Letter to the Editor by Cynthia Jones to “Quality and Safety Education for Nurses (QSEN): The Key is Systems Thinking”

Healthcare and Quality: Perspectives from Nursing

December 15, 2014

Response by Cynthia Jones to “Quality and Safety Education for Nurses (QSEN): The Key is Systems Thinking” by Mary A. Dolansky, PhD, RN and Shirley M. Moore, PhD, RN (September 30, 2013):

With reply by Author

Dear Editor:

I am writing in response to the article written by Dolansky & Moore “Quality and Safety Education for Nurses (QSEN): The Key is Systems Thinking.” The authors delineate a clear understanding of how to apply the process of “system thinking” on a continuum exemplifying examples that can be clinically applied easily. However, I believe that there still remains a potential gap in the application of this principle, flowing from the leader nurse to the bedside nurse that should be addressed. ;Although nursing curriculum has and is being modified to include this area of education, we have many current nurses that will not have had the opportunity to gain the needed knowledge to apply “system thinking” due to a vast amount of reasons such as longevity of service in the profession, lack of continuing/furthering education, and failure to stay abreast of changes, etc. Many nurses believe the nursing process is about developing an individualized plan of care based on the uniqueness of each patient to meet his or her needs while maintaining patient safety and ensuring quality of care. This concept for many may appear contradictive to that philosophy. As mentioned in the article, providing a framework that would enable the nurse to take the focus from the individual and place it on the system to improve safety and quality of the patient will be a new concept for many. Therefore, we must rely on effective leadership to transcend this information and guide the clinical staff towards effective performance in systems thinking (Dolansky & Moore, 2013).

Leaders must be aware that change is not always welcomed and can be challenging. We have all heard the cliché, “it’s hard to teach an old dog new tricks.” Leaders must be mindful of these individual characteristic traits and use strategies that promote innovation yet maintain group integrity. An effective leader is only as effective as his followers. With this in mind, we must have leaders that understand and support systems thinking if we expect to have team members that are proficient with this process. Leaders must exhibit effective organizational behaviors to obtain followers that exhibit the same. An effective leader has the ability to create an effective group through collaboration and teamwork with the use of communication, decision-making skills, problem solving, critical thinking, support, adaptation, and direction. Utilizing these skills, a leader can obtain excellence in organizational performance. To ensure the systems thinking process will be effective, supervision, education, and restructuring will need to take place under the direction of an effective nurse leader (Dierckx De Casterlé, Willemse, Verschueren, & Milisen, 2008).

Cynthia Jones, BSN, RN
E-mail: cynthia.jones@mavs.uta.edu


Dierckx De Casterlé, B., Willemse, A., Verschueren, M., & Milisen, K. (2008). Impact of clinical leadership development on the clinical leader, nursing team and care-giving process:  A case study. Journal of Nursing Management, 16, 753-763. doi: 10.1111/j.1365-2834.2008.00930.x

Dolansky, M.A., & Moore, S.M., (2013). Quality and safety education for nurses (QSEN): The key is systems thinking. The Online Journal of Issues in Nursing, 18(3). doi: 10.3912/OJIN.Vol18No03Man01