Reference — Leadership & Management
Nursing Quality Indicators Reference
NDNQI nursing-sensitive indicators, HCAHPS domains, hospital-acquired conditions, indicator types, and the nurse's role in quality measurement for leadership and NCLEX preparation.
Educational use only. Quality indicators and benchmarks change annually. Consult your facility's quality department for current targets and reporting requirements. This material supports nursing education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional policy, or medical direction. Always follow facility protocols and current provider orders.
Types of Quality Indicators
| Indicator Type | Definition | Nursing Examples |
|---|---|---|
| Structure | Characteristics of the care setting — staff, facilities, resources | RN-to-patient ratio, RN education level, certification rate, staffing hours |
| Process | What was done for the patient — care activities and interventions | Fall risk assessment completion rate, CAUTI bundle compliance, hand hygiene rates |
| Outcome | The result of care — what happened to the patient | Patient fall rate, CLABSI rate, pressure injury rate, 30-day readmission rate |
NDNQI Nursing-Sensitive Indicators
The National Database of Nursing Quality Indicators (NDNQI) is the primary national repository for nursing-sensitive quality data. Hospitals submit data quarterly and receive benchmark comparisons to peer facilities.
| Indicator | Type | Nursing Responsibility |
|---|---|---|
| Patient fall rate | Outcome | Fall risk assessment, interventions, post-fall protocol |
| Falls with injury rate | Outcome | Prevent high-risk falls; non-skid footwear, bed alarm compliance |
| CLABSI rate | Outcome | Central line bundle adherence: hand hygiene, maximal barrier precautions, CHG, proper site selection, daily necessity review |
| CAUTI rate | Outcome | Catheter bundle: indication review, sterile insertion, perineal care, daily removal assessment |
| Hospital-acquired pressure injury (HAPI) | Outcome | Braden scale assessment, repositioning schedule, skin assessment, nutrition support |
| Restraint use rate | Outcome | Explore alternatives, assess every 2 hours, reassess need every shift |
| RN satisfaction / turnover | Structure | Impacts care quality; charge nurses promote staff wellbeing |
| Nursing hours per patient day | Structure | Reflects staffing adequacy; low NHPPD correlates with adverse outcomes |
HCAHPS Overview
HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) is the standardized patient satisfaction survey mandated by CMS. Scores affect Medicare reimbursement through the Hospital Value-Based Purchasing program.
Key HCAHPS domains nurses influence:
- Communication with nurses (most heavily weighted)
- Responsiveness of hospital staff
- Communication about medications
- Discharge information
- Hospital environment (cleanliness and quietness)
- Care transitions (follow-up plan, understanding of next steps)
Hospital-Acquired Conditions (HACs)
CMS does not reimburse hospitals for conditions patients develop during their stay that could have been prevented with proper care. These are called Hospital-Acquired Conditions (HACs).
Common HACs — all preventable with nursing care:
- Catheter-associated urinary tract infection (CAUTI)
- Central line-associated bloodstream infection (CLABSI)
- Surgical site infection (SSI)
- Ventilator-associated pneumonia (VAP)
- Pressure injuries (Stage III, IV, unstageable, DTPI)
- Patient falls with injury
- Wrong-site or wrong-patient surgery
- Vascular catheter-associated infection
NCLEX Focus Points
- →CLABSI and CAUTI are nursing-sensitive. Rates go up when nursing care slips. NCLEX expects nurses to know bundle elements for each.
- →HACs are not reimbursed. CMS non-payment applies — facilities bear the full cost of care for preventable conditions. This drives compliance.
- →HCAHPS = communication matters. Patient perception of nurse communication is the most weighted HCAHPS domain.
- →Outcome vs structure vs process. NCLEX may ask nurses to distinguish between types of indicators — outcomes are what happened; process is what was done; structure is the environment of care.
Related Resources
Standards & sources
Fact-checked Jun 21, 2026This page is written to align with American Nurses Association (ANA) — Nursing Administration: Scope & Standards · American Organization for Nursing Leadership (AONL). It is an educational summary, not a citation of any single document — always verify specific doses, values, and protocols against current guidelines and your facility policy. How we source content →