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The Impact of Transition Experience on Practice of Newly Licensed Registered Nurses Suling Li, PhD, RN Associate Director of Research NCSBN.

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Presentation on theme: "The Impact of Transition Experience on Practice of Newly Licensed Registered Nurses Suling Li, PhD, RN Associate Director of Research NCSBN."— Presentation transcript:

1 The Impact of Transition Experience on Practice of Newly Licensed Registered Nurses Suling Li, PhD, RN Associate Director of Research NCSBN

2 Background New RNs struggling with transition into practice Shortened gap between taking NCLEX and being licensed High job stress and high turnover rates in new RNs Complexity of health care environment Increased workload due to acute nursing shortage

3 Goals To describe the transition experience of newly licensed RNs To identify factors that influence transitions into practice To examine the impact of the transition experience on clinical competence and safe practice issues of newly licensed RNs

4 Conceptual Framework on Transition Structure of transition Content of transition Characteristics of preceptors Characteristics of the new nurse Partnerships between the new nurse and the preceptor Institutional support for both the new nurse and the preceptor

5 Outcomes Primary Outcomes Clinical competency Practice errors and risks for practice breakdown Secondary Outcomes Stress level Job turnover

6 Assessing Outcomes Two perspectives: –Perspective of the new RN –Perspective of his/her preceptor/mentor

7 Outcome Measures Clinical competence (35 items): –Clinical reasoning and judgment –Pt care delivery and management skills –Communication and interpersonal relationships –Recognizing limits and seeking help Practice errors and risks for practice breakdown

8 Design Survey of nurse-preceptor dyad

9 Sample Profile – Demographics New RNsPreceptors N: RN560231 BSNs 32.8% 31.5% ADNs 60.7% 49.7% Age (yrs) 32.4 42.2 Female 94.4% 92.2% White 81.2% 88%

10 Characteristics of the New RNs Hospital 86.4% Full time 91.2% English first language 92.6% Graduates of USA programs 99.0% With LPN experiences 19.9% Employed in urban area 47.3% Months of working experience 11.4

11 Characteristics of Preceptors Experience in nursing Experience in current position >1 year experience on the unit As preceptor for this nurse As a preceptor for any nurse Standardized training Took courses on their own Recommended by supervisor 13.7 yrs 8.6 yrs 81% 3.6 months 3.9 yrs 49% 11% 74%

12 Workload of Preceptors Client care assignment: Yes, regular load 45.8% Yes, reduced load 31.7% No 22.5%

13 Pre-Graduation Synthesis Experience ADNsBSNs (n=335)(n=181) Synthesis course required33.8% 68.2% Length of the course (wks) 7.09.9

14 Transition Experience % No orientation or internship2.0 Routine orientation only24.3 Internship or plus73.8

15 Internship Experience

16 Duration of Transition

17 Preceptor Involvement

18 Content of Transition Programs

19 Days Before First Patient Care Assignment

20 Patient Care Assignment

21

22 Clinical Competence: Overall

23 Clinical Competence: Subconcepts

24 Most Competent Areas Almost Always (%) Administer medications accurately92.3 Maintain safe & respectful environment83.6 Accurately perform client assessment80.2 Perform technical skills accurately79.7 Do what is right for clients no matter what73.4

25 Least Competent areas Almost always % Appropriately utilize research findings32.7 Meet clients cultural needs41.5 Strategically delegate and supervise others41.7 Recognize when demands exceed capability47.4 Manage time and workload effectively49.1 Use info. technology to enhance care49.3 Synthesize data from multiple sources50.0

26 Clinical Competence During 1 st Year Overall New RNsPreceptors

27 Clinical Competence During 1 st Year Subconcepts

28 Clinical Competence and Work Setting

29 Transition and Clinical Competence During first 3 months of practice, those who had a primary preceptor performed at a higher competent levels (B=0.45), especially in the areas of communication and interpersonal relationships (B=.51), as well as recognizing limits and seeking help (B=.49).

30 Practice Errors Only once % More than once % Total % Medication errors30.412.843.2 Client falls22.812.134.9 Contribute to treatment delays14.125.239.3 Charted on wrong client record30.814.355.2 Missed physician/provider order26.711.838.5 Misinterpreted physician/provider order 18.8 5.023.8 Error in performance of skills18.010.228.2 Avoidable client death.4.7 1.1 Client elopement 9.6 3.713.3

31 Practice Errors Index

32 Transition and Practice Errors

33 Clinical Competence and Practice Errors New nurses who were more competent (r= -.35), especially in the areas of clinical reasoning ability (ß=-.38) and communication and interpersonal relationships (ß=-.33), made less practice errors.

34 New RN Turnover* *Either changed position or plan to leave, 40.0% Changed position since being licensed. 21.2% Planning to leave current position within 6 months 23.0%

35 Transition and Turnover

36 Perceived Stress Almost Never % Some -times % Often/ Always % Felt overwhelmed with pt care responsibilities 19.456.724.0 Fear of harming the pt due to inexperience 71.725.52.8 Felt expectations unrealistic 45.838.615.6

37 Perceived Stress During 1 st Year

38 Clinical Competence and Stress

39 Transition and Stress The longer the work experience the less the fear experienced by graduates about harming the patients (B=-.11) Graduates who had an internship (B=-.11) were less likely to feel expectations were unrealistic Graduates who had a transition programs that addressed specialty knowledge (B=-.10) were less likely to feel expectations were unrealistic

40 Stress and Practice Errors Beta Felt overwhelmed by care responsibilities.158 Feared harming client due to inexperience.208 Felt expectations unrealistic.137

41 Summary of Findings Transition experiences of new RNs vary across practice settings New RNs are more competent in the areas of pt care delivery and management, compared to the areas of clinical reasoning and judgment skills, as well as recognizing limits and seeking help During the first 3 months of practice, new RNs who had a primary preceptor practiced at higher competent levels Without the assistance of preceptors, new RNs practiced at less competent levels during their initial phase of independent practice

42 Summary of Findings New RNs with preparation for specialty practice in transition programs made less errors Less competent and/or stressed new RNs made more practice errors New RNs who had an internship experience were less likely to leave their current position within the next 6 months

43 Acknowledgements Advisory Group: 2006 & 2007 NCSBN PR&E Committee Nancy Spector, NCSBN Director of Education Gino Chisari (Chair, 2006) Brenda S. Jackson (Chair, 2007) Mary Blubough (Board Liaison) Connie Brown Barbara Knopp Barbara Newman Cynthia Van Wingerden Debra Werner Lepaine McHenry Marcy Echternacht Therese Shipps Mary Calkins Mary Doherty, NCSBN Practice, Regulation, & Education Associate Research Support Data Collection: Lindsey Gross Statistical Support: Richard Smiley

44 Contact Information Suling Li, PhD, RN Tel: (312) 525-3658 sli@ncsbn.org


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