1. Associate Director of Research
The Impact of Transition Experience on Practice of Newly Licensed Registered Nurses
Suling Li, PhD, RN
Associate Director of Research
NCSBN

2. Background New RNs struggling with transition into practice
Shortened gap between taking NCLEX and being licensed
High job stress and high turnover rates in new RNs
Complexity of health care environment
Increased workload due to acute nursing shortage

3. Goals 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

4. Conceptual Framework on Transition
Structure of transition
Content of transition
Characteristics of preceptors
Characteristics of the new nurse
Partnerships between the new nurse and the preceptor
Institutional support for both the new nurse and the preceptor

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

6. Assessing Outcomes Two perspectives: Perspective of the new RN
Perspective of his/her preceptor/mentor

7. Outcome Measures Clinical competence (35 items):
Clinical reasoning and judgment
Pt care delivery and management skills
Communication and interpersonal relationships
Recognizing limits and seeking help
Practice errors and risks for practice breakdown

8. Design
Survey of nurse-preceptor dyad

9. Sample Profile – Demographics
New RNs Preceptors
N: RN
BSNs % 31.5%
ADNs % 49.7%
Age (yrs)
Female % 92.2%
White % 88%

10. Characteristics of the New RNs
Hospital %
Full time %
English first language %
Graduates of USA programs 99.0%
With LPN experiences %
Employed in urban area %
Months of working experience 11.4

11. Characteristics of Preceptors
Experience in nursing
Experience in current position
>1 year experience on the unit
As preceptor for this nurse
As a preceptor for any nurse
Standardized training
Took courses on their own
Recommended by supervisor
13.7 yrs
8.6 yrs
81%
3.6 months
3.9 yrs
49%
11%
74%

12. Workload of Preceptors
Client care assignment:
Yes, regular load %
Yes, reduced load 31.7%
No %

13. Pre-Graduation Synthesis Experience
ADNs BSNs
(n=335) (n=181)
Synthesis course required % 68.2%
Length of the course (wks)

14. Transition Experience%
No orientation or internship
2.0
Routine orientation only
24.3
Internship or plus
73.8

15. Internship Experience

16. Duration of Transition

17. Preceptor Involvement

18. Content of Transition Programs

19. Days Before First Patient Care Assignment

20. Patient Care Assignment

21. Patient Care Assignment

22. Clinical Competence: Overall

23. Clinical Competence: Subconcepts

24. Most Competent Areas Almost Always (%)
Administer medications accurately
92.3
Maintain safe & respectful environment
83.6
Accurately perform client assessment
80.2
Perform technical skills accurately
79.7
Do what is right for clients no matter what
73.4

25. Least Competent areas Almost always %
Appropriately utilize research findings
32.7
Meet clients cultural needs
41.5
Strategically delegate and supervise others
41.7
Recognize when demands exceed capability
47.4
Manage time and workload effectively
49.1
Use info. technology to enhance care
49.3
Synthesize data from multiple sources
50.0

26. Clinical Competence During 1st Year Overall
New RNs
Preceptors

27. Clinical Competence During 1st Year Subconcepts

28. Clinical Competence and Work Setting

29. Transition and Clinical Competence
During first 3 months of practice, those who had a primary preceptor performed at a higher competent levels (B=0.45), especially in the areas of communication and interpersonal relationships (B=.51), as well as recognizing limits and seeking help (B=.49).

30. Practice Errors Only once % More than once % Total % Medication errors
Only once %
More than once %
Total %
Medication errors
30.4
12.8
43.2
Client falls
22.8
12.1
34.9
Contribute to treatment delays
14.1
25.2
39.3
Charted on wrong client record
30.8
14.3
55.2
Missed physician/provider order
26.7
11.8
38.5
Misinterpreted physician/provider order
18.8
5.0
23.8
Error in performance of skills
18.0
10.2
28.2
Avoidable client death .4 .7
1.1
Client elopement
9.6
3.7
13.3

31. Practice Errors Index

32. Transition and Practice Errors

33. 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.

34. New RN Turnover* Changed position since being licensed. 21.2%
Planning to leave current position within 6 months
23.0%
*Either changed position or plan to leave, 40.0%

35. Transition and Turnover

36. Perceived Stress Almost Never % Some-times % Often/ Always %
Felt overwhelmed with pt care responsibilities
19.4
56.7
24.0
Fear of harming the pt due to inexperience
71.7
25.5
2.8
Felt expectations unrealistic
45.8
38.6
15.6

37. Perceived Stress During 1st Year

38. Clinical Competence and Stress

39. Transition and Stress
The longer the work experience the less the fear experienced by graduates about harming the patients (B=-.11)
Graduates who had an internship (B=-.11) were less likely to feel expectations were unrealistic
Graduates who had a transition programs that addressed specialty knowledge (B=-.10) were less likely to feel expectations were unrealistic

40. Stress and Practice Errors
Beta
Felt overwhelmed by care responsibilities
.158
Feared harming client due to inexperience
.208
Felt expectations unrealistic
.137

41. Summary of Findings
Transition experiences of new RNs vary across practice settings
New RNs are more competent in the areas of pt care delivery and management, compared to the areas of clinical reasoning and judgment skills, as well as recognizing limits and seeking help
During the first 3 months of practice, new RNs who had a primary preceptor practiced at higher competent levels
Without the assistance of preceptors, new RNs practiced at less competent levels during their initial phase of independent practice

42. Summary of Findings
New RNs with preparation for specialty practice in transition programs made less errors
Less competent and/or stressed new RNs made more practice errors
New RNs who had an internship experience were less likely to leave their current position within the next 6 months

43. Acknowledgements Advisory Group: 2006 & 2007 NCSBN PR&E Committee
Nancy Spector, NCSBN Director of Education
Gino Chisari (Chair, 2006)
Brenda S. Jackson (Chair, 2007)
Mary Blubough (Board Liaison)
Connie Brown
Barbara Knopp
Barbara Newman
Cynthia Van Wingerden
Debra Werner
Lepaine McHenry
Marcy Echternacht
Therese Shipps
Mary Calkins
Mary Doherty, NCSBN Practice, Regulation, & Education Associate
Research Support
Data Collection: Lindsey Gross
Statistical Support: Richard Smiley

44. Contact Information
Suling Li, PhD, RN
Tel: (312)