The National Quality Forum (NQF) is a nonprofit, Washington, DC-based membership organization established to set and implement national standards for health care quality measurement and reporting. Voluntary consensus standards have special legal status; federal agencies are obligated to adopt them in the absence of "government-unique standards" (which the government creates for its own reasons) and must be developed through a consensus process that incorporates five attributes: openness, balance of interest, due process, consensus, and an appeals process.

In 2004 the NQF endorsed a set of national voluntary consensus standards for nursing-sensitive care (available online at http://www.qualityforum.org/pdf/nursing-quality/txNCFINALpublic.pdf). These standards-15 outcomes, processes of care, and "structural proxies" of these measures-are linked by evidence to nursing variables. Endorsement by the NQF signals agreement among a diverse body (including provider organizations, clinicians, public and private payors, quality-improvement organizations, labor groups, and consumers) that these measures are useful in documenting and reporting hospital nursing care quality. Among the measures are prevalence rates of pressure ulcers and restraint use; whether smoking cessation counseling is offered to patients with acute myocardial infarction, heart failure, or community-acquired pneumonia; and nurse staffing that takes into account skill mix and nursing care hours per patient day.

The degree to which these nursing-sensitive standards have been used is unknown. A 2007 NQF report acknowledges "a considerable number of obstacles" to their adoption and recommends next steps for research, education, and strategies to promote the adoption of the NQF consensus standards in hospital operations (available online at http://www.qualityforum.org/pdf/reports/Nursing70907.pdf). Among the obstacles identified were the extensive planning and resources needed to phase in nursing performance measures and the effort required to engage physicians' support.