Continuous improvement of nursing practice: experience in Québec

Health care professionals must be accountable for the quality of their practice and self-regulating professional organizations have the responsibility to ensure that the public receives the best possible care to which it is entitled. Québec's legislation mandates professional corporations to supervise the practice of their members. The nursing profession comes under that legislation and, at l'Ordre des infirmières et infirmiers du Québec, a program of professional inspection has existed since 1976. The philosophy of this program is based on individual and collective responsibility of nurses towards the continuous improvement of their practice and the enhancement of the quality of care they provide. Standards and criteria of competence were elaborated with the participation of groups of nurses, validated by large samples of the population and distributed to all nurses. Evaluation tools were devised and have progressed over the years. The concepts of self-evaluation (Bandura, Am Psychol 33: 344, 1978; Bandura, Prentice Hall, 1986; Knox and MacKay, Nurs Papers/Perspect Nurs 4: 17, 1982) and of self-managed collective development (Payette, Rev québécoise Psychol 5: 104, 1984) have inspired the program, allowing nurses to identify their needs, set priorities and determine their plan of action. A study to evaluate the impact of the program is now in progress. This article will describe the conceptual framework, the method of evaluation, its application, the reactions of nurses as well as some of the results observed concerning the improvement of practice and of quality of care.