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 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 (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 abnormalities
Deficits supervising unlicensed personnel
Lacked psychomotor skills
Unable 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 confidence
Cost-benefit of transition programs

9. NCSBN’s New Transition Research (2006-2007)

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 only
24.3
Internship or plus
73.8

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 (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

21. Results: Perceived Stress During 1st 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, 2007
200 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