Graduate-Level QSEN Competencies: Six Competencies and KSAs Overview

Purpose and Background

The graduate-level Quality and Safety Education in Nursing (QSEN) competencies identify the knowledge, skills, and attitudes (KSAs) needed for graduate-prepared nurses to support high-quality, safe, effective, and patient-centered care. The indexed AACN document presents the graduate-level competencies as a consensus framework aligned with contemporary expectations for nursing education and practice. Reference: AACN Graduate-Level QSEN Competencies: Knowledge, Skills and Attitudes

The Six Graduate-Level QSEN Competencies

• Quality Improvement (QI): Using data to monitor outcomes of care processes and improvement methods to design and test changes that continuously improve quality and safety.
• Safety: Minimizing risk of harm to patients and providers through system effectiveness and individual performance.
• Teamwork and Collaboration: Functioning effectively within nursing and interprofessional teams through open communication, mutual respect, and shared decision-making.
• Patient-Centered Care: Recognizing the patient or designee as the source of control and a full partner in compassionate, coordinated care based on preferences, values, and needs.
• Evidence-Based Practice (EBP): Integrating best current evidence with clinical expertise and patient/family preferences and values.
• Informatics: Using information and technology to communicate, manage knowledge, mitigate error, and support decision-making.

Reference: AACN Graduate-Level QSEN Competencies: Knowledge, Skills and Attitudes

How the KSA Framework Organizes Competence

Each competency is described through three dimensions:

• Knowledge — what the graduate nurse understands.
• Skills — what the graduate nurse is able to do in practice.
• Attitudes — the values and commitments that shape professional action.

This structure emphasizes that graduate-level quality and safety performance requires more than awareness alone; it also requires action and professional commitment. Reference: AACN Graduate-Level QSEN Competencies: Knowledge, Skills and Attitudes

Representative KSA Themes Across the Competencies

Quality Improvement

• Knowledge: Strategies for improving outcomes across points of care; nationally accepted quality measures and benchmarks; principles of change management; effects of public reporting and linking payment to quality.
• Skills: Aligning aims, measures, and changes; reviewing outcomes from data sources and benchmarks; leading improvement efforts; applying change management; designing and evaluating small tests of change such as Plan-Do-Study-Act.
• Attitudes: Commitment to transparency, accountability, managing variability, planned change, and community engagement in quality improvement.

Safety

• Knowledge: Factors that create a culture of safety and just culture; best practices that promote patient, community, and provider safety; human factors and unsafe practices.
• Skills: Designing and implementing improvements using existing safety resources; integrating strategies that reduce risk of harm to patients, self, and others.
• Attitudes: Commitment to being a safety mentor and role model; valuing systems approaches instead of blaming individuals; valuing risk reduction in health systems.

Reference: AACN Graduate-Level QSEN Competencies: Knowledge, Skills and Attitudes

Teamwork and Collaboration

The competency framework emphasizes effective participation in nursing and interprofessional teams through communication, mutual respect, and shared decision-making to improve care quality. Reference: AACN Graduate-Level QSEN Competencies: Knowledge, Skills and Attitudes

Patient-Centered Care

The competency framework centers the patient or designee as a partner in care and emphasizes respect for preferences, values, and needs in care coordination and decision-making. Reference: AACN Graduate-Level QSEN Competencies: Knowledge, Skills and Attitudes

Evidence-Based Practice

The framework defines EBP as the integration of best current evidence with clinical expertise and patient/family values to guide optimal care. Reference: AACN Graduate-Level QSEN Competencies: Knowledge, Skills and Attitudes

Informatics

The framework identifies informatics as the use of information and technology to communicate, manage knowledge, mitigate error, and support decision-making. Reference: AACN Graduate-Level QSEN Competencies: Knowledge, Skills and Attitudes

Graduate-Level Emphasis

Compared with entry-level expectations, the graduate-level QSEN KSAs emphasize analysis, leadership, systems thinking, use of benchmarks and outcome data, change management, and leading improvement in context. The indexed material highlights a role for graduate-prepared nurses in mentoring others, evaluating system performance, and advancing improvement at the organizational and community levels. Reference: AACN Graduate-Level QSEN Competencies: Knowledge, Skills and Attitudes

Key Takeaways for Study

• Know all six competencies and be able to define each one.
• Understand that each competency includes knowledge, skills, and attitudes.
• Recognize that graduate-level practice stresses leadership, systems improvement, data use, and safety culture.
• Connect quality and safety work to measurement, change management, evidence, collaboration, and patient partnership.

Reference: AACN Graduate-Level QSEN Competencies: Knowledge, Skills and Attitudes