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

2. Welcome to Chicago!

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

4. Ohio

5. North Carolina

6. Illinois

7. Long-Term Care Home Health Ambulatory Care Public Health Total Illinois3032 -35 North Carolina2 -46 Ohio 7 - - -7 Total3932448

8. It Has Been a Collaborative Effort

9. 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

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

11. Special Gratitude

12. 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

13. 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

14. Background of the Problem

16. 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

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

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

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

20. Background… Research varies  Kovner (2009) – 26% in two years  Before economic downturn, as high as 35 -60%  What’s next? (Auerbach, Buerhaus & Staiger, 2011)

21. The Perfect Storm Brewing…  Expertise gap (Orsolini-Hain & Malone)  10% staff are new graduates  50% turnover from 2011-2020 (Dracup & Morrris, 2007)

22. Practice Expectations: Hit the Ground Running!

24. Transition to Practice: A Missing Piece in Nursing

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

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

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

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

29. 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

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

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

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

34. Visual Model

35. 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.

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

37. 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.

38. 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.

39. 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.

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

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

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

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

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

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

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

48. 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

49. 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

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

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

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

53. Timeline

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

55. The Future!!