The issues of patient safety and medical error have been well documented in a series of national studies by the Institutes of Medicine (IOM) of the National Academies. No longer is medical error viewed as a private concern of practitioners and hospitals but rather as a national, frontline healthcare matter requiring sweeping and urgent reforms. There is public outcry for dignified patient care that is provided in an environment that minimizes error and promotes safety as a core value. Addressing these changes requires significant alterations in how healthcare systems are engineered. Central to this ability to reengineer is the preparation of highly skilled healthcare professionals with a new and different set of knowledge, skills, and abilities. Health Professions Education a Bridge to Quality, a report of the IOM (2003, p. 45), recommends an overarching vision for all programs and institutions engaged in the education of health professions:

All health professions should be educated to deliver patient-centered care as members of an interdisciplinary team, emphasizing evidence-based practice, quality improvement approaches, and informatics.

As staff developers and educators, we are in a pivotal place to be advancing this call to action within our organizations-both clinical and academic. Are we meeting this challenge? It might be helpful to stop and reflect on your work in this respect. Where are you making progress? Where can you still make headway? As we attend to the hectic nature of our days, it easy to forget the big picture as we race from task to task. In general, healthcare professionals will need to be able to determine what constitutes good care from the scientific evidence, identify the gaps between good care and actual provided care, and know what changes and activities are needed to close any gaps. Some of these recommended competencies can be developed through innovations in interprofessional learning. It is past the time for us to break out of our respective discipline-specific silos toward meaningful engagement in collaborative, interdisciplinary learning activities. Nursing staff developers can take the lead in the design, implementation, and evaluation of these approaches. Each time a new offering is planned, include an assessment of how to foster collaboration and team involvement in its blueprint. Refine existing programs and learning materials to reflect the IOM's vision-it is not necessary to totally reinvent things or to develop new and separate content, rather seek to integrate and incorporate these concepts into what you already do. It is truly possible to view all our orientation, staff development, and continuing education programs through the lens of patient safety. Changing our practice can be slow- it can even generate anxiety as we step out of our comfort zone to try on new skills and ways of doing things. It can also be a time of incredible energy, innovation, and motivation-pulling professionals together for the common goal of enhancing patient safety. Highlight your accomplishments in this regard widely within your organization and disseminate them through the professional literature so that others can learn from and build on your experiences. What better way to promote evidence-based practice than to model it in our own work. As the specialty of nursing staff development grows, so does the need for a scientific practice base. Consider applying for an NNSDO Research Grant to support your ideas for a staff development-related research study.

It will not be sufficient to simply retool the existing workforce. It is important to note that changes will be required in how we educate the nurses of tomorrow. As the largest single group of healthcare providers, nurses must be prepared for the practice changes called for by the IOM. Given that nurses assess, plan, implement, and evaluate patient care, their education on and involvement in patient safety and quality care initiatives are vital. It is evident that significant prelicensure curricular innovation will need to occur now so that the next generation of nurses will emerge from their programs prepared with the requisite knowledge, skills, and attitudes. Nursing education has traditionally focused on the development of individual practitioners able to deliver quality care, while little emphasis has been placed on competency development related to improving systems that affect the individual's ability to provide that care. Curricular changes and the accompanying change in pedagogical strategies are necessary but daunting. Barriers such as an already overstuffed curriculum, a growing faculty shortage, the need for faculty development in the competency content areas, and the generally slow pace of curricular change must be addressed before the long-term vision of the Healthcare Professions Education: Bridge to Quality Report can be fully realized. In an effort to promote patient safety education for nurses, the Robert Wood Johnson Foundation has funded the Quality and Safety Education for Nurses (QSEN) project. Led by Dr. Linda Cronenwett, Dean and Professor at the University of North Carolina at Chapel Hill, the QSEN project seeks to address the challenge of preparing future nurses who will have the knowledge, skills, and attitudes necessary to continuously improve the quality and safety of the healthcare systems in which they will work. Supported by a nationally prominent core faculty and advisory board, the first phase of the project has built and expanded upon the IOM's vision: to identify and define six core competencies for prelicensure nursing students. The content domains include evidence-based practice, informatics, patient-centered care, teamwork and collaboration, and safety and quality improvement. Currently, work is underway to develop innovative pedagogical strategies such as narrative pedagogy, simulation experiences, interprofessional learning opportunities, and new approaches to clinical learning that will help to impart these content domains to students. In addition, QSEN staff is undertaking a national survey of selected bachelor of science in nursing and associate degree in nursing programs to determine the current state of the prelicensure curricula as it relates to these six domains and the teaching methods being used. A major outcome of this project, anticipated by Spring 2007, will be the publication of an electronic compendium of curricular materials and educational resources for educators. The QSEN Web site under development will house the compendium and serve as a central repository for safety- and quality-related educational information. Although the current project focuses on prelicensure nursing education, the QSEN team is already contemplating expansion of the work to include advanced practice competencies.

How will these new competencies for students affect nursing staff development practice? Perhaps, we will see a change in the nature of clinical rotations with nursing students investigating quality-related issues in the work environment. Students will be challenged to define and evaluate the evidence base for their interventions. Sentinel/ critical incident reviews may be ideal experiences for seeing quality improvement practices and interprofessional learning occur. Staff developers can work to minimize barriers to the use of electronic documentation and medication administration systems and automated dispensing units by students so they can experience technological influences on safety. They can also help the faculty by identifying existing opportunities for collaboration and teamwork on the clinical units. Preceptor development programs can be modified to ensure that preceptors incorporate core competencies into their practice. The list can go on-it is up to us to prioritize these important actions. We will be several steps closer to minimizing errors if we continue to work together to explore and push the margins of practice as it is-to practice as it can and should be. Staff developers have a critical role to play.

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