems

Describe processes used to analyze causes of error and allocation of responsibility and accountability (such as root cause analysis and failure mode effects analysis) Participate appropriately in analyzing errors and designing, implementing and evaluating system improvements Value vigilance and monitoring of care, including one’s own performance, by patients, families and other members of the health care team
Describe methods of identifying and preventing verbal, physical and psychological harm to patients and staff Prevent escalation of conflictRespond appropriately to aggressive behavior Value prevention of assaults and loss of dignity for patients, staff, and aggressors
Analyze potential and actual impact of national patient safety resources, initiatives and regulations Use national patient safety resources:
• for own professional development
• to focus attention on safety in care settings
• to design and implement improvements in practice
Value relationship between national patient safety campaigns and implementation in local practices and practice settings


Definition: Use information and technology to communicate, manage knowledge, mitigate error, and support decision making.
Knowledge Skills Attitudes

Contrast benefits and limitations of common information technology strategies used in the delivery of patient care

Evaluate the strengths and weaknesses of information systems used in patient care

Participate in the selection, design, implementation, and evaluation of information systems

Communicate the integral role of information technology in nurses’ work

Model behaviors that support implementation and appropriate use of electronic health records


Assist team members to adopt information technology by piloting and evaluating proposed technologies

Value the use of information and communication technologies in patient care

Formulate essential information that must be available in a common database to support patient care in the practice specialty

Evaluate benefits and limitations of different communication technologies and their impact on safety and quality

Promote access to patient care information for all professionals who provide care to patients

Serve as a resource for how to document nursing care at basic and advanced levels

Develop safeguards for protected health information


Champion communication technologies that support clinical decision-making, error prevention, care coordination, and protection of patient privacy

Appreciate the need for consensus and collaboration in developing systems to manage information for patient careValue the confidentiality and security of all patient records
Describe and critique taxonomic and terminology systems used in national efforts to enhance interoperability of information systems and knowledge management systems

Access and evaluate high-quality electronic sources of healthcare information

Participate in the design of clinical decision-making supports and alertsSearch, retrieve, and manage data to make decisions using information and knowledge management systems


Anticipate unintended consequences of new technology

Value the importance of standardized terminologies in conducting searches for patient information

Appreciate the contribution of technological alert systems

Appreciate the time, effort, and skill required for computers, databases, and other technologies to become reliable and effective tools for patient care



1 Institute of Medicine. Health professions education: A bridge to quality. Washington DC: National Academies Press; 2003.

2 Cronenwett, L., Sherwood, G., Pohl, J., Barnsteiner, J., Moore, S., Sullivan, D., Ward, D., Warren, J. (2009). Quality and safety education for advanced nursing practice. Nursing Outlook 57(6), 338-348.