Title : Innovative strategies to elevate quality: The impact of a med-surg quality Registered Nurses (RNs)
Abstract:
Background: Quality registered nurses (RNs) are frequently embedded in high-acuity areas such as the Intensive Care Unit (ICU) and Emergency Department (ED), where continuous oversight and rapid-cycle interventions can immediately influence patient outcomes. In contrast, the medical surgical environment—often the largest and most operationally complex unit type within hospitals—has historically lacked a dedicated quality-focused nursing role. Despite caring for a broad and vulnerable patient population, medical surgical units have not consistently benefited from the same level of structured quality oversight. This gap is significant, as medical surgical units directly influence key nursing-sensitive indicators, patient safety outcomes, and staff engagement. Strengthening quality infrastructure in this setting presents a meaningful opportunity to improve both clinical outcomes and the professional practice environment.
Problem Statement: Within one academic hospital system, leadership identified declining performance in National Database of Nursing Quality Indicators (NDNQI) metrics and other internal quality measures on a high-volume inpatient medical surgical unit. Trends included increased patient falls, a rise in Hospital-Acquired Pressure Injuries (HAPIs), and poor compliance with bathing and Chlorhexidine Gluconate (CHG) treatment protocols. Although data were readily available, there was a persistent gap between reviewing performance metrics and translating findings into actionable, frontline practice change. Leaders recognized the need for a focused strategy to bridge this divide.
Project Overview: To address this need, a pilot medical surgical quality RN role was developed. Distinct from traditional unit leadership positions, this RN focused exclusively on quality outcomes, staff education, real-time auditing, and implementation of best practices. The quality RN partnered closely with bedside nurses, nurse managers, and quality colleagues to interpret NDNQI and internal data, identify trends, and design targeted interventions. The role emphasized collaboration and shared accountability rather than punitive oversight, reinforcing professional governance principles and frontline engagement.
Implementation: A dedicated quality RN was embedded within the medical surgical unit. Clear role definition and leadership support were essential to ensure the position was viewed as a resource rather than an evaluator. The RN conducted daily safety discussions, facilitated real-time root cause analyses following adverse events, and provided in-the-moment education to staff. Chart audits were completed routinely, with feedback shared across both day and night shifts to promote transparency and consistency. The approach was intentionally proactive. For example, daily review of patients with a Braden score of 18 or below prompted immediate communication when pressure injury prevention interventions were missing. Similarly, noncompliance with bathing or CHG treatment for patients with lines, tubes, or drains was addressed in real time, allowing corrective action before increasing the risk of hospital-acquired infection. This model shifted the focus from retrospective data reporting to purposeful, preventive intervention and fostered frontline ownership of quality metrics.
Outcomes: The results were substantial. Bathing and hygiene compliance improved from 47.26% in Q3 2024 to 66.28% in Q3 2025. CHG treatment compliance increased from 41.74% to 74.19% during the same period. Most notably, HAPIs decreased from nine cases in Q4 2024 to one case in Q3 2025—an 89% reduction. Additional data collection is ongoing to evaluate long-term sustainability and broader scalability. With nurse managers overseeing both inpatient and ambulatory settings, expansion into outpatient areas is underway to support quality across the continuum of care.
Lessons Learned and Implications: Embedding a quality RN in medical surgical units effectively bridges the gap between data and practice. Success depended on clear role delineation, leadership endorsement, and cultural integration. This scalable model strengthens shared decision-making, reinforces accountability, and advances nursing professional governance. Organizations seeking to improve NDNQI performance and drive sustainable clinical and financial outcomes can leverage this innovative role to embed nursing leadership closest to the point of care.
