Aim

To understand the facilitators and barriers of quality improvement (QI) from the perspective of nurses and leaders at the frontline.

Background

Nurse engagement in QI has been associated with quality care and improved patient outcomes, yet nurse reported participation is low.

Methods

A descriptive qualitative design and purposive sampling was used to examine barriers and facilitators of nurse engagement.

Results

Facilitators 1) A leader’s influence on a QI culture. Sub themes: creating buy-in, support of a just culture and working in partnership with nurses. Barriers 1) Barriers in organizational culture for nurses to lead QI. Sub themes: hierarchy, absence of a just culture, nurses’ role not valued, lack of accountability for QI in nursing role, and resistance to change 2) Barriers in organizational structure for nurses to lead QI. Sub themes: manager disengagement, time pressure, lack of access to timely data, lack of QI knowledge, siloed departments, and lack of QI experts.

Conclusion

Barriers to QI engagement prevent nurses from fully engaging in QI. Creating a just culture and building the infrastructure to support nurse engagement is critical for success.

Implications for Nursing Management

Specific facilitators and barriers were identified that nurse leaders can assess in their practice setting and use relevant strategies to support engagement in QI.