10 March 2023

Integrating Nursing Quality Indicators into the Military Health System to Support Data-Driven Decisions

Researcher to Watch: COL Pauline Swiger, PhD, RN, CNL, CMSRN, USA


On the front lines of care, nurses and their leaders need insight. How well military treatment facilities are able to standardize nursing best practices can impact patients and employees.

Nurse scientist and Chief of Nursing Research at Madigan Army Medical Center, Army Colonel Pauline Swiger, PhD, RN, CNL, CMSRN, applies evidence-based best practices to improve the U.S. Army’s operations and deliver exceptional health care. COL Swiger oversees nursing researchers at Madigan who work on priorities aligned with the core mission of the U.S. Army Nurse Corps, as well as clinical nurse specialists who integrate research findings into the hospital system. COL Swiger has 22 years of experience serving in the U.S. Army Nurse Corps.

Under a descriptive pilot study managed by Geneva, COL Swiger is measuring the value and feasibility of leveraging data insights from the National Nursing Quality Indicators (NDNQI®) to determine how the data can be used to support decisions and spur improvement within the Military Health System’s MHS GENSIS. The NDNQI® was developed by the American Nurses Association in 2001 and is the only national nursing database that provides quarterly and annual reporting of structure, process, and outcome indicators to evaluate nursing care at the unit level. Linkages between nurse staffing, skill mix, the practice environment, and patient outcomes have been demonstrated using this database.

COL Swiger’s research team will be assessing the collection, submission, and use of the NDNQI® databases and resources. In addition, the team will appraise stakeholder perspectives of NDNQI® participation to determine compatibility with MHS Genesis and utility of the reports. NDNQI’s mission is to aid the nurse in patient safety and quality improvement efforts by providing research-based, national, comparative data on nursing care and the relationship of this care to patient outcomes. Ultimately, COL Swiger’s research will help military nurses spend more quality time working on data-based improvements and reduce the burden of data collection by nurses. If adopted system-wide, this initiative could improve nursing care throughout the MHS.

MHS GENESIS is the Department of Defense’s new electronic health record. When fully deployed, MHS GENESIS will provide the Department of Defense’s 9.6 million beneficiaries and 205,000 medical providers with a single, integrated health record across the continuum of care. MHS GENESIS began deploying in waves across the Military Health System in 2017 with full deployment anticipated at the end of calendar year 2023.

“Professional nurses have a responsibility to measure, evaluate, and improve practice – but our systems can be a barrier to these activities,” said COL Swiger. “The analytic capability of this national nursing database removes this barrier and allows nurses to spend their valuable time implementing solutions instead of hunting for data.”

COL Swiger has published 17 manuscripts on nursing research focused in the areas of care quality, nursing workforce, and nursing practice environment.

She was recognized for her career-long contributions to the field of nursing and patient care delivery as one of two active-duty Army nurses receiving a military nursing practice award for 2019. The award is presented to active-duty Army Nurse Corps officers in the ranks of major or lieutenant colonel who have made a noteworthy mark on military nursing and patient care delivery.

This research study titled “Data to Support Decisions: MHS Genesis and a National Nursing Database” was funded by the TriService Nursing Research Program (TSNRP) in 2022 under award number 11189-N23-B06.


Disclaimer: The views expressed do not reflect the official policy of the Army, the Department of Defense, or the U.S. Government.