The purpose of this study was to explore early-career registered nurses’ perceptions of high-quality nursing care in hospitals. The study findings contribute to ongoing work intended to explore and define what quality nursing care is and how it ultimately impacts patients. The final sample analyzed for this article consisted of 171 narrative responses from hospital-based registered nurses. We used Krippendorff’s technique for qualitative content analysis to identify themes. Three themes emerged as integral to high quality nursing care: registered nurse presence, developing relationships, and facilitating the flow of knowledge and information. Development of nursing quality indicators should focus on nursing processes in addition to patient outcomes. Such a focus would better capture the complexity of hospital nursing care.
Aiken, L.H., Clarke, S.P., Sloane, D.M., Sochalski, J.A., Busse, R., Clarke, H., . . . Shamian, J. ( 2001). Nurses’ reports on hospital care in five countries . Health Affairs, 20(3), 43-53.
2.
American Association of Colleges of Nursing. ( 2008). The essentials of baccalaureate nursing for professional nursing practice. Retrieved from http://www.aacn.nche.edu/education/pdf/BaccEssentials08.pdf
Baggs, J.G., & Schmitt, M.H. ( 1997). Nurses’ and resident physicians’ perceptions of the process of collaboration in an MICU. Research in Nursing & Health, 20(1), 71-80. doi:10.1002/(sici)1098-240x(199702)20:1<71::aidnur8>3.0.co;2-r
5.
Benner, P. ( 1984). From novice to expert: Excellence and power in clinical nursing practice. Menlo Park, CA: Addison-Wesley.
6.
Bernardo, A. ( 1998). Technology and true presence. Holistic Nursing Practice, 12(4), 40-49. Retrieved from http://journals.lww.com/hnpjournal/Abstract/1998/07000/Technology_and_True_Presence_in_Nursing.7.aspx
7.
Bodrock, J.A., & Mion, L.C. ( 2008). Pay for performance in hospitals: Implications for nurses and nursing care. Quality Management in Health Care, 17(2), 102-111. doi:10.1097/01.QMH.0000316988.71544.ec
8.
Boyle, D.K., & Kochinda, C. ( 2004). Enhancing collaborative communication of nurse and physician leadership in two intensive care units. Journal of Nursing Administration, 34(2), 60-70. Retrieved from http://journals.lww.com/jonajournal/Abstract/2004/02000/Enhancing_Collaborative_Communication_of_Nurse_and.3.aspx
9.
Buerhaus, P.I., Donelan, K., Ulrich, B.T., Norman, L., DesRoches, C., & Dittus, R. ( 2007). Impact of the nurse shortage on hospital patient care: Comparative perspectives. Health Affairs, 26(3), 853-862. doi:10.1377/hlthaff.26.3.853
10.
Buerhaus, P.I., Donelan, K., Ulrich, B.T., Norman, L., Williams, M., & Dittus, R. ( 2005). Hospital RNs’ and CNOs’ perceptions of the impact of the nursing shortage on the quality of care. Nursing Economic$, 23(5), 214-221. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/16315651
11.
Clarke, S.P., Raphael, C., & Disch, J. ( 2008). Challenges and directions for nursing in the pay-for-performance movement. Policy, Politics, & Nursing Practice, 9(2), 127-134. doi:10.1177/1527154408320419
12.
Codman, E. ( 2001). Re-engineering clinical records for production control . Australian Health Review, 24(2), 71-73. doi:10.1071/AH010071
13.
Codman, E.A. ( 1990). The product of a hospital. Archives of Pathology & Laboratory Medicine, 114(11), 1106-1111.
14.
Corrigan, J.M., Donaldson, M.S., Kohn, L.T., Maguire, S.K., & Pike, K.C. ( 2001). Crossing the quality chasm: A new health system for the 21st Century. Washington, DC: National Academy Press.
15.
Cronenwett, L., Sherwood, G., Barnsteiner, J., Disch, J., Johnson, J., Mitchell, P., . . . Warren, J. ( 2007). Quality and safety education for nurses. Nursing Outlook, 55(3), 122-131. doi:10.1016/j.outlook.2007.02.006
16.
Donabedian, A. ( 1985). Twenty years of research on the quality of medical care: 1964-1984. Evaluation & the Health Professions, 8(3), 243-265. doi:10.1177/ 016327878500800301
17.
Donabedian, A. ( 1997). The quality of care. How can it be assessed? Archives of Pathology & Laboratory Medicine, 121(11), 1145-1150.
18.
Donabedian, A. ( 2005). Evaluating the quality of medical care. Milbank Quarterly, 83(4), 691-729. Retrieved from http://www.milbank.org/quarterly/830416donabedian.pdf
Hsieh, H.F., & Shannon, S.E. ( 2005). Three approaches to qualitative content analysis. Qualitative Health Research, 15, 1277-1288. doi:10.1177/1049732305276687
21.
Institute for Healthcare Improvement. (2010 ). Transforming care at the bedside. Retrieved from http://www.ihi.org/IHI/Programs/Collaboratives/TransformingCareattheBedside.htm
22.
Irurita, V.F. ( 1999). Factors affecting the quality of nursing care: The patient’s perspective. International Journal of Nursing Practice, 5(2), 86-94. doi:10.1046/j.1440-172x. 1999.00156.x
23.
Jain, M., Miller, L., Belt, D., King, D., & Berwick, D.M. ( 2006). Decline in ICU adverse events, nosocomial infections and cost through a quality improvement initiative focusing on teamwork and culture change. Quality and Safety in Health Care, 15(4), 235-239. doi:10.1136/ qshc.2005.016576
24.
Joint Commission on Accreditation of Healthcare Organizations. (1999). Florence Nightingale: Measuring hospital core outcomes. Oakbrook Terrace, IL: Author.
