Nursing Sensitive Quality Indicators (NSQI)

Table of Contents


Nursing is a complex practice consisting of diverse elements. In order to assess the effectiveness of the provided care, nursing sensitive quality indicators (NSQI) have been introduced. Several definitions of the concept exist, but they all involve a set of major components. For instance, Xiaoquan Xu defined NSQI as “numerical measures that quantify the effectiveness of nursing care, cost efficiency and organization performance” (as cited in Joseph & Samson, 2016, p. 254). According to another definition provided by Joseph and Samson (2016), NSQI is the “collection of data to identify and evaluate nursing outcomes on patient care or a health care system” (p. 254). It is clear that NSQI estimates the effectiveness of care by focusing on specific areas. Three types of NSQI exist, such as structural, process, and outcome indicators. Structural indicators, such as nurse staffing, nurses’ skill levels, certification level, and others, are often analyzed and revealed to the public. Outcome indicators, such as falls or ulcers, also receive considerable attention. Process indicators that include nursing interventions, as well as nurse satisfaction, receive less public attention. This tutorial addresses nurse job satisfaction relevance based on a literature review and an interview.

Nurses’ Job Satisfaction as an Important NSQI

This indicator was chosen due to its relevance and direct impact on the quality of care. It has been acknowledged that nurses’ job satisfaction has a substantial influence on patient outcomes and other NSQI (Hudgins, 2016). Many people tend to believe that nurses’ job satisfaction is a purely organizational aspect. Therefore, administrators, policymakers, and the public tend to pay little attention to this aspect, leaving the evaluation of this indicator to medical administrators. However, Hudgins (2016) notes that nurses’ job satisfaction is directly linked to patient outcomes and care quality because nurses displaying higher levels of satisfaction perform better and are committed to the provision of high-quality care. Stalpers and colleagues in their 2016 study found that these practitioners were also more willing to perform more tasks and focus on quality improvement (Stalpers et al., 2016). Hence, it is essential to measure this indicator in order to predict other NSQI and influence the quality of provided care.

Collection and Distribution of the NSQI

In order to collect data associated with nurses’ job satisfaction, diverse instruments are used in hospitals. For example, Chien and Yick (2016) note that some common tools include self-administered structured interviews, such as the Index of Work Satisfaction (nurses’ job satisfaction). Other data collection methods are the Michigan Organizational Assessment Questionnaire (nurses’ intention to quit), and Anxiety-Stress Questionnaire (job stress evaluation). The interviewed nurse reported that they mainly used the Index of Work Satisfaction. At that, in order to introduce this data collection method and make it effective, the hospital had to implement “meaning changes” (H. Johnson, personal communication, 2020). The relevance of nurses’ job satisfaction as an indicator was discussed and regarded as an integral part of quality improvement incentives.

The interviewee adds that significant resistance to the implementation of this change existed for a certain period. However, the benefits of monitoring this indicator became apparent quite soon. According to Hudgins (2016), job satisfaction enables managers to trace the changes in the working atmosphere and predict the deterioration of organizational performance. When the tool became incorporated into nursing practice, as well as the organizational culture, nurses became more responsible and accurate when completing their questionnaires.

Data collection is an ongoing process, and nurses complete the questionnaires on a regular basis. Once in three months or when care quality is assessed, nurses’ job satisfaction is measured, and the corresponding information is collected. Nurses receive questionnaires through corporate email and send completed forms through the existing information system. The data is analyzed automatically, which enhances the relevance of data and the cost-effectiveness of this measurement.

The interviewee also notes that the data is also disseminated in order to raise employees’ awareness of some indicators. The overall level of job satisfaction across different departments is available through the utilized information system. At that, the discussion of the findings is “rather rare,” and the data is often analyzed by administrators (H. Johnson, personal communication, 2020). At the same time, the understanding of the level of job satisfaction, as well as other indicators, has an impact on employees’ performance (Hudgins, 2016). Nurses are willing to discuss the existing issues, as well as the level of their satisfaction, as it tends to influence the working environment. The interviewee states that nurses reflect on and “discuss the underlying reasons” behind high or low levels of job satisfaction (H. Johnson, personal communication, 2020). These discussions lead to favorable outcomes as ineffective practices or policies are identified and improved. Therefore, it is essential to regularly disseminate the findings of surveys related to nurses’ job satisfaction.

The Role of Nurses

Clearly, nurses play an essential role in supporting accurate reporting as the indicator is based on their perceptions and attitudes. Hudgins (2016) claimed that it had been found that self-reporting was associated with a certain degree of bias and could depend on various factors. For instance, employees may try to report a higher level of satisfaction (than their actual satisfaction levels) due to their fear of losing the job or being treated differently. The interviewee mentioned this problem and claimed that it was addressed through discussions. Nurse leaders explained the employed “principles of confidentiality” and the major goals of reporting and this kind of data collection (H. Johnson, personal communication, 2020). The collection of this information was compared to reporting related to other aspects of care.

For instance, the interviewee recollected that some nurses’ practices, such as the documentation of medication administration, were compared with nurses’ self-reporting. The nurses were told that accurate reporting of their job satisfaction was similar to the proper documentation of the procedures mentioned above due to the potential outcomes of both indicators. Errors in medication administration reporting could lead to the deterioration of patient health status, while inaccurate reporting of the level of job satisfaction could lead to the deterioration of the quality of provided care. Since quality improvement was one of the organizational priorities, nurses knew that low performance was associated with an increase in medical errors and other undesirable consequences. Eventually, nurses started providing accurate information, which had a positive effect on reporting, as well as organizational performance.


To sum up, such nursing sensitive quality indicators as job satisfaction is a relevant measurement that is instrumental in maintaining a high quality of care. Many people, including healthcare professionals, do not associate it with patient outcomes and regard it as purely organizational. Nevertheless, the experience of various healthcare facilities suggests that this indicator should be regularly measured and discussed by the personnel. The analysis of nurses’ job satisfaction enables medical organizations to trace the changes in the working atmosphere and assess the effectiveness of some measures and changes. Nurses should also discuss this data in order to collaborate effectively and work on the development of effective strategies to address existing issues.


  1. Chien, W. T., & Yick, S. Y. (2016). . The Open Nursing Journal, 10(1), 99-112.
  2. Hudgins, T. A. (2016). . Journal of Nursing Management, 24(1), E62-E69. Web.
  3. Joseph, L., & Samson, R (2016). Indicators of nursing quality: Quantifying effects of nursing care interventions. International Journal of Current Multidisciplinary Studies, 2(5), 254-258.
  4. Stalpers, D., Kieft, R. A. M. M., van der Linden, D., Kaljouw, M. J., & Schuurmans, M. J. (2016). . BMC Health Services Research, 16(1). Web.

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