Transition to Practice Regulatory Model: Implementing Change Nancy Spector, Director of Regulatory Innovations NM Statewide Nursing Faculty Conference June 4, 2009, 1:00-2:30 p.m.

Mission of NCSBN The National Council of State Boards of Nursing (NCSBN), is composed of Member Boards, provides leadership to advance regulatory excellence for public protection.

Resources for Educators  Go to: programs & services  For Transition:  Leader to Leader 

Background of the Problem

 Benner’s work over 20 years  Kramer’s “Reality Shock,” from 1974

Background… NCSBN delegates voted in 2002 to: “Identify and promote effective models to facilitate a successful transition of new nurses from education to practice.” and “Participate in strategies for retention of the new graduate.”

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

Transition to Practice: A Missing Piece in Nursing

Background…  Turnover rates (2006 Nurse Executive Center: “Transitioning New Graduates to Hospital Practice”)  One Year- 36%  Two Years- 75%  Three Years- 50%

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)

Background…  Computerized NCLEX, allowing for almost immediate licensure  Context of practice: “frenzy”  Health care becoming more complex  Nursing shortage  IOM and other studies on patient safety

Transition to Practice Work  Goals: To promote public safety by supporting newly licensed nurses during their critical entry period and progression into practice.  Premises  Definitions

Transition to Practice Model

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

Description of Model  1 year institutional support  Feedback and reflection  License renewal

Description of Model  Website plans for modules  Preceptorship training  QSEN for RNs

Transition to Practice Fact Sheet The problem The impact The solution

Transition to Practice Evidence Grid  International Work  National Work  Individual Work

FAQs…  Why should this be implemented through regulation?  How was the model designed?  Are you seeing this as a failure of education and/or practice?

FAQs…  Are the modules just re-teaching?  What about cost?  How can this be implemented in rural areas?

FAQs…  Will NCSBN mandate transition to practice in all boards?  What about the current climate of job shortages?

It’s a Collaborative Model

Collaborative Input… Formally with 14 organizations as well as our membership:  Pilot before mandating through regulation  Consider costs

Collaborative Input…  Outcomes from pilots will be important  Successful national programs are being implemented  Be sure LPN needs are met  Tightening of job market

Collaborative Input…  Preceptor training  Several states are interested in piloting  Timeframe needed  Embraced the model for being inclusive  Willingness for collaboration

Transition Dashboard  Pilots (June 2011)  Modules  Marketing  Business Plan

Transition Dashboard  Preceptor Development  Research  Funding

Transition Tool Kit  Available at:

Transition Tool Kit  Evidence grid  Fact sheet  FAQs  Most recent article  Dashboard

Transition Tool Kit  Goals/definitions/premises  Model description  Example of model rules for Boards  Example of Transition to Practice Verification form (TPV form)

Timeline  Business plan  Content outline for nurse (LPN and RN) modules  Convene research advisory panel  Develop specifics of pilots  Identify funding sources  stakeholder collaboration

Timeline  Develop nurse (LPN and RN) modules  Develop preceptor modules and online connections  Establish pilot sites  Identify funding sources  stakeholder collaboration

Timeline  Implement pilots  Collect data  Identify funding sources  stakeholder collaboration

Transition to Practice… “…the one goal that unifies us all – improvement both in individual patient care and in the health care delivery system – might be achieved.” - Marlene Kramer, 1974

The Future!!