1. Project Director: Peggy Hawkins, RN, PhD peggyhawkins1@creighton.edu Sheila.Exstrom@nebraska.gov Statistics: June Smith, RN, PhD

2.  Grant from Center for Regulatory Excellence to study educational needs of RNs and LPNs in rural and urban Nebraska including both long-term care and acute care facilities.  Project launch Spring 2010  Conclusion Spring 2012

3.  Phase One: ◦ Determine educational needs  Phase Two: ◦ Quasi-experimental study of new graduates ◦ Purpose to determine whether educational modules and preceptor development made a difference in new graduate transition to practice  Phase Three: ◦ Analysis of data

4.  Representatives from the 5 nursing organizations  Nebraska Board of Nursing  Nebraska Assembly of Deans and Directors  Licensed Practical Nursing Association of Nebraska  Nebraska Organization of Nurse Leaders  Nebraska Nurses Association

5.  Baseline data: 2009 new nursing graduates by mailed questionnaires plus interviews and expert panel Delphi study  Determined which modules to develop for the educational intervention

6.  Do new nursing graduates who have online educational modules and preceptors who attended a preceptor development program have greater satisfaction, higher confidence, and less errors than new graduates who have regular orientation programs?  Secondary question was to estimate costs.

7.  Control ◦ Surveys  Managers  Preceptors  New nursing graduates ◦ Observational studies  Interventions introduced ◦ Educational Modules ◦ 8 Preceptor programs (n = 239 at 22 facilities)  Treatment ◦ Surveys  Managers,  Preceptors  New grads ◦ Observational studies

8. Control GroupTreatment Group New Graduate Interim Conclusion 97 40 60 45 Preceptors Interim Conclusion 118 81 56 57 Managers3029

9. Significant Items <.05ControlTreatment New Graduate: % Satisfied Assigned classes Length of transition 83% 85% 96% 97% New Graduate: % Prepared Make patient care decisions76%93% Preceptor perception: % of new grads prepared Delegate Tasks Make patient care decisions Administer meds to large groups Provide care to 6 or more 35% 43% 54% 25% 46% 75% 77% *17%

10. Preparedness Items <.05ControlTreatment Felt prepared to precept68%81% Develop coaching plans47%58% Develop new grad critical thinking54%78% Understand learning styles55%78% Evaluate new grad competence59%81% Utilize variety of teaching strategies 56%65% Assuring new grad gave safe care86%92%

11. Items <.05ControlTreatment Development of critical thinking in new grads 83%93% Resolution of issues/conflicts92%*80% Acting as a role model for my facility100%*98% Evaluating the competency of new graduates 81%92% Planning meaningful experiences for new graduates each work day 78%92%

12. Items <.05ControlTreatment Satisfied with new grads 88%96% Manager satisfaction with self60%100%

15. ControlTreatment New Graduatesn=47n=45 Number and % of new graduates reporting errors32 (68%)29 (64%) Total errors reported by new grads9788 Preceptorsn=84n=66 Number and % of preceptors reporting new grad errors51 (61%)34 (52%) Total errors reported by preceptors258120 Managersn=30n=29 Number and % of managers reporting new grad errors19 (63%)17 (59%) Total errors reported by managers206144

16. ControlTreatment Estimated cost per manager$1128$634 Estimated cost per preceptor$5900*$3932 Estimated total cost:$7028$4566

17. Control GroupTreatment Group New Graduate Rural Urban 48 56 27 33 Preceptors Rural Urban 54 64 34 38 Managers Rural Urban 18 11 9 19

18. ItemControlTreatment Preparation documenting care Urban Rural 72.7% 81.3% 77.8% *30% Preparation of preceptors (major/minor issue) Urban Rural 45.6% *93.4% 58.9% 55.5% Satisfaction with transition program Urban Rural 90% *40% 100% Client falls Urban Rural *80% 40% 57.1% 25.0% Treatment delays Urban Rural 77.8% *26.7% 46.2% 37.5% Costs estimate per new grad Urban Rural $417.65 *$1754.6 $546.59 $799.92

19. ItemControlTreatment Yes, enough time in transition Urban Rural 71.7% *93.5% 93.9% 88.5% Yes, each day unofficial preceptor Urban Rural 7.3% *27.7% 9.7% 0% Yes, courses improved general nursing knowledge in program Urban Rural 87.0% *68.9% 87.9% 80.0% Yes, courses improved specialty nursing knowledge in program Urban Rural 76.9% 61.9% 87.9% *60.0% Dissatisfaction with length of time Urban Rural 20.0% *6.5% 3.0% 3.8%

20. ItemControlTreatment Very satisfied with preceptor classes Urban Rural 31.3% *8.1% 33.3% 19.0% Very satisfied with ability to assist new grad decision making Urban Rural 54.7% *34.0% 54.5% 43.5% Very satisfied with developing critical thinking in new grad Urban Rural 31.5% *10.0 % 48.5% 20.8% Very satisfied with collegial support Urban Rural 42.3% *17.8 % 40.6% *27.3 %

21. Control (n = 7)Treatment (n = 10) CategoryfField Note Examplesf Safety52 Lack of proper identification (n=23) Lack of infection control (n=19) Improper hand hygiene (n=8) Hazards (n=2) 56 Lack of proper identification (n=16) Lack of infection control (n=22) Improper hand hygiene (n=10) Hazards (n=8) Medications16 Prep (n=12) Administration (n=4) 10 Prep (n=7) Administration (n=3) Privacy4 Enter without knocking (n=3) Patient information left out (n=1) 3Patient information left out (n = 3) Cares4 Missed weight ac (n=1) Omitted bruise assessment (n=1) Improper technique BG (n=1) Did not know how to transfer (n=1) 4 Omitted assessment (n=2) Improper technique BG (n=2) Communication 10Failed to inform or report (n=10)7 Fail to inform, report or chart timely manner (n=7) Total86 M=12 80 M=8

22.  New graduates ◦ Higher satisfaction ◦ More Prepared ◦ Fewer errors  Preceptors ◦ More prepared to precept  Managers ◦ Higher satisfaction  Costs estimates reduced

23.  New graduates need mentoring  Education assists in transition  Modules and trained preceptors reduce errors  Internships in programs of study are valued and positively impact transition  Preceptors educated in role are essential  Financial opportunities exist  Rural and urban patients deserve an equal opportunity to receive safe care

24.  The likelihood to provide safe, timely, effective, efficient, equitable, and patient- centered care to Nebraska patients during new graduate transition to practice improves when focused, standardized, and evidence- based educational modules are available/mandated for new graduates, and new graduates are paired with a consistent, formally educated preceptor.

25.  Lack of LPNs  Long-term care underrepresented  Limited generalization as pilot study