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Hallmarks of Quality and Patient Safety

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Recommended Baccalaureate Competencies and Curricular Guidelines
to Assure High Quality and Safe Patient Care

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Professional nurses play a critical role in protecting patient safety and providing quality health care. In fact, an expert committee formed by the Institute of Medicine (IOM) found that "how we are cared for by nurses affects our health, and sometimes can be a matter of life and death … nurses are indispensable to our safety" (IOM, 2004). This finding has been confirmed by an emerging body of research showing that nurses are much more likely than any other health professional to recognize, interrupt and correct errors that are often life threatening (Rothschild et al., 2006), that higher levels of baccalaureate-prepared nurses in hospital settings reduce mortality and failure to rescue rates (Aiken, et al, 2004), and that inadequate nurse staffing levels may lead to a higher incidence of complications and inadequate care (Aiken et al., 2002, JCAHO, 2002; Needleman et al., 2002).

Calls from the Institute of Medicine, the Robert Wood Johnson Foundation, Agency on Healthcare Research and Quality, and other authorities to address patient safety issues are growing louder and must be addressed by all health disciplines, including nursing. In the report titled Health Professions Education: A Bridge to Quality (2003, p. 1), the IOM found that nurses and other health professionals are not adequately prepared to provide the highest quality and safest care possible. The authors concluded that "education for the health professions is in need of a major overhaul."

In response to the urgent calls to transform health care delivery and better prepare today's nurse for professional practice, the American Association of Colleges of Nursing (AACN) convened a task force on the essential patient safety competencies and charged this group with identifying the essential baccalaureate core competencies that should be achieved by professional nurses to assure high quality and safe patient care. The AACN Board of Directors instructed the task force to consider what knowledge the professional nurse must have related to quality and patient safety, as well as the leadership and communications skills needed to address quality and patient safety issues effectively within the context of an interdisciplinary team. The following competencies are the result of the work of the task force. This preliminary work will continue as the Essentials of Baccalaureate Education for Professional Nursing Practice (AACN, 1998) are revised in 2007. The Patient Safety Task Force recommends that baccalaureate programs begin to evaluate current curricula to determine where these competencies are being taught as well as where opportunities exist for further integration of these competencies into curricula. The following competencies are organized according to selected categories of the conceptual framework used in the Essentials of Baccalaureate Education for Professional Nursing Practice.

Hallmarks of Quality and Patient Safety
in Baccalaureate Nursing Education

Critical Thinking

  • Recognize quality and patient safety as complex issues that involve all health care providers and systems.
  • Apply research-based/evidence-based knowledge from nursing and the sciences as the basis for practice.
  • Employ data to investigate quality and safety issues and develop action plans for improvement.

Health Care Systems and Policy

  • Provide nursing care that contributes to safe and high quality patient outcomes.


  • Establish and maintain effective working relationships and open communication and cooperation within the interdisciplinary team.
  • Use a standardized approach to "hand off" communications including an opportunity to ask and respond to questions (JCAHO, 2006).

Illness and Disease Management

  • Use individual and system performance methods to assess and improve the health care outcomes of individuals and communities.


  • Take action to prevent or limit unsafe or unethical health and nursing care practices by others.
  • Advocate for health care that is sensitive to the needs of patients, with particular emphasis on the needs of vulnerable populations.
  • Negotiate and advocate for high quality and safe patient care as a member of the interdisciplinary health care team.

Information and Healthcare Technologies

  • Evaluate various information and communication technologies and utilize those that are most appropriate to enhance the delivery of patient care and to improve patient outcomes.


Aiken, L.H., Clarke, S.P., Cheung, R.B., Sloane, D.M., & Silber, J.H. (2003, September 24). Educational levels of hospital nurses and surgical patient mortality, Journal of the American Medical Association, 290, 1617-1623.

Aiken, L.H., Clarke, S.P., Cheung, R.B., Sloane, D.M., Sochalski, J. & Silber, J.H. (2002, October 23). Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. Journal of the American Medical Association, 288, 1987-1993.

American Association of Colleges of Nursing. (1998). The essentials of baccalaureate education for professional nursing practice. Washington, DC: Author.

Institute of Medicine. (2004). Keeping patients safe: Transforming the work environment of nurses. Washington, DC: National Academies Press.

Institute of Medicine. (2003). Health professions education: A bridge to quality. Washington, DC: National Academies Press.

Joint Commission on the Accreditation Healthcare Organizations. 2006 National Patient Safety Goals. Retrieved August 25, 2006 from http://www.jcaho.org

Joint Commission on Accreditation of Healthcare Organizations. (2002). Health care at the crossroads, Strategies for addressing the evolving nursing crisis. Chicago: Author.

Needleman, J., Buerhaus, P., Mattke, S., Stewart, M., & Zelevinsky, K. (2002, May 30). Nurse-staffing level and the quality of care in hospitals. The New England Journal of Medicine, 346, 1715-1722.

Rothschild, J.M., Hurley, A.C., Landrigan, C.P., Cronin, J.W., et al. (2006, February). Recovering from medical errors: the critical care nursing safety net. Joint Commission Journal on Quality and Patient Safety, 32(2), 63-72.


Approved by the AACN Board of Directors, September 11, 2006