Abstract
BACKGROUND: As global healthcare systems face increasing pressure from population aging and diversified patient needs, ensuring high-quality, standardized nursing services has become a strategic priority. However, persistent gaps in nursing quality control mechanisms hinder the delivery of efficient, patient-centered care, especially in large-scale hospital systems. OBJECTIVE: This study aims to identify structural barriers in nursing quality control implementation and to provide evidence-based insights for improving nursing management and service effectiveness in tertiary hospitals. METHODS: A qualitative study was conducted using data collected from nursing quality control inspections in 59 tertiary hospitals in Shanghai during the second half of 2024. A total of 46 experts from 23 professional groups participated. Data were analyzed using content analysis to extract recurring themes and sub-themes. The study was ethically approved by the Tenth People's Hospital affiliated with Tongji University. RESULTS: Three major themes and seven sub-themes were identified. The primary issues included: (1) inadequate standardization of nursing procedures and operational protocols; (2) insufficient professional competency and training of nursing staff; and (3) deficiencies in nursing informatization and quality improvement systems. Underlying factors included disjointed management frameworks, superficial capacity-building efforts, and fragmented digital infrastructure. CONCLUSION: The findings highlight significant structural contradictions between institutional frameworks and clinical execution of nursing quality control, which are not unique to the local setting but may reflect broader challenges in complex healthcare systems. Future research should incorporate quantitative outcome indicators to evaluate the real-world impact of nursing quality initiatives and inform the development of scalable, evidence-based strategies for enhancing nursing performance and ensuring patient safety. CLINICAL RELEVANCE: This study provides actionable insights for hospital administrators and nursing managers to optimize nursing quality control systems. By addressing procedural standardization, professional competency development, and informatics infrastructure, the findings offer a practical framework for improving nursing quality and patient safety in tertiary hospitals.