Update on Phase II of NCSBN’s Transition to Practice Study NCSBN Long-Term Care Conference August 24, 2011 Josephine Silvestre, MSN, RN Nancy Spector, PhD, RN Associate, Regulatory Innovations
Update on Phase II of
NCSBN’s
Transition to Practice Study
NCSBN Long-Term Care Conference
August 24, 2011
Josephine Silvestre, MSN, RN
Nancy Spector, PhD, RN
Associate, Regulatory Innovations
2009 New Nurse:
“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.”- NC Transition Study
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
Background…
Advisory Board Company (2008)
Surveyed
5,700 frontline nurse leaders
400 nursing deans/directors/chairs
Background…
90% academic leaders believe their new
students are prepared.
10% of health system nurse leaders believe
new nurses are prepared.
Advisory Board Study
Biggest Improvement Needed:
Follow up
Initiative
Quality improvement
Time management
Tracking multiple responsibilities
Conflict resolution
Delegation
Background…
NCSBN hosted the Transition Forum
February 22, 2007
Speakers from other disciplines and countries all
came together.
Various research findings showed need for
transition programs.
Stakeholders agreed to a standardized
regulatory model (AACN, AONE, ANA,
NAPNES, NLN)
The Perfect Storm Brewing…
Expertise gap (Orsolini-Hain & Malone)
10% staff are new
graduates
50% turnover from
2011-2020 (Dracup & Morrris, 2007)
Practice Expectations: Hit the Ground
Running!
Transition to Practice: A
Missing Piece in Nursing
Lack of Transition Programs Affect
Safety and Quality
Patient safety
Competency
Retention
Visual Model
It’s a Collaborative Model
Modules
Illinois, North Carolina and
Ohio are the Study States: 113
sites
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.
Unique Study of Transition
1. Actual patient outcomes
2. Randomization to study or control group
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 –
Versant
5. Louis Fogg, PhD – Rush College of Nursing
Research ObjectivesPrimary:
To determine whether newly licensed nurses’
participation in NCSBN’s TTP model improves
safety and quality outcomes
Secondary:
To determine how well the preceptor module
prepares preceptors for their role
To identify the challenges, and potential solutions,
of implementing the NCSBN transition model
To determine cost/benefit analysis
Survey Measurement Tools
New Nurse Surveys
Demographics
Competency – NEC & QSEN
Satisfaction – Modified Brayfield & Rothe
Practice issues – NCSBN
Preceptorship experience – National
Institute of Health (NIH) and North
Carolina Foundation for Nursing
Excellence
Survey Measurement Tools
Preceptor Surveys
Demographics
Competency – NEC & QSEN
Preceptorship experience – NIH and
North Carolina Foundation for Nursing
Excellence
Phase I Patient Outcomes
Patient falls with and without injury
Postoperative thromboemboli
Hospital acquired pressure ulcers
Patient satisfaction with nursing care
Phase I Patient Outcomes
Catheter associated UTI
Central line associated blood stream
infections
Failure to rescue
Medication administration errors
LOS
Data Collection
Web-based data
collection system
Surveys/evaluations
Knowledge
assessments
Hospital outcomes
data
Confidentiality
Participants will receive individual
password-protected access to the website
Information collected from new nurses,
preceptors, nurse managers
Outcomes data entered by site coordinators
will be kept confidential; data will be
reported in aggregate
Phase I - Randomization to Model
or Control
Stratified by:
Rural, suburban, urban
Numbers of new nurses
Number of sites
Phase I – June 2011
Educate institutions regarding TTP study
Obtain informed consent and enroll
preceptors & their nurse managers
Preceptors (intervention group) completed
training module
Complete surveys
Phase I – July 2011
Obtain informed consent & enroll new
graduate nurses
Complete measurement tools
Demographic & Initial surveys
Knowledge Assessment
Initiate interactive online modules
To be completed within 3 months of start date
Each module will take approximately 6-10 hours
Phase II
Applications are being accepted for Phase II in
Ohio, Illinois and North Carolina
External validity
RNs and LPNs in settings other than hospitals
Long-term care, community-based facilities,
ambulatory care, etc.
Long-Term Care Facilities
Assisted living
Nursing homes
Rehab centers
Skilled nursing care centers
Community-Based Facilities
Home health
Public health
Visiting nurses
Ambulatory-Care Facilities
Free-standing urgent care
Free-standing surgical centers
Health care provider offices
Transition to Practice Website
Located at:
www.transitiontopractice.org
Timeline
The Future!!
Questions