2. FNE Mission To improve health outcomes of our citizens by enhancing the practice of nursing through…. –leadership development –research –demonstration projects

3. FNE Vision To become a significant conduit through which innovative ideas related to health and healthcare can be evaluated and disseminated to the principal arenas of professional nursing and healthcare practice in North Carolina

4. The Niche and Role of The FNE A non-profit organization, bridging the activities of important sectors with separate and distinct interests in nursing practice and performance. Employers of Nursing Personnel Educators of Nursing Personnel Foundation For Nursing Excellence Governmental Entities Professional Associations

5. Board of Directors Beverly Foster, RN, PhD – Chair Janice McRorie, RN, MSN – Vice Chair Gordon DeFriese, PhD – Sec/Treas Lynda McDaniel, MPA Gary Bowers, JD Tremonteo Crawford, RN, MSN Mary Ellen Bonczek, RN, MPA Charles Willson, MD Chair, NC Board of Nursing Ex-officio Polly Johnson, RN, MSN, FAAN, President & CEO

6. Foundation History & Initiatives Created in 2002 by NC Board of Nursing Convened first Patient Safety Symposium in NC – 2005; Just Culture Enhancing new nurse competence and confidence development; retention Increasing # of BSN-prepared nurses in NC

7. Financial Support Grants to support specific projects from BCBSNCF, TDE, KBR, UNC-GA, RWJF/NWHF/Jonas Center Major support from leading healthcare systems in NC and the NCBON Individual donations

8. WNC RIBN Project

9. RIBN Background Partners Investing in Nursing (PIN) grant from RWJF/NWHF/Jonas Center for Nursing Excellence of NYC Multi-regional project (NC & NYC) Adapt Oregon (OCNE) model to increase supply & distribution of BSN-prepared RN s WNC Project Partners: WCU, AB Tech, FNE NC IOM Nursing Workforce Priority

10. Expected Outcomes Increase # of BSNs poised for higher degrees Increase RN preparation for complex, hi tech, fast-paced work environment Increase RN preparation in public health, gerontology, leadership Increase diversity of nursing workforce

11. Increasing Nurse Faculty Pipeline Current & increasing faculty shortage 65% of new nurses have ADN degrees 80% of current MSN/doctoral faculty began @ BSN level Only 15% of ADN graduates complete BSN degrees; 3% complete MSN or higher degree

12. New Educational Tract Partnership between community college and baccalaureate nursing programs Dual Acceptance/Dual Enrollment Four Year program: –Year 1: Meet prerequisites for both nursing programs @ community college –Years 2 -3: Complete ADN Program plus university courses; take NCLEX –Year 4: Complete BSN degree while eligible for employment as licensed RN

13. RIBN Project Status Finalize all CC and University entrance and curriculum requirements – Fall 2009 Hired RIBN Nursing Advisor 9/2009 1 st cohort of students begin Fall 2010; first BSN graduates in 2014 To serve as model for implementation across NC

14. Transition to Practice Project NC IOM Nursing Workforce Priority AHRQ-funded Research Conference 2005 Funders: BCBSNCF, TDE, KBR Phase I – 2006-08 –Survey existing transition programs in NC –Identify key elements that contribute to competence and confidence development

15. Phase I Study Population Newly Licensed RNs within 1 st 6 months of employment and their preceptors 3 comparison groups in 29 hospitals: –a nationally standardized assessment and competence development system –employer-developed formal transition programs –“traditional” new employee orientation programs

16. Phase I Research Questions What is the relationship of the type of transition to practice experience and: –progression of competency development –practice errors –risk for practice breakdown? What is the relationship of the preceptor characteristics to competency development among newly licensed RNs?

17. The Data Reveals… The better the quality rating of new nurse/preceptor relationship, the higher the new RN perceived competence (statistically significant across all 3 rounds of data collection) The higher the competency score, the fewer reported errors (statistically significant Rounds 2 and 3)

18. Competence Development Areas of Concern –Recognizing care demands exceeding ability –Effective time management/workload organization –Recognizing implications of clinical presentation –Appropriate use of research findings –Fully understanding assignments/physician’s orders (Statistically significant differences between comparison groups in Round 3)

19. Errors & Risk for Practice Breakdown 30-55% reported errors in 1 st 6 months >70% new nurses in all three rounds reported risk for practice breakdown occurring at least once New nurse identified a significantly higher risk for practice breakdown than that identified by the preceptor The longer the orientation period the fewer errors or risk for breakdown reported

20. Summary of Findings Quality of partnership with preceptor has a direct relationship with how competent new RNs feel about their nursing practice; competence links to fewer errors No one transition approach emerged as significantly superior to others in all perspectives 8 weeks = average length of orientation New RNs reported lower competence scores in clinical reasoning and judgment across all Rounds Full Report of Data Analysis @ www.ffne.orgwww.ffne.org

21. Phase II - Transition to Practice Project Identify Best/Promising Practices: –Preceptor role development/preparation –Preceptor interface with new nurse –Use of simulation in competence assessment and development Develop Interventions based on best/promising practices

22. Preceptor Role Development Best Practices Need organizational “buy in” for effective preceptor preparation and function. Preceptor selection criteria, competencies, position description, and performance evaluation, plus recognition are needed. Ongoing preceptor education and support are needed. A “tool box” for preceptors to use with new nurses helpful

23. Best Practices in Simulation Facilitator development & debriefing essential to successful use of tool Collaboration among organizations to decrease cost & maintain quality Build statewide “scenario” bank Relationship between SONs & healthcare delivery systems builds stronger baseline for new grad performance

24. Preceptor Role Development Training Package QSEN Competencies as framework Basic preceptor training principles in online learning modules On-site interactive learning modules using simulation scenarios Incorporates TeamSTEPPS and other patient safety training modules/concepts

25. Transition to Practice Project Timeline Phase II –Identification of Best Practices 2009 –Development of Interventions 2009 (in progress) Phase III –Pilot/evaluate/Revise Interventions 2010-11 –Training package available for use2012 Phase IV –Consider Preceptor Certification Program –Augment new nurse training scenarios –Finalize model for statewide implementation by 2015

26. Building a Just Culture Healthcare Community To enhance patient safety by supporting: –Cultural shift from “blame and shame” to learning and quality improvement –Analyze behaviors/causes of adverse events –Assign accountability Support current efforts of NC Hospital Center for Quality & Patient Safety and the NC BON Extend this framework into all delivery and regulatory systems

27. Questions? Please visit our website at www.ffne.org