Transition into Practice Study: Overview Nancy Spector, PhD, RN, Director of Regulatory Innovations Phase II Site Coordinator Meeting Chicago, February 1-2, 2012

Welcome to Chicago!

Illinois, North Carolina and Ohio: Selected as the Study States

Ohio

North Carolina

Illinois

Long-Term Care Home Health Ambulatory Care Public Health Total Illinois North Carolina2 -46 Ohio Total

It Has Been a Collaborative Effort

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 – Vice President, Hospital Services, CAE Healthcare 5.Louis Fogg, PhD – Rush College of Nursing

Your State Coordinators  Illinois – Debra Bacharz, PhD, RN  North Carolina – Ashley Trantham, MS  Ohio – Joyce Zurmehly, PhD, DNP, RN  Lea Yoakem, MSN, RN

Special Gratitude

Board of Directors  Myra Broadway, Maine – President  Shirley Brekken, Minnesota – Vice President  Julie George, North Carolina – Treasurer  Debra Scott, Nevada – Director  Betsy Houchen, Ohio – Director  Lanette Anderson, West Virginia – Director  Katherine Thomas, Texas – Director  Ann O’Sullivan, Pennsylvania – Director  Pam Autry, Alabama – Director  Julio Santiago, Illinois – Director  Emmaline Woodson, Maryland - Director

NCSBN Staff  Kathy Apple, CEO  Maryann Alexander, Chief Officer Nursing Regulation  Interactive Services Department  Finance Department  Human Resources Department  Information Technology Department  Marketing and Communications Department  Research Department  Regulatory Innovations Department

Background of the Problem

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… Research varies  Kovner (2009) – 26% in two years  Before economic downturn, as high as %  What’s next? (Auerbach, Buerhaus & Staiger, 2011)

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

Transition to Practice in Other Disciplines  Medicine, Pharmacy and Pastoral Services: CMS funding.  Physical Therapy: regulatory community is discussing it.  Teachers: “mentor induction programs.”

International Work with Transition to Practice  Australia  Canada  Ireland  Portugal  Scotland

National Bodies/Studies Recommending a Transition Program  UHC/AACN  Joint Commission (2003)  Carnegie Study of Nursing Education (2010)  IOM Future of Nursing report (2010)

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

The Real Evidence… “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.”  New graduate - NC Transition Study

Description of Model  Pass NCLEX  Separate Orientation  Flexible and robust  6 month preceptorship

Description of Model  Integration: feedback & reflection; safety & clinical reasoning  License renewal  Preceptors are trained

Institutional Support for One Year  Support starts at the top  Organizational communication about the program  Cooperation with personnel, resources, etc.  Celebration!

Visual Model

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 intervention or control group

Research Objectives Primary: To determine whether it is feasible to implement a standardized model for transitioning new RNs and LPNs/VNs to practice in long-term care, ambulatory care, home health care, and public health settings.

Research Objectives  To determine whether newly licensed RNs’ and LPNs’/VNs’ participation in NCSBN’s TTP model improves patient safety, leads to improved quality outcomes, and improves nurse retention.  To determine whether NCSBN’s preceptor module adequately prepares nurses for the preceptor role.

Research Objectives  To identify the challenges of and potential solutions for planning and implementing the transition model.  To determine the cost-benefit analysis to implement the TTP model.

Phase I  Internal Validity  RNs only  Hospitals: rural, suburban, urban, consortia  1500 new graduates were enrolled

Phase II  External validity  RNs and LPNs  Long-term care, home health, public health, and ambulatory care

Survey Measurement Tools New Nurse and Preceptor Surveys  Demographics  Competency – NEC & QSEN  Study: Evaluation of Modules

New Nurse Surveys  Knowledge assessment (pre- and post-)  Satisfaction – Modified Brayfield & Rothe  Practice issues - NCSBN

Preceptor Survey 360 degree – National Institute of Health and North Carolina Foundation for Nursing Excellence

Site Coordinator Surveys  Demographics  Patient satisfaction  Staffing/turnover  Number of patients

Site Coordinator: Perception of Outcomes Inventory  To be completed at all sites  Adapted from existing tool developed by Alexander & Kroposki

Site Coordinator Long-Term Care Patient Outcomes Survey  Unit and organizational level  Medicare Nursing Home Compare database Pressure ulcers Immunizations UTI’s Mobility Pain management

Site Coordinator Home Health Patient Outcomes Survey  Complete outcomes at organizational level  Medicare Home Health Compare Pain management Wound health Medication administration Immunizations Diabetes management

Site Coordinator Ambulatory Care Patient Outcomes Survey  Department and organizational level  Based on AHRQ standardized outcomes:  Falls  Immunizations  Medication reconciliation  Emergency room visits

Site Coordinator Public Health Patient Outcomes Survey  Program and organizational level Childhood immunizations Chlamydia Prenatal care

Reliability and Validity  Three sites in Chicago area  Reliability: Internal consistency  Validity: Two phases  Cognitive interviews  Factor analysis

Timeline

Transition to Practice… “The quality of our expectations determines the quality of our actions.” - A. Godin

The Future!!