Using the PDSA Cycle for Clinical Change in Nursing

In today’s evolving healthcare landscape, nurses are not only caregivers but also essential drivers of clinical change and quality improvement. Continuous improvement in patient outcomes, safety, and efficiency is no longer optional—it’s expected. One of the most practical and widely used methods for implementing and sustaining such change is the Plan-Do-Study-Act (PDSA) cycle. The PDSA Cycle in Nursing offers a structured yet flexible framework for testing changes on a small scale, evaluating outcomes, and scaling up successful practices. As a key tool in quality improvement (QI), the PDSA cycle supports evidence-based nursing interventions and promotes a culture of continuous learning and adaptation.

Understanding the PDSA Cycle

The PDSA cycle was originally developed by Walter Shewhart and later refined by W. Edwards Deming as a core component of quality control and process improvement (Taylor et al., 2014). In healthcare, it has been widely adopted to guide iterative testing and improvement of clinical interventions. The four phases are:

Plan – Identify a clinical problem or area for improvement, set objectives, develop a strategy for change, and predict outcomes.
Do – Implement the intervention on a small scale.
Study – Analyze data collected during the implementation phase to assess the impact of the intervention.
Act – Based on the findings, adapt the intervention, expand it, or abandon it if it’s not effective.

This cycle emphasizes learning through action, encouraging healthcare professionals to use data-driven decision-making to enhance patient care (Institute for Healthcare Improvement [IHI], 2022).

Relevance of the PDSA Cycle in Nursing Practice

Nurses are uniquely positioned to identify areas in need of improvement due to their constant, front-line engagement with patients and systems. Using the PDSA cycle empowers nurses to take ownership of problems, collaborate with colleagues, and implement changes that directly impact patient outcomes.

1. Enhancing Evidence-Based Practice

The PDSA model aligns with the core principles of evidence-based nursing. It encourages nurses to test evidence-informed interventions in a real-world context and to refine practices based on observed results (White, Dudley-Brown, & Terhaar, 2021). For example, if research supports the use of hourly rounding to reduce patient falls, a PDSA cycle can test how this intervention performs in a specific unit or shift pattern before wider implementation.

2. Driving Patient Safety and Quality Improvement

Patient safety remains a cornerstone of nursing practice. Many safety initiatives—such as reducing hospital-acquired infections, improving medication administration accuracy, or streamlining discharge instructions—are implemented and refined using the PDSA cycle. Nurses can initiate these cycles as part of broader quality improvement efforts, helping to reduce errors and increase efficiency (Sherwood & Barnsteiner, 2017).

3. Encouraging Team-Based Change

PDSA cycles promote collaboration among nurses, physicians, administrators, and other healthcare professionals. They encourage shared accountability for outcomes and foster a problem-solving culture. This team approach enhances communication and interdisciplinary learning, which are essential for sustained improvements in complex care environments (Johnson et al., 2020).

Real-World Application: A Nursing-Led Fall Reduction Initiative

A common quality concern in hospitals is the incidence of patient falls, which can lead to serious injuries and extended hospital stays. In one nursing unit, a spike in falls during night shifts prompted a quality improvement project using the PDSA framework.

Plan: The team reviewed fall reports and identified that many incidents occurred between 2 a.m. and 4 a.m., when staff rounding was inconsistent. They planned to test a new hourly rounding protocol including a safety checklist and risk reminder signs at the bedside.
Do: The protocol was piloted over two weeks in one hallway of the unit, with nursing staff trained and supplied with tracking sheets.
Study: Data showed a 60% reduction in falls in the test area. Nurses reported that the new process was manageable and improved their awareness of high-risk patients.
Act: Based on the results, the rounding protocol was adjusted to include a quick visual check and then expanded to other areas of the unit.

This small test of change, supported by data, helped inform a broader policy change while engaging staff in a positive, manageable way (Taylor et al., 2014).

Overcoming Barriers to PDSA in Nursing

Despite its advantages, implementing the PDSA cycle in nursing practice can face several challenges:

Time constraints: Nurses often struggle to fit QI activities into already demanding workloads. Time must be protected for planning, data collection, and evaluation (Johnson et al., 2020).
Data collection skills: Many nurses are unfamiliar with QI data methods. Training in basic statistics and documentation practices is essential to help nurses feel confident in their role.
Lack of support: Without administrative backing or access to mentors, nurses may feel their efforts are undervalued or ignored. Institutional leadership must actively support nursing-led initiatives.

To overcome these barriers, nursing education programs and employers should include quality improvement training as a core competency and build it into performance development plans (Sherwood & Barnsteiner, 2017).

PDSA and Professional Growth

Beyond its clinical impact, the use of the PDSA cycle contributes to professional development for nurses. Participating in QI projects improves leadership skills, encourages critical thinking, and often aligns with career advancement opportunities or specialty certifications (White et al., 2021). It also fosters a sense of agency and professional pride, reinforcing the nurse’s role as both a caregiver and a change agent.

The PDSA Cycle in Nursing is more than a quality improvement tool—it’s a mindset that promotes continuous learning, safe experimentation, and collaborative change. By empowering nurses to identify problems, test solutions, and learn from outcomes, the PDSA cycle builds a foundation for evidence-based, patient-centered care. In an era where healthcare systems demand better outcomes, greater efficiency, and higher accountability, nurses who understand and apply the PDSA model are not only meeting expectations—they’re leading the way.

References

Institute for Healthcare Improvement. (2022). Science of improvement: Testing changes. https://www.ihi.org/resources/Pages/HowtoImprove/ScienceofImprovementTestingChanges.aspx

Johnson, J. K., Barach, P., & Vernooij-Dassen, M. (2020). Quality improvement strategies in nursing practice. BMJ Quality & Safety, 29(2), 89–93.

Sherwood, G., & Barnsteiner, J. (2017). Quality and safety in nursing: A competency approach to improving outcomes (2nd ed.). Wiley Blackwell.

Taylor, M. J., McNicholas, C., Nicolay, C., Darzi, A., Bell, D., & Reed, J. E. (2014). Systematic review of the application of the plan–do–study–act method to improve quality in healthcare. BMJ Quality & Safety, 23(4), 290–298.

White, K. M., Dudley-Brown, S., & Terhaar, M. F. (2021). Translation of evidence into nursing and health care (4th ed.). Springer Publishing Company.