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Quality improvement (QI) aims to enhance local care processes within accepted standards, using rapid-cycle testing (PDSA) and operational metrics (e.g., 30-day ED visits). When interventions are evidence-based and the intent is internal improvement rather than generating generalizable knowledge, many institutions do not require formal IRB review—though privacy protections and governance still apply. However, boundaries can blur: if a project includes randomization, novel interventions, or plans to publish as research beyond typical QI reporting, IRB consultation may be necessary. Therefore, best practice is to submit a determination request to your IRB or QI office for classification. Assuming all data use mandates IRB (Option A/C) overregulates QI and can impede timely care improvements. Declaring QI never needs oversight (Option D) ignores institutional policies for data security/HIPAA, risk review, and ethical considerations. APRNs should define aims, measures, and methods clearly; secure appropriate approvals; ensure data de-identification where possible; and transparently communicate results within the health system.