Update on Phase II of NCSBN’s Transition to Practice Study NCSBN Long-Term Care Conference August 24, 2011 Josephine Silvestre, MSN, RN Nancy Spector, PhD, RN Associate, Regulatory Innovations

2009 New Nurse: “I am frightened for my patients and for my own license as I soon will be turned loose with only a resource person and expected to take a full load after only 5 days of orientation in my new assigned unit.” - NC Transition Study

Background… NCSBN 2002 & 2004 Employer Studies: “Yes definitely” to survey question regarding novice graduates being prepared to provide safe and effective care:  45% (2002) & 48.8% (2004)-diploma graduates  40% (2002) & 41.9% (2004)- BSN graduates  35% (2002) & 41.9% (2004)- ADN graduates  30% (2002) & 32.9% (2004)- PN graduates

Background… Advisory Board Company (2008) Surveyed  5,700 frontline nurse leaders  400 nursing deans/directors/chairs

Background…  90% academic leaders believe their new students are prepared.  10% of health system nurse leaders believe new nurses are prepared.

Advisory Board Study Biggest Improvement Needed:  Follow up  Initiative  Quality improvement  Time management  Tracking multiple responsibilities  Conflict resolution  Delegation

Background…  NCSBN hosted the Transition Forum February 22, 2007  Speakers from other disciplines and countries all came together.  Various research findings showed need for transition programs.  Stakeholders agreed to a standardized regulatory model (AACN, AONE, ANA, NAPNES, NLN)

The Perfect Storm Brewing…  Expertise gap (Orsolini-Hain & Malone)  10% staff are new graduates  50% turnover from (Dracup & Morrris, 2007)

Practice Expectations: Hit the Ground Running!

Transition to Practice: A Missing Piece in Nursing

Lack of Transition Programs Affect Safety and Quality  Patient safety  Competency  Retention

Visual Model

It’s a Collaborative Model

Modules

Illinois, North Carolina and Ohio are the Study States: 113 sites

Transition to Practice Study Longitudinal, randomized, multi- site study comparing patient outcomes in organizations that use our transition model versus those that use their traditional method.

Unique Study of Transition 1.Actual patient outcomes 2. Randomization to study or control group

Research Advisory Panel Participants 1.Jane Barnsteiner, PhD, RN, FAAN – University of Pennsylvania 2.Mary Blegen, PhD, RN, FAAN – UCSF 3.Mary Lynn, PhD, RN – University of North Carolina, Chapel Hill 4.Elizabeth Ulrich, EdD, RN, FACHE, FAAN – Versant 5.Louis Fogg, PhD – Rush College of Nursing

Research Objectives Primary:  To determine whether newly licensed nurses’ participation in NCSBN’s TTP model improves safety and quality outcomes Secondary:  To determine how well the preceptor module prepares preceptors for their role  To identify the challenges, and potential solutions, of implementing the NCSBN transition model  To determine cost/benefit analysis

Survey Measurement Tools New Nurse Surveys  Demographics  Competency – NEC & QSEN  Satisfaction – Modified Brayfield & Rothe  Practice issues – NCSBN  Preceptorship experience – National Institute of Health (NIH) and North Carolina Foundation for Nursing Excellence

Survey Measurement Tools Preceptor Surveys  Demographics  Competency – NEC & QSEN  Preceptorship experience – NIH and North Carolina Foundation for Nursing Excellence

Phase I Patient Outcomes  Patient falls with and without injury  Postoperative thromboemboli  Hospital acquired pressure ulcers  Patient satisfaction with nursing care

Phase I Patient Outcomes  Catheter associated UTI  Central line associated blood stream infections  Failure to rescue  Medication administration errors  LOS

Data Collection  Web-based data collection system  Surveys/evaluations  Knowledge assessments  Hospital outcomes data

Confidentiality  Participants will receive individual password-protected access to the website  Information collected from new nurses, preceptors, nurse managers  Outcomes data entered by site coordinators will be kept confidential; data will be reported in aggregate

Phase I - Randomization to Model or Control Stratified by:  Rural, suburban, urban  Numbers of new nurses  Number of sites

Phase I – June 2011  Educate institutions regarding TTP study  Obtain informed consent and enroll preceptors & their nurse managers  Preceptors (intervention group) completed training module  Complete surveys

Phase I – July 2011  Obtain informed consent & enroll new graduate nurses  Complete measurement tools  Demographic & Initial surveys  Knowledge Assessment  Initiate interactive online modules  To be completed within 3 months of start date  Each module will take approximately 6-10 hours

Phase II  Applications are being accepted for Phase II in Ohio, Illinois and North Carolina  External validity  RNs and LPNs in settings other than hospitals  Long-term care, community-based facilities, ambulatory care, etc.

Long-Term Care Facilities  Assisted living  Nursing homes  Rehab centers  Skilled nursing care centers

Community-Based Facilities  Home health  Public health  Visiting nurses

Ambulatory-Care Facilities  Free-standing urgent care  Free-standing surgical centers  Health care provider offices

Transition to Practice Website Located at:

Timeline

The Future!!

Questions