Quality Improvement (QI) Proposal Paper

Quality Improvement (QI) Proposal Paper

Quality Improvement (QI) Proposal Paper

Introduction of QI Proposal

Nursing staff, departments, organizations, and the entire health practice encounter numerous problems affecting care quality adversely. In health practice, evidence-based interventions are the standard practice to ensure that solutions are based on scientific evidence. The central focus of this QI proposal is nurse burnout. It is among the prevalent issues in health care organizations affecting nurses’ health and well-being adversely and hampering their ability to provide patient care professionally, promptly, and competently. Nurse burnout is characterized by physical, mental, and emotional drain stemming from demanding workloads, conditions of the work environment, and organizational leadership, among other factors (Shah et al., 2021). Workload, which increased after the outbreak of the COVID-19 pandemic, is among the leading causes of nurse burnout in today’s practice. A recent survey of 50,000 nurses in the United States showed that nurse burnout cause approximately one-third (31.5%) of turnover cases (Shah et al., 2021). As a result, it is crucial to explore the problem, its dynamics in health care settings, and the most effective current solutions. Among many settings, nurse burnout is typical in the emergency department. Unlike other areas, nurses in the emergency department are more susceptible to nurse burnout due to their continuous exposure to traumatic events, COVID-19 pandemic stressors, and varying work schedules (Phillips et al., 2022). The problem intensifies when nurses experience workplace violence, bullying, and other forms of incivility. New graduate nurses are the most vulnerable due to their low resilience, inadequate support, and lack of mentorship. Most cannot cope, particularly when they lack instant and appropriate support. In response, this QI proposal recommends building nurses’ resilience to cope with the increased burnout stemming from the emotional, mental, and physical burden of the COVID-19 pandemic in the emergency department. The purpose of this Quality Improvement Proposal is to determine the effect of mindfulness and resilience training on nurse burnout among nurses in the emergency department.


How the QI Proposal Addresses the Problem

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Nurses in the emergency department handle complex and critical patient issues. Their health and well-being are essential to providing quality care. Nurse burnout implies a high turnover rate and a lack of consistent patient care. Tavakoli et al. (2018) observed that nurse burnout triggers dissatisfaction since workplace stress and satisfaction are inversely related. Accordingly, a quality improvement initiative is needed to optimize nurses’ health and well-being in the emergency department. Focus areas include building resilience, enabling the nurses to cope, and helping them to have a positive work-life balance. Mindfulness-based stress reduction (MBSR) and resilience training are effective approaches. They are expected to help nurses improve concentration and situational awareness, overcome workplace stressors, and other positive outcomes. The expected outcome is to improve nurses’ health and well-being and their readiness to care for patients visiting the emergency department. Tavakoli et al. (2018) stated that nurse burnout leads to exhaustion, dissatisfaction, lack of concentration, and depression. The quality improvement initiative will prevent nurses in the emergency department from such impacts. Addressing nurse burnout implies high patient engagement since most nurses in the emergency department disengage from their patients due to compassion fatigue. Nurse turnover will also be reduced, reducing the costs of regularly recruiting new nurses.

Research Supporting the Quality Improvement Initiative

Health care and nursing research intensively explore the benefits of mindfulness-based techniques and resilience training in addressing nurse burnout. Most studies depict nurses as vulnerable to burnout, albeit at varying levels depending on the workplace conditions and support. Penque (2019) investigated the impacts of MBSR and found it effective in enabling nurses to cope with workplace stressors. MBSR involves class instruction in mindfulness techniques, yoga, and meditation to promote nurses’ physical and psychological well-being. During the program, nurses learn to embrace their lived experiences, including pain and stress, be open and nonjudgmental, and be present for others. Favorable outcomes include decreased stress and burnout, increased relaxed states, and enhanced situational awareness (Penque, 2019). Professionally trained nurses have a deeper connection with patients and high levels of self-compassion. In a systematic review and meta-analysis of the relationship, Suleiman-Martos et al. (2020) found that mindfulness training reduces nurses’ emotional burden, reducing burnout. In a different study, Slatyer et al. (2018) studied the impacts of a brief mindful self-care and resiliency (MSCR) program on nurse burnout. Among many valuable outcomes, the program helped nurses in a tertiary care hospital to develop feelings of inner calm, gain more perspective and insight, and participate more productively in self-care. Burnout reduced as nurses continued to practice the taught skills. 

Steps to Implement the QI Proposal

The entire process starts with recommending training for nurses in the emergency department experiencing burnout or vulnerable to burnout. As the change agent, the nurse proposing the need for mindfulness and resilience training meets the organization management and stakeholders to rationalize the training as an evidence-based practice project. Stakeholder support is vital since it reduces resistance to change (Jasinska, 2020). An organization’s management prepares its members for change and provides the necessary resources to implement programs with valuable outcomes. After meeting stakeholders and earning the necessary support, nurses should undergo intensive training to enable them to deal effectively with workplace stressors to reduce burnout. Positive outcomes of an MBSR program can be realized in eight weeks (Penque, 2019). Trainers can be internal or external, depending on the availability of the training personnel and resources in the organization.

