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Domain 5: Quality and Safety
Descriptor: Employment of established and emerging principles of safety and improvement
science. Quality and safety, as core values of nursing practice, enhance quality and
minimize risk of harm to patients and providers through both system effectiveness and
individual performance.
Contextual Statement: Provision of safe, quality care necessitates knowing and using
established and emerging principles of safety science in care delivery. Quality and safety
encompass provider and recipient safety and the recognition of synergy between the two.
Quality or safety challenges are viewed primarily as the result of system failures, as opposed
to the errors of an individual. In an environment fostering quality and safety, caregivers
are empowered and encouraged to promote safety and take appropriate action to prevent
and report adverse events and near misses. Fundamental to the provision of safe, quality
care, providers of care adopt, integrate, and disseminate current practice guidelines and
evidence-based interventions.
Safety is inclusive of attending to work environment hazards, such as violence, burnout,
ergonomics, and chemical and biological agents; there is a synergistic relationship between
employee safety and patient safety. A safe and just environment minimizes risk to both
recipients and providers of care. It requires a shared commitment to create and maintain a
physically, psychologically, secure, and just environment. Safety demands an obligation to
remain non-punitive in detecting, reporting, and analyzing errors, possible exposures, and near
misses when they occur.
Quality and safety are interdependent, as safety is a necessary attribute of quality care. For
quality health care to exist, care must be safe, effective, timely, efficient, equitable, and personcentered. Quality care is the extent to which care services improve desired health outcomes
and are consistent with patient preferences and current professional knowledge (IOM, 2001).
Additionally, quality care includes collaborative engagement with the recipient of care in
assuming responsibility for health promotion and illness treatment behaviors. Quality care both
improves desired health outcomes, and prevents harm (IOM, 2001). Addressing contributors
and barriers to quality and safety, at both individual and system levels, are necessary.
Essentially, everyone in health care is responsible for quality care and patient safety. Nurses
are uniquely positioned to lead or co-lead teams that address the improvement of quality and
safety because of their knowledge and ethical code (ANA Code of Ethics, 2015). Increasing
complexity of care has contributed to continued gaps in healthcare safety.
Entry-Level Professional Nursing Education

Advanced-Level Nursing Education

5.1 Apply quality improvement principles in care delivery.
5.1a Recognize nursing’s essential role in improving
healthcare quality and safety.

5.1i Establish and incorporate data driven
benchmarks to monitor system performance.

5.1b Identify sources and applications of national
safety and quality standards to guide nursing
practice.

5.1j Use national safety resources to lead teambased change initiatives.

THE ESSENTIALS: CORE COMPETENCIES FOR PROFESSIONAL NURSING EDUCATION 39