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NLN Professional Nurse and QSEN Competencies
Estefania Gomez
Dutchess Community College
NUR 218: Nursing Synthesis
Professor Scaria and Professor Dorner
May 10, 2022
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NLN Professional Nurse and QSEN Competencies
Nurses play an important role in a patient’s life; that is why nurses must be well prepared
to always provide quality and patient-centered care. Throughout nursing school, nursing students
are taught to implement the best evidence-based practices to care for patients and families while
taking into consideration their culture, values, and preferences. QSEN competencies enhance
patient care by providing six components that nurses must adhere to in order to meet expected
standards for each patient and to provide safety. The concept of patient safety was certainly
nothing new to nursing education; however, at the time, the introduction of the six QSEN
competencies provided the foundation for curriculum development and professional practice
(Spencer, 2021). The six QSEN competencies are patient-centered care, quality improvement,
teamwork and collaboration, informatics and technology, safety, and evidence-based practice.
Nurses also have the NLN core competencies that cover four aspects of professionalism.
According to the National League for Nursing (2022), NLN competencies guide nurse educators
to design curricula that position graduates for practice in a dynamic health care arena: a practice
that is informed by a body of knowledge and ensures that all members of the public receive safe
quality care. The four NLN competencies are nursing judgment, a spirit of inquiry, professional
identity, and human flourishing. The purpose of this paper is to illustrate these QSEN and NLN
competencies and how the student should take them into consideration when providing patient
care at clinical sites.
One of the expected standards, number nine, under the competency of professional
identity is “Participating in clinical activities as scheduled, arriving on time and prepared for the
clinical assignment” (Scaria & Dorner, 2022, p. 23). Students on the maternity unit were
expected to perform a post-partum assessment called “BUBBLE HE,” which is meant to make
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nurses aware of potential changes that take place in women’s bodies and minds. B stands for
breast, and they should be non-tender with nipples pointing outward. U stands for uterus, which
should shrink in size and firm; this is particularly important, and nurses should massage if boggy.
Next is the double BBs which stand for bladder and bowel. Nurses assess urine color and if
bladder distention is present. Bowel to assess bowel movement and pain on palpation. The letter
L stands for lochia, and this assesses how much vaginal discharge the new mom is producing.
Letter E stands for episiotomy and this assesses swelling or bruising on the incision if there was
one. The H stands for Homans’ sign. This is very helpful in detecting blood clots. The Homas’
sign has been changed to a modified Homans’s sign due to the possibility of breaking a clot free
and ending up in the lungs. However, Homans’ sign is not so accurate. Research by Hattab et al.,
(2017) shows that “Homan’s sign is considered to have no diagnostic value since a positive sign
does not indicate DVT and a negative sign does not rule it out”. Lastly, the letter E stands for
emotions. Nurses must be aware of post-partum blues and post-partum depression in order to
treat patients and offer them resources.
The instructor took students one by one but not everyone was prepared. This affects the
performance of students on that day. Being prepared is very important when providing care
because it shows that nurses really care for their patients by also showing competence. It is
imperative that when walking into a patient’s room, nurses portray a caring demeanor because
the first impression is very important when forming nurse-patient relationships. The student
walked into the room and the family was present. Since the student in charge of the assessment
was not well prepared, the husband seemed a little uncomfortable with the process. Another
student took charge of the assessment and started asking the patient some questions to give the
patient some reassurance. The preceptor had the unprepared student go to the breakroom and
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familiarize her/himself with the BUBBLE HE assessment. As mentioned previously, being
prepared when caring for patients is one of the NLN and QSEN competencies, and nurses, as
well as nursing students, are expected to comply with them.
Another expected standard, number 12, under the competency of professional identity is
“Follows communication practices that minimized risks associated with handoffs among
providers and across transitions in care” (Scaria & Dorner, 2022, p. 23). Nurses on the unit were
very busy and overwhelmed. There were 6 nursing students assigned to help with patients and a
handoff report to these students was performed. Nursing schools provide students with SBARs to
take a report and give a report. Since the nurses were very busy that day, some critical
information about one specific patient was missed. The student nurse was very attentive in taking
reports and immediately went into that patient’s room to take vital signs. The patient’s
temperature was 95 F, and this was not noted by any technician on the floor. The prompted
diligence by the student nurse was very important in the care of this specific patient. The nurse in
charge immediately started warming fluids and the temperature went back to normal range. This
is an excellent example of how taking vital signs as soon as nurses take charge can save a
patient’s life. The behavior of the nurse taking report did not show the expected standard
mentioned above. When taking reports, nurses should ask questions about their patients, not just
what’s on the electronic record, but what the previous nurse did for those patients on their shifts.
