title: Measuring nurses' impact on health care quality: progress, challenges, and future directions.
abstract: BACKGROUND
  Quality measurement is central in efforts to improve health care delivery and financing. The Interdisciplinary Nursing Quality Research Initiative supported interdisciplinary research teams to address gaps in measuring the contributions of nursing to quality care.
  
  
  OBJECTIVE
  To summarize the research of 4 interdisciplinary teams funded by The Interdisciplinary Nursing Quality Research Initiative and reflect on challenges and future directions to improving quality measurement.
  
  
  METHODS
  Each team summarized their work including the targeted gap in measurement, the methods used, key results, and next steps. The authors discussed key challenges and recommended future directions.
  
  
  RESULTS
  These exemplar projects addressed cross-cutting issues related to quality; developed measures of patient experience; tested new ways to model the important relationships between structure, process, and outcome; measured care across the continuum; focused on positive aspects of care; examined the relationship of nursing care with outcomes; and measured both nursing and interdisciplinary care.
  
  
  CONCLUSIONS
  Challenges include: measuring care delivery from multiple perspectives; determining the dose of care delivered; and measuring the entire care process. Meaningful measures that are simple, feasible, affordable, and integrated into the care delivery system and electronic health record are needed. Advances in health information systems create opportunities to advance quality measurement in innovative ways.
  
  
  CONCLUSIONS
  These findings and products add to the robust set of measures needed to measure nurses' contributions to the care of hospitalized patients. The implementation of these projects has been rich with lessons about the ongoing challenges related to quality measurement.
authors.affiliation: University of Utah College of Nursing, Salt Lake City, UT 84112, USA. susan.beck@nurs.utah.edu
authors.forename: Susan L
authors.initials: SL
authors.lastname: Beck
authors.forename: Marianne E
authors.initials: ME
authors.lastname: Weiss
authors.forename: Nancy
authors.initials: N
authors.lastname: Ryan-Wenger
authors.forename: Nancy E
authors.initials: NE
authors.lastname: Donaldson
authors.forename: Carolyn
authors.initials: C
authors.lastname: Aydin
authors.forename: Gail L
authors.initials: GL
authors.lastname: Towsley
authors.forename: William
authors.initials: W
authors.lastname: Gardner
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002673:Child, Hospitalized; D002983:Clinical Competence; D003365:Costs and Cost Analysis; D003430:Cross-Sectional Studies; D005582:Foundations; D006801:Humans; D024802:Nurse's Role; D009741:Nursing Staff, Hospital / Q000600:supply & distribution; D019982:Organizational Case Studies; D010043:Outcome and Process Assessment, Health Care; D059408:Pain Management / Q000451:nursing; D010147:Pain Measurement; D010348:Patient Care Team; D010351:Patient Discharge; D010353:Patient Education as Topic; D017060:Patient Satisfaction; D010371:Pediatric Nursing; D010561:Personnel Staffing and Scheduling; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care; D012109:Research Support as Topic; D011795:Surveys and Questionnaires; D014481:United States; D055815:Young Adult