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Reply by Authors Dolanski and Moore to Cynthia Jones on “Quality and Safety Education for Nurses (QSEN): The Key is Systems Thinking”

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December 15, 2014

Response by Dolanski and Moore to Cynthia Jones on “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):

Dear Editor:

Cynthia Jones makes an important point regarding a gap between the need for systems thinking to improve healthcare quality and safety and the current belief of many bedside nurses that nursing is about an individualized plan of care based on the uniqueness of each patient. Contemporary quality and safety science demonstrates that healthcare professionals must extend care of the individual to include systems of care. We agree with Ms. Jones that application of systems thinking at the bedside will depend not only on education to all nurses (students, practicing nurses, and leaders) but also on the involvement of the unit leadership in implementing change.

In meeting the challenge of this needed change and paradigm shift, unit managers, clinical nurse specialists, and directors of nursing are challenged by a diverse workforce that includes four generations (baby boomers, Gen Xers, Gen Yers, and Millennials) who have received different levels of education (diploma, associate degree, baccalaureate degree) (Putre, 2013). In addition, the diverse culture among academic medical centers, rural hospitals, and hospitals with Magnet recognition contributes to the diversity of the healthcare setting.

As Ms. Jones points out, change is not always welcome but nursing leaders must step up to the challenge as unsafe healthcare is the third leading cause of death (Leapfrog, 2013). Nursing leaders and nursing educators are challenged with shifting a long-standing belief of what nurses do.  Nursing organizations such as the American Nurses Association (Special Report, 2014) and specialty organizations such as the American Organization of Nurse Executives provide resources to assist nurse leaders. It is time for nurses to lead the way in improving the quality and safety of healthcare.

Mary A. Dolansky, PhD, RN & Shirley M. Moore, PhD, RN


Leapfrog Group. (2013). Hospital errors are the third leading cause of death in U.S. and new hospital safety scores show improvements are too slow. Retrieved from

Putre, L. (2013). Generations in the work place. Hospitals & health networks. Retrieved from

Special report: Focus on quality and safety (2014). The American Nurse Today, 9(1). Retrieved from