Nursing-Sensitive Quality Indicators

I am a member of the Quality Improvement Council for our General Hospital. I want to welcome you to our community and express how glad I am that you are joining us! We value collaboration here at General Hospital, and I look forward to meeting you. For now, I would like to use this opportunity to talk to you about Nursing-Sensitive Quality Indicators.


It is no secret that nurses are the backbone of the American healthcare system, and we are always looking for ways to improve our quality of care. Of course, high-functioning teamwork is an essential aspect of our complex profession. That is why the American Nursing Association pioneered an ingenious method of expanding our nursing knowledge: creating a national database of nursing performance relative to patient outcomes. This database, known as the NDNQI (National Database of Nursing Quality Indicators), tracks factors of patient care directly influenced by nursing practice (Connolly & Wright, 2017). When it was published for the first time in 1998, the list included factors like patient satisfaction with pain management, rates of nosocomial infections, and patient falls (National Database of Nursing Quality Indicators [NDNQI], n.d.). The Quality Indicators are divided into three types. Structural indicators involve the nursing staff’s supply, skills level, and education (NDNQI, n.d.) Process indicators measure patient care methods and nursing interventions (NDNQI, n.d.). Outcome indicators are patient outcomes that are dependent on nursing care, such as pressure ulcers and falls (NDNQI, n.d.).

Keeping track of all this information allows the healthcare industry to quickly determine the best procedures for patient care and develop relevant evidence-based training programs and protocols (Connolly & Wright, 2017). This is especially important for our hospital, given that we always aim to provide the highest-quality, safe, and effective long-term and emergency care.

Data collection and analysis

In essence, the NDNQI is a giant collaborative research project involving every nurse in the United States. To discover the best patient care strategy, we depend on your help. The Quality Improvement Council utilizes the Delphi method, first developed by Dalkey and Helmer, to collect and analyze data on our nursing practices (Varndell, 2021). All nurses are sent anonymous online surveys and periodic requests to provide anonymous feedback to other nurses’ responses. A consensus is reached based on statistical aggregation of group responses (Varndell, 2021). We enforce anonymity to ensure that we are getting the most accurate, honest results without social pressures and the domination of a few experts (Varndell, 2021). We send these results to Press Ganey, the parent company of the NDNQI, along with non-nursing-related outcomes, such as incident reports and readmission data. After, they send us comprehensive research-based statistical reports relative to national data. This allows our Council to understand what our nursing home is doing well and what we need to improve. The same process is replicated by healthcare facilities all over the country.

Just imagine – a few quick surveys and thousands of facilities can pinpoint exactly what they need to do to ensure their patients are safe, satisfied, and healthy. This is why we need you to approach these surveys with utmost respect, responsibility, and accuracy. We ask you to check your hospital email daily and make an effort to complete the surveys as soon as possible. The platform for the surveys is easy to navigate and only requires a few minutes of your time. The data collected, however, has the capacity to influence millions of people.

Pressure ulcers

To showcase just how useful the NDNQI can be, I would like to talk to you about a single nursing-sensitive quality indicator that has been improved by nurse-led clinical quality intervention. Pressure ulcers are some of the worst problems faced by inpatients, given the low mobility rates of most of our patients. In 2019, the Odense University Hospital suffered from a 32.3% prevalence of pressure ulcers among inpatients (Fremmelevholm & Soegaard, 2019). Pressure ulcers are considered a Nursing-sensitive Outcome Indicator because their prevalence directly depends on nursing interventions. A committee and a specialist nurse were appointed, and strict guidelines were enforced: all patients must be risk assessed upon admission and every day thereafter while maximizing mobility by repositioning and pressure-distributive aids (Fremmelevholm & Soegaard, 2019). All nurses received one-day training on prevention, and an annual “pressure ulcer” theme day was set. By enforcing these simple protocols, the hospital managed to reduce the number of ulcers by fifty percent (Fremmelevholm & Soegaard, 2019). We enacted similar guidelines based on this study and managed to practically double patient satisfaction over the past year. Our patients are healthier and happier – all it takes is a little bit of effort and attention from nurses like you.


In conclusion, Nursing-Sensitive Quality Indicators are aspects of patient health that directly depend on the decisions you make during your day. If you are cognizant of these indicators, you can take care of your patients better and make their time in our facility easier to bear. By completing online surveys, you contribute to the knowledge of thousands of medical care professionals and enable us to develop evidence-based guidelines that maximize patient health and safety. You are following the tradition of exemplary figures like Florence Nightingale, who was the first to measure patient outcomes to maximize hospital efficiency. I hope this short introduction has helped you grasp just how valuable you can be to our hospital. I would like to once more welcome you to our team and wish you good luck!


Connolly, D., & Wright, F. (2017). The nursing quality indicator framework tool. International Journal of Health Care Quality Assurance, 30(7), 603–616.

Fremmelevholm, A., & Soegaard, K. (2019). Pressure ulcer prevention in hospitals: a successful nurse-led clinical quality improvement intervention. British Journal of Nursing, 28(6), S6-S11.

National Database of Nursing Quality Indicators. (n.d.). NDNQI Nursing-Sensitive Indicators. Web.

Varndell, W., Fry, M., Lutze, M., & Elliott, D. (2021). Use of the Delphi method to generate guidance in emergency nursing practice: A systematic review. International emergency nursing, 56, 100867.

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