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Nursing Quality

For more than 100 years, the American Nurses Association (ANA) has worked to improve patient safety by promoting quality in nursing care and nurses’ work lives. ANA advocates for nursing quality through quality measurement, research collaborative learning, and using quality data to change practice. On this page, you will find an overview of ANA’s work on nursing quality and useful related resources, including:

  • Quality organizations;
  • Collaborative activity;
  • Research and measurement;
  • Advocacy; and
  • Education on quality.

Examples of ANA’s efforts to improve patient safety using quality data include translating traditional quality measurements into eMeasures, and the development of a streamlined tool to prevent catheter-associated urinary tract infections (CAUTIs).

Quality organizations

Many government agencies and nonprofit or educational organizations are working to promote patient safety by improving health care quality.

List of organizations

Agency for Healthcare Research and Quality

Agency for Healthcare Research and Quality's (AHRQ) mission is to improve the quality, safety, efficiency, and effectiveness of health care for all Americans. An agency within the Department of Health and Human Services, AHRQ supports research that improves the quality of healthcare services.

ANCC Magnet Recognition Program ®

The Magnet Recognition Program designates organizations worldwide where nursing leaders successfully align their nursing strategic goals to improve the organization’s patient outcomes. Magnet provides a roadmap to nursing excellence, which benefits the whole of an organization.

Centers for Medicare and Medicaid Services

Centers for Medicare and Medicaid Services (CMS)is a branch of the U.S. Department of Health and Human Services. CMS is the federal agency that administers the Medicare program and monitors the Medicaid programs offered by each state.

Hospital Compare

Hospital Compare, a project of the Hospital Quality Alliance (HQA), is a web tool developed to publicly report credible and user-friendly information about the quality of care delivered in the nation's hospitals. Hospital Compare enables healthcare providers and patients to compare the quality of care provided in the hospitals that agree to submit data. This quality information helps patients make good decisions about care and encourages hospitals to improve the quality care they provide.

Hospital Quality Alliance

Hospital Quality Alliance (HQA)is a public-private collaboration committed to making meaningful, relevant, and easily understood information about hospital performance accessible to the public and to informing and encouraging efforts to improve quality. ANA is an HQA Principal. We participate in HQA subgroups focused on improving Hospital Compare by including nurse-sensitive measures; revising the Hospital Compare display, and expanding membership.

Institute for Healthcare Improvement

Institute for Healthcare Improvement (IHI)is a nonprofit organization focused on motivating and building the will for change, partnering with patients and healthcare professionals to test new models of care, and ensuring the broadest adoption of best practices and effective innovations.

National Coordinating Council for Medication Error Reporting and Prevention

National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP)is an independent body comprised of 27 national organizations, including ANA, cooperating to address the interdisciplinary causes of errors and to promote the safe use of medications.

National Quality Forum

National Quality Forum (NQF) is a nonprofit organization with a three-part mission to improve the quality of American health care: building consensus on national priorities and goals for performance; endorsing national consensus standards for measuring and reporting on performance, and promoting the attainment of national goals through education programs.

Nursing Alliance for Quality Care

Nursing Alliance for Quality Care (NAQC)is a partnership among the nation’s leading nursing organizations (including ANA), consumers, and other stakeholders to advance the highest quality safety and the value of consumer-centered health care for patients, their families, and their communities.

Physician Consortium for Performance Improvement

The American Medical Association (AMA)-convened Physician Consortium for Performance Improvement® (PCPI) is committed to enhancing the quality of care and patient safety by taking the lead in the development, testing, and maintenance of evidence-based clinical performance measures and measurement resources for physicians. ANA is a healthcare professional organization member of PCPI.

The Joint Commission

The Joint Commission accredits thousands of health care organizations and programs nationwide. The Joint Commission focuses on making sure facilities provide quality care and uphold high standards of patient safety. The accreditation is a well-known symbol of quality, awarded by a Board of Commissioners, which includes 29 members with diverse experience in medicine, business, and policy.

Activities

  • National Quality Organization Endorses Performance Measures Used by ANA to Assess Nursing Care in Hospitals (3/5/13)  
  • Steering Committee and Technical Advisory Panel Nominations
  • Nursing Feedback on New Measure Sets

    ANA regularly provides comment with input from the greater nursing community on measures under consideration for endorsement. Staff monitors the work of the Steering Committees and TAPS. ANA meets quarterly with representatives of the NQF Nursing Organizational Members and more frequently with those of the American Academy of Nursing to develop strategies to increase nursing visibility in the work of the greater quality enterprise.

