1. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 10 New Graduate RN Transition to Practice Programs (Nurse Residencies)

2. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Transition to Practice Programs Focus: helping nursing students bridge from school to employment Residencies, externships, internships Formal program of active learning with educational sessions and work experiences for the newly licensed RN

3. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Arguments for Transition to Practice Programs Incongruence between expectations of education and employees Gap between academia and practice setting –Skills lacking –Lack of preparation for emotional demands –Questions about expectations for entry-level clinical judgment –Difficulty translating knowledge and theory into practice

4. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Arguments for Transition to Practice Programs Effects –Facilitation of “onboarding” –Reduction in turnover—less stressful Programs: focus on additional skills and competencies; not a repeat of academic program –Organization and priority setting; communication –Clinical leadership skills –Emergency response; end-of-life care –Specific technical skills

5. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins National Call California Institute for Nursing & Health Care National Council of State Boards of Nursing University Health System Consortium and the American Association of Colleges of Nursing Benner and work for the Carnegie Foundation Versant Advisory Board Company The Joint Commission Institute of Medicine

6. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Is the following statement true or false? Transition to practice programs are repetitive in nature, covering the same content as that which is covered in nursing school.

7. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer False. Transition to practice programs are not a repeat of nursing school content. Rather, they focus on additional skills and competencies to bridge the gap from school to practice.

8. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Hiring Dilemma: Unanticipated Fall-Out & Economic Recession Nursing shortage continuing to persist and likely to worsen “Perfect storm” brewing; attempts to curtail shortage (California) Unexpected “perfect storm” in 2008 for new RN graduates –Plummeting economy & hospital days and revenue; less demand for nurses –Experienced RNs working more –Financial hardships of hospitals

9. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Hiring Dilemma: Unanticipated Fall-Out & Economic Recession (cont.) Temporary concealment of chronic nurse shortage Conditions expected to pass  increasing demand for nurses and grossly inadequate supply Further worsened by demands of health care reform

10. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins California Story—Demonstration Project Surveys identifying issues Five regional forums held to report findings and determine solutions Solution: development of community-based transition programs for new graduate RNs in schools of nursing Programs –Schools providing classroom instruction –Clinical partners providing intense clinical instruction & preceptorships –QSEN competencies as standard for curriculum

11. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Is the following statement true or false? The nursing shortage currently is being overshadowed by the nation’s economic situation.

12. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer True. The economic situation of today is temporarily concealing the chronic nursing shortage. As the economy improves, it is expected to increase the demands for nurses, reemphasizing the grossly inadequate supply.

13. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins QSEN Competencies Knowledge, skills, attitudes to improve quality and safety of health care systems Prelicensure and graduate quality and safety competences Proposed targets for knowledge, skills, and attitudes (see Box 10.3)

14. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins School-Based Programs: Components NCLEX and licensure Local schools of nursing Academic or continuing education credit Common certificate of completion Clinical, didactic, simulation, skills lab, and e-learning 12 to 18 weeks in length; 24 hour/week commitment QSEN competencies as indicators

15. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins School-Based Programs: Components (cont.) QSEN-based evaluation tools Extended experiential learning opportunities Training to program preceptors Unfunded positions

16. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins School-Based Programs: Status and Evaluation Different from hospital-based residencies: clinical sites not required to hire participants ahead of time Characteristics reflecting Recommendation #3 of IOM report (implement nurse residency programs) Workgroup: goals and action steps for achievement; certificate of completion; statewide database Interest in programs growing Evaluation in progress

17. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Challenges & Threats Not intended to take the place of employer-based residencies Programs dependent on willingness of partners for qualified preceptors Concern over loss of clinical sites and preceptors by schools of nursing Possible difficulty securing qualified clinical faculty Increased workload on partners for program development and implementation

18. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Challenges & Threats (cont.) Securing of funding sources Employers possibly forgoing programs with improved economy and increased demand for nurses “Free labor” and the right thing to do

19. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Is the following statement true or false? A nurse participating in a school-based transition program would be required to spend at least 32 hours per week in the program.

20. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer False. Typically, school-based transition programs are 12 to 18 weeks in length with nurses being required to commit to 24 hours per week.

21. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins End of Presentation