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Any initiative of the magnitude of QSEN depends on two groups of leaders: thought leaders in the field and thought leaders within a funding organization. Within the professional community, the seeds for what became QSEN were sown in a series of annual summer week‐long conferences initiated and led by Paul Batalden, a pediatrician and one of the earliest health care quality thought leaders (Kenny, 2008). Started in 1995, these Dartmouth Summer Symposia (DSS) were invitational meetings for 60–70 participants, about 12–20 of whom in any given year were nurses. The nurse, physician, and hospital administrator educators who attended DSS described themselves as “an interprofessional community of educators devoted to building knowledge for leading improvement in health care.” Linda Norman, Associate Dean at Vanderbilt, was the first nursing leader who worked with Dr. Batalden to attract nursing deans and faculty members to this work.

Figure 3.1 QSEN Phases I and II: Aims and Actions. IOM, Institute of Medicine.

I had worked with Dr. Batalden during my years at Dartmouth‐Hitchcock Medical Center (1984–1998), participated in Quality Improvement Camp training, attended one summer symposium, and worked on a number of quality improvement projects. After I became a faculty member at the University of North Carolina (UNC) at Chapel Hill in 1998, I was invited to DSS regularly and subsequently served as the second representative of nursing in the leadership of the DSS community.

From 1997 to 2002, the DSS topics involved work underway within the physician community to alter educational objectives, curricula, and residency training accreditation and certification standards to include requirements for competency development related to the continuous improvement of health care. Leaders of the professional organizations responsible for these initiatives participated with us as we created and advanced ideas about content and learning opportunities that would, as was the stated DSS goal, “change the world.” Many subsequently participated in the Institute of Medicine (IOM) conference that resulted in the 2003 IOM publication Health Professions Education: A Bridge to Quality, wherein the charge was issued that all health professionals should be educated to deliver patient‐centered care as members of an interdisciplinary team, emphasizing evidence‐based practice, quality improvement approaches, and informatics. It was fascinating and exciting work.

Figure 3.2 QSEN Phase III: Embedding New Competencies. AACN, American Association of Colleges of Nursing; UNC, University of North Carolina‐Chapel Hill; VAQS, Veterans Administration Quality Scholars Program.

Each summer, Dr. Batalden would ask who was going to lead this work for nursing. We nurses would plot strategies for finding funding to advance this agenda and agreed that if anyone could secure funding, the rest of us would help. Each took away an assignment, and, for a couple of years, we came back empty‐handed. I presented proposal ideas to RWJF and one other foundation without results. Yet we persisted.

During this same period, seeds were being sown for QSEN on the RWJF leadership side as well. When I first unsuccessfully proposed the idea for a nursing faculty development initiative in quality and safety education to RWJF’s nursing leader, Susan Hassmiller, she was involved in directing the RWJF initiative Transforming Care at the Bedside (TCAB). She had recognized the importance of linking nursing faculty to the TCAB initiative and its quality/safety/cost goals. Beginning in 2002, first I and then Patricia Chiverton, dean of the University of Rochester School of Nursing, initiated attempts to work with the faculty in schools affiliated with the hospitals involved in the initiative. Few successes were achieved, however, primarily because nursing faculty were generally disconnected from the patient safety/quality improvement methods and goals being adopted by hospitals at the time. As Dr. Hassmiller pressed hospital leaders to engage nursing faculty in their projects, she experienced the faculty knowledge gap at first hand, and this evidence of the need for faculty development would eventually provide the strong rationale Dr. Hassmiller used to convince RWJF executive leaders to fund QSEN.

In another development, Rosemary Gibson, a senior program officer for RWJF and co‐author of the book Wall of Silence: The Untold Story of the Medical Mistakes That Kill and Injure Millions of Americans (Gibson and Singh, 2003), joined the DSS community in 2003 as a participant who could contribute the patient advocacy perspective to our conversations. She and Dr. Hassmiller were leading efforts that crossed the quality and nursing portfolios at RWJF, and over the course of the next year, we continued in discussions about ideas for an initiative that would improve quality and safety education in nursing.

In 2004, Ms. Gibson and I spent hours during DSS debating the merits of various approaches to an initiative and its proposed products. One consideration was whether this work should be housed in a nursing professional organization, an idea promoted by the American Association of Colleges of Nursing (AACN). Nurses in the DSS community argued that we needed to reach all of nursing education, which by definition included diploma and associate degree schools as well as faculty in collegiate schools that are affiliated with the National League for Nursing. We proposed that the “thought leader” work would be stronger if done by experts in quality and safety, rather than appointees of professional organizational task forces who at times are assigned for reasons other than topical expertise. We wanted to involve and share the work with leaders from all the organizations that supported nursing licensure, certification, or accreditation of nursing education programs, and thought that would more likely occur if the initial grant were housed in a neutral site. In the end, these views prevailed, and we received an official invitation to submit a proposal.

As the RWJF decision‐making processes advanced, Ms. Gibson provided guidance about the need to break the initiative into short phases that, if successful, could build on each other. We were charting unknown territory and did not yet have a basis for knowing how open or resistant nursing faculties would be to this paradigm shift. She suggested taking the work one piece at a time so that we could adapt the methods to the needs that emerged. Her experience with other major RWJF initiatives (e.g., palliative care) was invaluable, and the final proposal was a true partnership with a visionary philanthropic leader.

Members of the DSS community responded to proposal drafts and, most importantly, agreed to play key roles as members of the QSEN faculty (Barnsteiner, Disch, Moore, and Mitchell) and advisory board (Batalden and Hall). Ironside’s participation in the DSS community began soon thereafter. At the same time, Dr. Gwen Sherwood became the Associate Dean for Academic Affairs at UNC‐Chapel Hill. As someone experienced with patient safety initiatives, she was not only a knowledgeable local colleague but also someone with whom I could share the responsibilities of project management. We invited the participation of people we thought would be the strongest contributors with respect to each competency, area of pedagogical expertise, and the major nursing organizations associated with licensure and accreditation. Amazingly, every person invited to participate said yes.