Aim: To understand the facilitators and barriers of quality improvement (QI) from the perspective of nurses and leaders at the frontline.

Background: Nurse engagement in QI has been associated with quality care and improved patient outcomes, yet nurse reported participation is low.

Methods: A descriptive qualitative design and purposive sampling was used to examine barriers and facilitators of nurse engagement.

Results: Facilitators 1) A leader's influence on a QI culture. Sub themes: creating buy-in, support of a just culture and working in partnership with nurses. Barriers 1) Barriers in organizational culture for nurses to lead QI. Sub themes: hierarchy, absence of a just culture, nurses' role not valued, lack of accountability for QI in nursing role, and resistance to change 2) Barriers in organizational structure for nurses to lead QI. Sub themes: manager disengagement, time pressure, lack of access to timely data, lack of QI knowledge, siloed departments, and lack of QI experts.

Conclusion: Barriers to QI engagement prevent nurses from fully engaging in QI. Creating a just culture and building the infrastructure to support nurse engagement is critical for success.

Implications for nursing management: Specific facilitators and barriers were identified that nurse leaders can assess in their practice setting and use relevant strategies to support engagement in QI.