The Quality and Safety Education for Nurses (QSEN) initiative has played an important role in transforming how nursing can improve quality and safety in education and practice. Assessing whether a nurse is competent to perform the duties of his or her job role involves more than completing a skills checklist. The American Academy of Ambulatory Care Nursing’s Ambulatory Care Registered Nurse Residency Program used the QSEN framework to support development of competencies that will provide the new nurse to the ambulatory care setting with the knowledge, skills, and attitudes to provide safe quality care.