A deeper insight for quality and safety revolution is at work with United States healthcare system and innovation in current medicine to improve safety and quality is the efficient focus of Quality Improvement. (QI). To correct the gaps in quality improvement overuse, underuse, and misuse of health services, six aims was identified namely safety, effective, patient-centered, timely, efficient, and equitable (IOM, 2012). The nursing profession interest has always been on ethical and justice related to quality of patient care, the distress on insufficient staffing and work situation makes it impossible to claim non-maleficence (Aiken et al., 2012; Martin, 2015).…