Evaluating the QI Proposal

Quality improvement initiatives involving training usually consume considerable time and the organization’s resources. Outcome evaluation is necessary to determine whether the project achieved the desired outcomes. The proposed project (mindfulness and resilience training for nurses working in the emergency department) will be evaluated qualitatively and quantitatively. A qualitative evaluation seeks to gain an in-depth understanding of issues, interactions, and observed behaviors (Peters & Fontaine, 2020). It will focus on nurses’ feelings and perceptions of the training and their readiness to implement the taught skills. Focused group discussions and interviews will be used for qualitative evaluation. A quantitative evaluation focuses on numerical figures. It statistically assesses the outcomes of an intervention mathematically using finite data (Peters & Fontaine, 2020). By quantifying outcomes, change leaders can create a factual representation of the outcomes to justify whether the projected outcomes were achieved. Several elements will be used to assess improvement quantitatively. The first element is the percentage change in the reported cases of workplace fatigue/nurse burnout. Reducing burnout is expected to reduce such cases proportionately. The second element is the rate of nurse turnover. A comparative analysis of the turnover before the training and three months after it will reliably indicate whether the project achieved the desired improvement.

Variables, Hypothesis Test, and Statistical Test

Some variables will be used descriptively and others as quantitative elements. Independent variables include mindfulness and resilience training, and nurse burnout is the dependent variable. Regarding the hypothesis test, mindfulness and resilience training will reduce nurse burnout in three months. A comparative analysis of the nurse burnout effects, such as retention/turnover rates and complaints of fatigue before and after the training, will prove or disprove the hypothesis. Statistical tests include calculating the mean and mode of the most reported observations.


Quality improvement should be a priority area in health care organizations and the entire nursing practice. Health care organizations should persistently identify issues that hamper care quality and develop evidence-based interventions to enhance performance. In this paper, nurse burnout has been described as a genuine concern for nurses working in the emergency department. Such nurses are vulnerable to burnout since they work in a high-pressure environment, and their workload has increased since the outbreak of the COVID-19 pandemic. To help them cope with stressors, mindfulness and resilience training can effectively help nurses in critical care areas like the emergency department. Expected outcomes include more resilience, increased coping ability, more engagement in self-care, and a positive work-life balance.


Jasinska, J. (2020). Stakeholders identification affecting the scope and the changes in the health care system. Frontiers, 1(03), 1-15. DOI: 10.2020/fmcr/000013120

Penque, S. (2019). Mindfulness to promote nurses’ well-being. Nursing Management, 50(5), 38–44. https://doi.org/10.1097/01.NUMA.0000557621.42684.c4

Peters, B. G., & Fontaine, G. (Eds.). (2020). Handbook of research methods and applications in comparative policy analysis. Edward Elgar Publishing.

Phillips, K., Knowlton, M., & Riseden, J. (2022). Emergency department nursing burnout and resilience. Advanced Emergency Nursing Journal, 44(1), 54-62. doi: 10.1097/TME.0000000000000391

Shah, M. K., Gandrakota, N., Cimiotti, J. P., Ghose, N., Moore, M., & Ali, M. K. (2021). Prevalence of and factors associated with nurse burnout in the US. JAMA Network Open, 4(2), e2036469-e2036469. doi:10.1001/jamanetworkopen.2020.36469

Slatyer, S., Craigie, M., Rees, C., Davis, S., Dolan, T., & Hegney, D. (2018). Nurse experience of participation in a mindfulness-based self-care and resiliency intervention. Mindfulness, 9(2), 610-617. DOI: 10.1007/s12671-017-0802-2

Suleiman‐Martos, N., Gomez‐Urquiza, J. L., Aguayo‐Estremera, R., Cañadas‐De La Fuente, G. A., De La Fuente‐Solana, E. I., & Albendín‐García, L. (2020). The effect of mindfulness training on burnout syndrome in nursing: a systematic review and meta‐analysis. Journal of Advanced Nursing, 76(5), 1124-1140. https://doi.org/10.1111/jan.14318

Tavakoli, N., Shaker, S. H., Soltani, S., Abbasi, M., Amini, M., Tahmasebi, A., & Hosseini Kasnavieh, S. M. (2018). Job burnout, stress, and satisfaction among emergency nursing staff after health system transformation plan in Iran. Emergency (Tehran, Iran), 6(1), e41. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6289161/


Assessment Description
Identify a quality improvement opportunity in your organization or practice. In a 1,250-1,500 word paper, describe the problem or issue and propose a quality improvement initiative based on evidence-based practice. Apply “The Road to Evidence-Based Practice” process, illustrated in Chapter 4 of your textbook, to create your proposal.

Include the following:

Provide an overview of the problem and the setting in which the problem or issue occurs.
Explain why a quality improvement initiative is needed in this area and the expected outcome.
Discuss how the results of previous research demonstrate support for the quality improvement initiative and its projected outcomes. Include a minimum of three peer-reviewed sources published within the last 5 years, not included in the Class Resources or textbook, that establish evidence in support of the quality improvement proposed.
Discuss steps necessary to implement the quality improvement initiative. Provide evidence and rationale to support your answer.
Explain how the quality improvement initiative will be evaluated to determine whether there was improvement.
Support your explanation by identifying the variables, hypothesis test, and statistical test that you would need to prove that the quality improvement initiative succeeded.
While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide, located in the Student Success Center.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

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