Transition of Nurses from Education & Practice Nancy Spector, Director of Education

Strategic initiative that seeks excellence in regulation Board needs: Unintended consequence of CAT PERCs recommendations Background

January – March 2002 Stratified random 1000 RNs (focus on RNs) 3 stage mailing 633 usable surveys 2002 Practice & Professional Issues Survey (Spring)

Surveys – Drs. Smith & Crawford Self reports Questions –Work environment –Education and transition –Involvement in errors and difficulty with assignments –Demographics

Outcome 1: Involvement in errors – 49% –Definition: incidents or occurrences that resulted in harm to clients or had the potential to place a client at risk for harm. You may have been involved as the one making the error, the supervisor of others making errors, or as the one discovering errors made by others. Outcomes

Problems understanding English & non English speaking clients & staff Problems reading or understanding MD orders Prior work as NA – more likely Prior work as PN – less likely OT – more likely Age – younger more likely Other Factors Related to Errors

20% too difficult Average days to first assignment: 8 days 13% said first assignment too challenging Outcome 2: Difficulty of Current Assignment

Self report of perceptions Definition of error Study Limitations

Secondary Analysis of Data for Transition Models Multiple chi squares and t-tests on variables

Knowledge type: General versus Specific –General includes core information –Specific includes specialty knowledge –Mixed results Evidenced-Based Models for Successful Transition

Specific knowledge –Fewer errors (p=.000) –Better prepared for current assignment (p=.047) Core knowledge –More prepared to function as a team (p=.036) –More prepared to provide teaching (p=.024) Evidenced-Based Models for Successful Transition (Cond)

Provide a transition program with core knowledge and also specialty knowledge. * Best Practice Recommendations

Evidenced-Based Models for Successful Transition (Cond) Placement of transition programs –Before or after graduation –Pre hire versus post hire –Pre licensure versus post licensure

Evidenced-Based Models for Successful Transition (Cond) Placement of transition programs –Fewer errors with post graduate programs (p=.004) –Better prepared for current assignment with post graduate programs (p=.015)

Evidenced-Based Models for Successful Transition (Cond) * Best Practice Recommendation: Post hire/pre licensure transition programs –Kentucky Model

Evidenced-Based Models for Successful Transition (Cond) Mandatory versus Voluntary Programs –Mixed results –Mandatory – more errors (p=.044) –Voluntary – less prepared to administer meds (p=.027) No recommendation – bears watching

Evidenced-Based Models for Successful Transition (Cond) Same mentor with same schedule –More confidence (sum score) (p=.000) –Evidence supports increase confidence * Best Practice Recommendation: Same mentor with same schedule

Evidenced-Based Models for Successful Transition (Cond) * Best Practice Recommendation: For regulators the following are key aspects of education: –Making decisions –Providing direct care to 2 clients –Knowing when and how to call the physician –Supervising care –Working effectively within a health team

2003 Employers Survey (Drs. Crawford & Smith) – 1189 employer responses – 41.9% said new RN (BSN & ADN) provide safe, effective care Other Research

2003 Employers Survey (Drs. Crawford & Smith) –69.1% said their transition programs last 6.7 weeks –Longterm care offered the least –Employers rated these skills as most important: 1.Critical thinking or clinical decision-making 2.Therapeutic relationships 3.Medication administration 4.Management leadership 5.Psychomotor skills Other Research (Cond)

Experienced and new nurses July 2002 – June 2003 N=592 Design 56% standardized transition 36% customized transition Type 62% preceptorship 21% orientation Survey Spring 2003 (Drs. Smith & Crawford)

1.Critical thinking and clinical decision-making 2.Medication administration 3.Psychomotor 4.Therapeutic relationship 5.Management/leadership Most Important Skills (Students)

Collaborate with VNIP Investigate HRSA work with residencies Study on outcomes –Vermont –Kentucky –National Develop model based on outcomes NCSBN Future

The art of progress is to preserve order amid change and to preserve change amid order. Alfred North Whitehead