Taking vital signs gives the nurse an overall glimpse of the patient’s wellbeing. An example is
detecting the early signs of infection; a temperature out of the normal (98.6), gives the nurse the
idea that something is not right, prompting the nurse to perform interventions and implement
treatments. A nurse that asks questions is a nurse that cares for his or her patients. A clear report
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is essential and should not be quick and simple, nurses need to take their time when giving and
getting reports because as mentioned previously, this can save a patient’s life.
Safety is another expected standard by which the nurse “Identifies and adheres to client
safety practices instituted at clinical agencies. (Including, but not limited to name band checks,
timely reporting of client condition, accurate and comprehensive communication, verbal reports,
and written communication, appropriate abbreviations, use of safety-enhancing technologies and
practices, maintaining safe pt. environment)” (Scaria & Dorner, 2022, p. 25). Safety is huge in
nursing practice. As a nurse, you have the responsibility of caring for your assigned patients.
Nursing students are taught this principle from the first day of nursing school. Sloane et al.
(2019) stated that “Nursing is crucial to transforming the hospital work environment for all the
reasons that nurses, and especially registered nurses (RNs), are crucial to hospital care. Nurses
are the only professional caregivers at the patient’s bedside around the clock; they are the
primary sources of information to physicians regarding the condition of patients, and in
particular changes in condition; and they are skilled practitioners in their own right. One of the
student’s patients had multiple pressure ulcers throughout his whole body. Wound care was
making rounds and they assessed his wounds and recommended treatment. The patient’s supplies
were not organized and the whole room was a mess. The nursing student in charge took
everything out of the drawers and started organizing the patient’s supplies to know what the
patient needed and what was out of date. The student came to find out that more than half of
those supplies were expired. This puts the patient in danger and does not give him the right
treatment. When the wound round team came into that patient’s room, they were able to assess
his wounds and prescribed whatever was expired. This action by the nursing student
demonstrated the expected standard of safety. Nurses must scan patients’ rooms as soon as they
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take charge in order to prevent any further injury. Patients with pressure ulcers should be turned
and positioned to prevent any more ulcers to develop.
Under patient-centered care is another expected standard that says that all nurses should
“Demonstrate the ability to develop and maintain therapeutic relationships and appropriate
personal boundaries with clients” (Scaria & Dorner, 2022, p. 24). A psychiatric unit is very
unique, and nurses should have knowledge when caring for these patients. Brain injury affects
how a patient behaves and their thinking. Specifically, personality disorders like schizoaffective
disorder are a mental health condition that includes schizophrenia and mood disorder like
bipolar. Patients with this condition are sometimes inappropriate and need redirection. Nursing
students were in the psychiatric unit caring for patients with schizoaffective disorder. That
morning the unit was very calm, and students were assessing patients and interviewing them. The
questions on the interview guide were a little uncomfortable and one specific patient was not
happy to answer them. Despite this situation, the student nurse continued the interview, and the
patient became very agitated when one specific question was asked. The question was: are you
having a sexual relationship with someone in your life at the moment? The patient looked at the
student nurse and told her that he was engaged and to please stop trying to be with him. The
student nurse made it clear that those questions were part of an assignment from school and that
she had to ask them. Giving patients with schizoaffective disorder constant redirection is very
important and works well while maintaining boundaries. Another important point would be
identifying triggers for these patients. The student nurse avoided asking any more questions
related to any sexual activity to this client easing the situation and diverting the patient to another
topic. This intervention demonstrated the expected standard of maintaining therapeutic
relationships with her patients. After the student nurse changed the topic of conversation, the
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patient continued answering without becoming agitated and this helped them both in forming
that patient-nurse relationship. Throughout the shift, the student nurse and the patient continued
working together towards the patient’s goal.
Human flourishing is another expected standard by which nurses should “Assess learning
needs and conducts client teaching appropriate to client abilities and needs” (Scaria & Dorner,
2022, p. 24). When student nurses are assessing patients, it is very important to take the learning
needs of the patient into consideration. On the med Surg unit, students were responsible to care
for a group of patients. There was one patient who did not speak English and needed additional
teaching regarding his medication. The student nurse in charge received a report from the night
nurse and it seemed that no one had offered the patient an interpreter. That was when the student
nurse advocated for her patient and requested an interpreter present when teaching the side
effects of medications and any follow-ups for this patient. The patient was 84 years old and
needed to communicate some concerns to the nurses, but he was not able to do this during the
night shift due to the language barrier. As soon as the interpreter arrived at the room, the patient
started communicating and showing interest in learning how to take care of himself. The family
was present and indicated that the student nurse did an amazing thing requesting the interpreter.
