Nurses are the largest group of health care providers in the U.S., and health care leaders and experts agree that engaging registered nurses in quality improvement efforts is essential to improving our health care system, patient care, and our nation's health.

Despite studies demonstrating the value of nurse-led quality improvement efforts, too few nurses are involved in such efforts, and the number isn't growing, asserts a study published in theJournal of Nursing Care Quality.

The study, part of the larger RN Work Project funded by the Robert Wood Johnson Foundation, compared the participation levels in hospital quality improvement activities for RNs who were first licensed between 2004 and 2005, and RNs first licensed between 2007 and 2008. The research team found little difference in participation levels between the two cohorts for a variety of activities, including performance measurement, working to improve processes or systems of care, monitoring sustainability of improved practices, and efforts at performance improvement. The only exception was use of appropriate strategies to improve hand-washing compliance to reduce hospital-acquired infections.

"We expected to find a greater variation in QI (quality-improvement) participation between the two groups," says Maja Djukic, a registered nurse and assistant professor at the New York University's College of Nursing. "These findings underscore the need for hospitals to collaborate with nursing schools to develop effective strategies to ensure that RNs expect and are prepared to engage in QI activities. Nurses are an important resource in efforts to improve care and patient outcomes, and right now, that resource is too often being underutilized."

The team notes that there has been an increase in the number of hospitals that participate in formal programs aimed at increasing nurses' engagement in quality and safety initiatives since 2008. They expected that trend would increase the likelihood of participation in QI activities for the later cohort. Among those initiatives are Transforming Care at the Bedside, National Database of Nursing Quality Indicators Program, the hospital Magnet Recognition Program, and the Quality and Safety Education for Nurses initiative.

The research team cites several promising programs for engaging staff RNs in QI activities, including the Integrated Nurse Leadership Program in California, and the Bi-State Nursing Workforce Innovation Center's Clinical Scene Investigator Academy in Kansas and Missouri.

It also recommends better data systems for monitoring quality outcomes specific to nursing care, so that RNs receive timely feedback on their performance. Other recommendations for hospital leadership include having more experienced colleagues guide early-career RNs in translating newly-acquired QI knowledge into action and ensuring that staffing levels are high enough and that RNs have sufficient release time to participate in QI activities, among others.

The study was based on surveys of 539 RNs who work in hospitals in 15 states: Alabama, Kentucky, Maryland, Michigan, North Carolina, New Jersey, Nevada, New York, Oklahoma, Oregon, Pennsylvania, South Carolina, Tennessee, Texas, and West Virginia. The National Council of State Boards of Nursing Center for Regulatory Excellence provided funding for the study, in addition to the Robert Wood Johnson Foundation support.

The RN Work Project is a 10-year study of newly licensed registered nurses. It's a multistate, longitudinal study of new nurses' turnover rates, intentions, and attitudes, including intent, satisfaction, organizational commitment, and preferences about work. The broad study draws on data from nurses in 34 states and the District of Columbia, covering 51 metropolitan areas and nine rural areas.