25.
Joint Commission on Accreditation of Healthcare Organizations. (2002, June 17). Delays in treatment. Sentinel Event Alert, Issue No. 26. Retrieved from http://www.jointcommission.org/SentinelEvents/SentinelEventAlert/sea_26.htm
26.
Kohn, L. T., Corrigan, J. M., & Donaldson, M. S. (Eds.). (2000). To err is human: Building a safer health system . Washington, DC: National Academy Press.
27.
Kovner, C., Brewer, C., Fairchild, S., Poornima, S., Kim, H., & Djukic, M. ( 2007). Newly licensed RNs’ characteristics, work attitudes, and intentions to work. American Journal of Nursing, 107(9), 58-70. doi:10.1097/01.NAJ .0000287512.31006.66
28.
Kovner, C., Brewer, C., Yingrengreung, S., & Fairchild, S. ( 2010). New nurses’ views of quality improvement education . Joint Commission Journal on Quality and Patient Safety, 36(1), 29-35. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/20112663
29.
Kovner, C., Jones, C., Zahn, C., Gergen, P.J., & Basu, J. ( 2002). Nurse staffing and postsurgical adverse events: An analysis of administrative data from a sample of U.S. hospitals, 1990-1996. Health Services Research, 37(3), 611-629. doi:10.1111/1475-6773.00040
30.
Krippendorff, K. ( 2004). Content analysis: An introduction to its methodology . Thousand Oaks, CA: Sage.
31.
Kutney-Lee, A., McHugh, M.D., Sloane, D.M., Cimiotti, J.P., Neff, D.F., & Aiken, L.H. ( 2009). Nursing: A key to patient satisfaction. Health Affairs, 28(4), w669-w677. doi:10.1377/hlthaff.28.4.w669
32.
Leonard, M., Graham, S., & Bonacum, D. ( 2004). The human factor: The critical importance of effective teamwork and communication in providing safe care. Quality and Safety in Health Care, 13(Suppl. 1), i85-i90. doi:10.1136/ qshc.2004.010033
33.
Melnechenko, K. ( 2003). To make a difference: Nursing presence. Nursing Forum, 38(2), 18-24. doi:10.1111/j.1744-6198.2003.tb01207.x
34.
Miller, R.S., Norris, P.R., Jenkins, J.M., Talbot, T.R., Starmer, J.M., Hutchinson, S.A., . . . Morris, J.A. ( 2010). Systems initiatives reduce healthcare-associated infections: A study of 22,928 device days in a single trauma unit. Journal of TRAUMA, 68(1), 23-31. doi:10.1097/ TA.0b013e3181c82678
35.
National Committee for Quality Assurance. ( 2010). HEDIS & Quality Measurement. Retrieved from http://www.ncqa.org/tabid/59/Default.aspx
36.
National Quality Forum. (2007). Tracking NQF-endorsed consensus standards for nursing-sensitive care: A 15-month study. Retrieved from http://www.qualityforum.org/WorkArea/linkit.aspx?LinkIdentifier=id&;ItemID=17733
37.
Needleman, J., Buerhaus, P., Mattke, S., Stewart, M., & Zelevinsky, K. (2002). Nurse-staffing levels and the quality of care in hospitals. New England Journal of Medicine , 346(22), 1715-1722. Retrieved from http://www.nejm.org/doi/full/10.1056/NEJMsa012247
38.
Needleman, J., Kurtzman, E.T., & Kizer, K.W. ( 2007). Performance measurement of nursing care: State of the science and the current consensus. Medical Care Review, 64(Suppl. 2), s10-s43. doi:10.1177/1077558707299260
39.
Parker, L.E., Kirchner, J.E.Bonner, L.M., Fickel, J.J., Ritchie, M.J., Simons, C.E., & Yano, M.E. ( 2009). Creating a quality-improvement dialogue: Utilizing knowledge from frontline staff, managers, and experts to foster health care quality improvement. Qualitative Health Research, 19, 229-242. doi:10.1177/1049732308329481
40.
Preheim, G.J., Armstrong, G.E., & Barton, A.J. ( 2009). The new fundamentals in nursing: Introducing beginning quality and safety education for nurses’ competencies. Journal of Nursing Education, 48(12), 694-697. doi:10.3928/01484834-20091113-10
41.
Propp, K.M., Apker, J., Ford, W.S.Z., Wallace, N., Serbenski, M., & Hofmeister, N. (2010). Meeting the complex needs of the health care team: Identification of nurse team communication practices perceived to enhance patient outcomes. Qualitative Health Research, 20, 15-28. doi:10.1177/1049732309355289
42.
U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality. ( 2006). Patient safety indicators. Retrieved from http://www.qualityindicators.ahrq.gov/psi_overview.htm
43.
Velji, K., Baker, G.R., Fancott, C., Andreoli, A., Boaro, N., Tardif, G., . . . Sinclair, L. ( 2008). Effectiveness of an adapted SBAR communication tool for a rehabilitation setting. Healthcare Quarterly, 111(Special Issue) 72-79. Retrieved from http://www.longwoods.com/content/19653
44.
Williams, M., Hevelone, N., Alban, R.F., Hardy, J.P., Oxman, D.A., Garcia, E., . . . Rogers, S.O. ( 2010). Measuring communication in the surgical ICU: Better communication equals better care. Journal of the American College of Surgeons , 210(1), 17-22. doi:10.1016/j.jamcollsurg .2009.09.025
45.
Williams, S.A. ( 1998). Quality and care: Patients’ perceptions. Journal of Nursing Care Quality, 12(6), 18-25. Retrieved from http://journals.lww.com/jncqjournal/Abstract/1998/08000/Quality_and_Care_Patients_Perceptions.6.aspx
