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
2 Chicago is a beautiful city Chicago is a beautiful city! We invite you to visit us whenever you have an opportunity.
3 Mission of NCSBNThe National Council of State Boards of Nursing (NCSBN), composed of Member Boards, provides leadership to advance regulatory excellence for public protection.
5 Background of Transition Initiative Context of practice: “frenzy”Health care becoming more complexNursing shortageComputerized NCLEX, making results available simultaneously
6 Background of Transition Initiative (Cont’d) 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 abnormalitiesDeficits supervising unlicensed personnelLacked psychomotor skillsUnable to respond effectively to emergencies
7 Background of Transition Initiative (Cont’d) 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 preceptor’s schedule.
8 Literature Nursing satisfaction Nurse retention/turnover Nurse confidenceCost-benefit of transition programs
10 Goals of the StudyTo describe the transition experience of newly licensed RNsTo identify factors that influence transitions into practiceTo 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 breakdownSecondary OutcomesStress levelJob turnover
12 New Nurse-Preceptor Dyad Two assessments:- New RN self-assessmentCorresponding preceptor/mentor assessment
13 Results: Transition Experience %No orientation or internship2.0Routine orientation only24.3Internship or plus73.8
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
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.
20 Results (Cont’d) 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
23 Results: Transition and Stress New RNs who had an internship were less likely to feel expectations were unrealisticNew RNs who had a transition programs that addressed specialty knowledge were less likely to feel expectations were unrealistic
24 2007 Transition Forum February 22, 2007 200 participants, 41 states, 5 countriesDiscuss vision of transitioning new graduates from broad perspectiveExamine national and international perspectives of transitioning new nursesSeek input from stakeholders and participants about effective transition models
25 Themes – Transition Forum Do the right thing for the right reasonsThe context of the workplace: Frenzy!A national, standardized transition program is desiredPreceptors need to be acknowledged and educatedArticulate the evidence to the practice arenaCollaborate 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 issueTransition is facilitated by active engagement of the new nurse and the preceptorTransition programs will improve practice and decrease errorsA standardized, national transition program will help the formation of professional nursesA standardized, national transition program will increase nurse retention
28 Conceptual FrameworkStructure, including type, duration, setting, preceptor involvementContent, including theoretical, clinical experiences, and learning lab/simulationCharacteristics/qualifications of preceptorsExpectations for competenciesDevelopment of new nurse/preceptor partnershipInstitutional support of new nurse/preceptor
29 Some Thoughts Flexible Robust: include all settings and all levels of educationNational Web site?Preceptor education?Relate to license?How do we gain consensus?Pilot study of states?
30 Next StepsNCSBN will look at feasibility of a national, standardized model