Nurses should be able to assess the learning needs of patients in order to provide the best care
possible. Nurses are advocates and should make sure that their patients are cared for in the best
possible way. The patient told the student nurse that he was going from hospital to hospital, and
no one seemed to advocate for him. He was diagnosed with diabetes a while back and because of
this language barrier, he didn’t know certain things like doing a glucose check every day, the
benefits of exercising and eating healthy, and his overall care. When there is a language barrier,
nurses need to take every possible measure to provide patients with a much clearer picture of
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how to care for themselves. Establishing trust is the first step in having a patient-nurse
relationship and it gives patients the feeling that somebody is advocating for them when they are
at their worst.
Lastly, as a nurse, you should “Communicate findings in a timely, accurate and effective
manner to RN preceptor and to nursing and interdisciplinary team members to meet the needs of
client and families. (This includes verbal and written communication)” (Scaria & Dorner, 2022,
p. 25). Communication between healthcare personnel is very important when taking care of
patients. According to The Joint Commission (2017), “Potential for patient harm – from the
minor to the severe – is introduced when the receiver gets information that is inaccurate,
incomplete, not timely, misinterpreted, or otherwise not what is needed. When hand-off
communication fails, many factors are involved, such as health care provider training and
expectations, language barriers, cultural or ethnic considerations, and inadequate, incomplete or
nonexistent documentation, to name just a few.” On a clinical day, a group of nursing students
was assigned to perform a rapid COVID test for the patients on the floor. It was roughly 40
patients that day. Students were getting two kits each to test the two patients together in one
room. The day was going well, and the students were very helpful according to the nursing staff.
One student nurse mixed up the COVID tests from two patients and she immediately
communicated it in time to the nurse preceptor. When the patient that was not tested came back
to the unit, she stated that she hasn’t been tested and this is when the mistake was noticed by the
preceptor. The student nurse responsible for testing these two patients did meet the expected
standard mentioned above. This could have had potential complications and because the student
nurse took responsibility, a report was done and all the patients got tested again, reassuring the
nursing staff that all COVID testing was done properly. When communicating among nurses, it
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is very important that the information we have on hand is passed over in a timely manner to
decrease any potential complications. As mentioned above, when nurses failed to communicate
with accuracy and effectiveness, patients are at risk. An example of this is when a patient is
taking a blood pressure medication, like metoprolol, nursing students have the responsibility to
check the patient’s vital signs and make sure the heart rate is above 60 bpm. If it is below 60, the
student is responsible for communicating this finding to the nurse preceptor in order to make a
decision.
In conclusion, QSEN and NLN competencies were created to guide nursing students and
nurses in properly caring for patients. Meeting these standards mentioned above is a priority and
should be accomplished when taking care of patients. Nurses are advocates for their patients and
meeting these standards shows interest in growing as a nurse. It also demonstrates the
competency of nurses by making sure nurses are providing patients with the best care possible in
a safe and compassionate manner. QSEN and NLN competencies give nursing students an idea
of how well prepared they are to step into the field. Meeting these standards indicates that a
student nurse is capable of caring for patients and taking responsibility for them, showing a
caring attitude while modifying care as needed. Another aspect of these competencies mentioned
above is the importance of providing evidence-based care. This is very important since it
provides nursing students and nurses with the knowledge, they need to implement interventions
that are reviewed and that provide an opportunity to change or evaluate and individualize care.
As part of the nursing program, these competencies need to be met before a nursing
student sets foot in the field. According to this paper, the writer has met these standards and is
capable of providing care to patients in the best possible way, while advocating for patients when
they need it the most.
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References
Alert, S. E. (2017). Inadequate hand-off communication. Sentinel event alert, 58(1), 6.
Hattab, Y., Küng, S., Fasanya, A., Ma, K., Singh, A. C., & DuMont, T. (2017). Deep venous
thrombosis of the upper and lower extremity. Critical Care Nursing Quarterly, 40(3),
230–236. https://doi.org/10.1097/cnq.0000000000000165
Sloane, D. M., Smith, H. L., McHugh, M. D., & Aiken, L. H. (2018). Effect of changes in
hospital nursing resources on improvements in patient safety and quality of care. Medical
Care, 56(12), 1001–1008. https://doi.org/10.1097/mlr.0000000000001002
Scaria, T., & Dorner, C. (2022). NUR 218 syllabus 2022. The Nursing Department, Dutchess
Community College, 23-25.
NLN Home. Default. (n.d.). Retrieved April 25, 2022, from https://www.nln.org/
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