    The process for soliciting input on measures/standards is as follows:

    1. A call for comments is received
    2. Staff disseminates the call to:
      • ANA Board of Directors
      • CMAs
      • Organizational Affiliates
      • AAN Expert Panel on Quality
      • Selected Reviewers
    3. Comments received are synthesized by staff
    4. Formal comments are reviewed and signed by the ANA President and CEO
    5. Staff advances the comments on behalf of ANA
  • Hospital Compare
    The goal of Hospital Quality Alliance (HQA) is to identify a robust set of standardized and easy-to-understand hospital quality measures. An important element of the collaboration, Hospital Compare, is a website/web-tool developed to publicly report credible and user-friendly information about the quality of care delivered in the nation's hospitals. HQA facilitates continuous improvement in patient care through:
    • Implementing measures that portray the quality, cost and value of hospital care;
    • Developing and using measure reporting in the nation’s hospitals; and
    • Sharing useful hospital performance information with the public.
    ANA is an HQA Principal and actively participates in a number of HQA subgroups focused on the inclusion of additional measures into Hospital Compare, including the nurse-sensitive measures; revision of the Hospital Compare display; and, membership expansion.

Research & Measurement

Through research and measurement, ANA is proving the direct impact of nursing quality and patient care and encouraging policymakers to take action.

Research projects have explored the relationship between nurse staffing and outcomes of patient care, leading to insight that health care centers use to make informed staffing decisions and improve patient outcomes. 

Nurse Quality Research Studies

The National Database of Nursing Quality Indicators® (NDNQI®), a Press Ganey solution, has research efforts that cover several directions. First and foremost is the generation of new knowledge regarding the relationship between nurse staffing and nursing practice and outcomes of patient care. Secondly, NDNQI® is committed to allowing reputable researchers to engage in research using certain aspects of the database. These researchers’ projects must contribute to the nursing knowledge base. Thirdly, NDNQI® evaluates existing “nursing-sensitive” indicators for their utility and validity for nursing. In addition, nursing-sensitive indicators are developed, pilot tested and implemented by NDNQI®.

The Economic Contributions of Nursing Care

The economic aspects of healthcare are a major national issue. In 2005, health care consumed 15% of the Gross National Product (GNP), which reflects continuing growth of healthcare consumption. ANA works with independent researchers and contracts with organizations to develop a portfolio of research in this area.

Literature Reviews

  • Relationship Between Nurse Staffing and Patient Outcomes 
    An extensive review of the empirical literature regarding the relationship between nurse staffing and patient outcomes was undertaken to ascertain the nature of the body of evidence. Although over 300 studies were identified, only 61 had quantified measures of nurse staffing and patient outcomes. The review found that research designs, indicator definitions, variety of indicators used, and sample size varied greatly among the studies. To ascertain the value of the 61studies with consistent findings, further evaluation of the individual studies is needed. The studies must be reviewed for the appropriateness of research methods, indicator definitions, risk adjustment, and all aspects of statistical analyses. Understanding the implications of design and analyses decisions should help to advance research in the area of nurse staffing and patient outcomes. (Unpublished as of July, 2004).
  • Patient Classification Systems 
    An extensive review of the literature was done to determine the state of the science on patient classification systems. The literature demonstrated that a myriad of approaches were taken. The most literature came from Europe where systems focusing on the nursing burden each patient presented were the core of the assessments. Most studies were case studies or limited to one or two facilities. Many articles contained sparse details on the approach used to test the systems. This research approach severely limited the generalizability of any of the studies. (Unpublished as of July, 2004).

Research Studies by ANA

ANA has conducted several data based studies (1997, 2000), as well as, several literature reviews (patient classification systems, relationship between nurse staffing and patient outcomes, etc.). The conduct of empirical studies is based upon the needs of the Association as related to emerging nursing issues. Literature reviews are conducted when the Association needs a better understanding of the extent of an issue, the breadth of opinion on an issue and/or the state of science in an area. Much of this research is conducted to support policy development.

Related resources

  • Research Toolkit. The online Research Toolkit will help you understand how to do research and provide evidence-based care. The Toolkit provides access to numerous resources to translate evidence into practice and to support nurse researchers.
  • The Impact of Nursing Care on Quality

Advocacy

Advocacy is a vital tool for ANA to protect patient safety and improve nurse quality. By creating dedicated initiatives that raise awareness both among legislators and the general public, ANA is able to encourage legislation on important issues such as safe patient handling and patients' rights. 

Education on Quality

ANA empowers nurses to improve patient outcomes, through continuing education on nursing quality. With on-demand and live webinars, conferences, books, collaborative learning, and more; nurses will find the style of leaning to suit them.

ANA's Continuing Education (CE) provides easy access to online courses on the topic of quality. ANA members and non-members can enroll in CE quality courses; ANA members pay a discounted tuition fee.

For over 100 years, ANA has worked to improve patient safety by promoting quality in nursing care

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