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

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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.

Transition of New Graduates to Practice

Background of Transition Initiative Context of practice: “frenzy” Health care becoming more complex Nursing shortage Computerized NCLEX, making results available simultaneously

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

Background of Transition Initiative (Cont’d) 2002-03 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.

Literature Nursing satisfaction Nurse retention/turnover Nurse confidence Cost-benefit of transition programs

NCSBN’s New Transition Research (2006-2007)

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

Outcomes Primary Outcomes Clinical competency Practice errors and risks for practice breakdown Secondary Outcomes Stress level Job turnover

New Nurse-Preceptor Dyad Two assessments: - New RN self-assessment Corresponding preceptor/mentor assessment

Results: Transition Experience % No orientation or internship 2.0 Routine orientation only 24.3 Internship or plus 73.8

Results: Internship Experience

Results: Duration of Transition

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

Results: Clinical Competence

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.

Results: Transition and Turnover

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

Results: Perceived Stress During 1st Year

Results: Clinical Competence and Stress

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

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

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

Vision Transition program of 6-12 months Standardized National Collaboration of practice, education, regulation

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

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

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?

Next Steps NCSBN will look at feasibility of a national, standardized model

Questions nspector@ncsbn.org sli@ncsbn.org www.ncsbn.org