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Designing Evidence-Based Models for Transitioning New Nurses to Practice Nancy Spector, PhD, RN Director of Education Suling Li, PhD, RN Associate Director.

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Presentation on theme: "Designing Evidence-Based Models for Transitioning New Nurses to Practice Nancy Spector, PhD, RN Director of Education Suling Li, PhD, RN Associate Director."— Presentation transcript:

1 Designing Evidence-Based Models for Transitioning New Nurses to Practice Nancy Spector, PhD, RN Director of Education Suling Li, PhD, RN Associate Director of Research

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3 Mission of NCSBN The National Council of State Boards of Nursing (NCSBN), composed of Member Boards, provides leadership to advance regulatory excellence for public protection.

4 Transition of New Graduates to Practice

5 Background of Transition Initiative Context of practice: frenzy Health care becoming more complex Nursing shortage Computerized NCLEX, making results available simultaneously

6 Background of Transition Initiative (Contd) Two NCSBN studies (2001 & 2003) of nurse employers found: –More than 50% of employers perceive that new graduates provide safe and effective care. –Employers reported the following weaknesses: Recognizing abnormalities Deficits supervising unlicensed personnel Lacked psychomotor skills Unable to respond effectively to emergencies

7 Background of Transition Initiative (Contd) developed the following evidence-based recommendations: –Placement - While immersion programs offered by nursing programs are valuable, posthire, structured transition programs are crucial. –Knowledge type - Transition programs should include general knowledge, but it should also include specialty content. –Same mentor/preceptor – New nurses benefit most when they work together with one preceptor, following the preceptors schedule.

8 Literature Nursing satisfaction Nurse retention/turnover Nurse confidence Cost-benefit of transition programs

9 NCSBNs New Transition Research ( )

10 Goals of the Study 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

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

12 New Nurse-Preceptor Dyad Two assessments: - New RN self-assessment –Corresponding preceptor/mentor assessment

13 Results: Transition Experience % No orientation or internship 2.0 Routine orientation only24.3 Internship or plus73.8

14 Results: Internship Experience

15 Results: Duration of Transition

16 Results: Transition and Clinical Competence During first 3 months of practice, those who had a primary preceptor performed at a higher competent levels, especially in the areas of communication and interpersonal relationships, as well as recognizing limits and seeking help. Without preceptor, new RNs (3-6 months) practiced at LESS competent levels during this phase of independent practice

17 Results: Clinical Competence

18 Results: 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.

19 Results: Transition and Turnover

20 Results (Contd) Perceived Stress (almost always) –Felt overwhelmed with patient care responsibilities – 24% –Experienced fear of harming patient due to inexperience – 2.8% (25.5% - sometimes) –Felt expectations unrealistic – 15.6% –All were significantly related to practice errors

21 Results: Perceived Stress During 1 st Year

22 Results: Clinical Competence and Stress

23 Results: Transition and Stress New RNs who had an internship were less likely to feel expectations were unrealistic New RNs who had a transition programs that addressed specialty knowledge were less likely to feel expectations were unrealistic

24 2007 Transition Forum February 22, participants, 41 states, 5 countries Discuss vision of transitioning new graduates from broad perspective Examine national and international perspectives of transitioning new nurses Seek input from stakeholders and participants about effective transition models

25 Themes – Transition Forum Do the right thing for the right reasons The context of the workplace: Frenzy! A national, standardized transition program is desired Preceptors need to be acknowledged and educated Articulate the evidence to the practice arena Collaborate extensively for buy-in

26 Vision Transition program of 6-12 months Standardized National Collaboration of practice, education, regulation

27 Premises of Transition Model(s) Failure to transition new nurses is a public safety issue Transition is facilitated by active engagement of the new nurse and the preceptor Transition programs will improve practice and decrease errors A standardized, national transition program will help the formation of professional nurses A standardized, national transition program will increase nurse retention

28 Conceptual Framework Structure, including type, duration, setting, preceptor involvement Content, including theoretical, clinical experiences, and learning lab/simulation Characteristics/qualifications of preceptors Expectations for competencies Development of new nurse/preceptor partnership Institutional support of new nurse/preceptor

29 Some Thoughts Flexible Robust: include all settings and all levels of education National Web site? Preceptor education? Relate to license? How do we gain consensus? Pilot study of states?

30 Next Steps NCSBN will look at feasibility of a national, standardized model

31 Questions


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