Transition into Practice Study: Overview

Nancy Spector, PhD, RN, Director of Regulatory Innovations

Phase II Site Coordinator MeetingChicago, February 1-2, 2012

Welcome to Chicago!

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

Ohio

North Carolina

Illinois

Long-Term Care

Home Health

Ambulatory Care

Public Health Total

Illinois 30 3 2  - 35

North Carolina 2  - 4 6

Ohio 7  -  -  - 7

Total 39 3 2 4 48

It Has Been a Collaborative Effort

Research Advisory Panel Participants

1. Jane Barnsteiner, PhD, RN, FAAN – University of Pennsylvania

2. Mary Blegen, PhD, RN, FAAN – UCSF3. Mary Lynn, PhD, RN – University of North

Carolina, Chapel Hill4. Elizabeth Ulrich, EdD, RN, FACHE, FAAN – Vice

President, Hospital Services, CAE Healthcare5. Louis Fogg, PhD – Rush College of Nursing

Your State Coordinators

Illinois – Debra Bacharz, PhD, RN

North Carolina – Ashley Trantham, MS

Ohio – Joyce Zurmehly, PhD, DNP, RN

Lea Yoakem, MSN, RN

Special Gratitude

Board of DirectorsMyra Broadway, Maine – PresidentShirley Brekken, Minnesota – Vice PresidentJulie George, North Carolina – TreasurerDebra Scott, Nevada – DirectorBetsy Houchen, Ohio – DirectorLanette Anderson, West Virginia – DirectorKatherine Thomas, Texas – Director Ann O’Sullivan, Pennsylvania – DirectorPam Autry, Alabama – DirectorJulio Santiago, Illinois – DirectorEmmaline Woodson, Maryland - Director

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

Background of the Problem

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…

Research varies

Kovner (2009) – 26% in two years

Before economic downturn, as high as 35 -60%

What’s next? (Auerbach, Buerhaus & Staiger, 2011)

The Perfect Storm Brewing…

Expertise gap (Orsolini-Hain & Malone)

10% staff are newgraduates

50% turnover from2011-2020 (Dracup & Morrris, 2007)

Practice Expectations: Hit the Ground Running!

Transition to Practice: A Missing Piece in Nursing

Transition to Practice in Other Disciplines

Medicine, Pharmacy and Pastoral Services: CMS funding.

Physical Therapy: regulatory community is discussing it.

Teachers: “mentor induction programs.”

International Work with Transition to Practice

AustraliaCanada IrelandPortugalScotland

National Bodies/Studies Recommending a Transition Program

UHC/AACN

Joint Commission (2003)

Carnegie Study of Nursing Education (2010)

IOM Future of Nursing report (2010)

Lack of Transition Programs Affect Safety and Quality

Patient safety

Competency

Retention

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

Description of Model

Pass NCLEX

Separate Orientation

Flexible and robust

6 month preceptorship

Description of Model

Integration: feedback & reflection; safety & clinical reasoning

License renewal

Preceptors are trained

Institutional Support for One Year Support starts at the top

Organizational communication about the program

Cooperation with personnel, resources, etc.

Celebration!

Visual Model

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 intervention or control group

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.

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.

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.

Phase I

Internal Validity

RNs only

Hospitals: rural, suburban, urban, consortia

1500 new graduates were enrolled

Phase II

External validity

RNs and LPNs

Long-term care, home health, public health, and ambulatory care

Survey Measurement Tools

New Nurse and Preceptor Surveys

Demographics

Competency – NEC & QSEN

Study: Evaluation of Modules

New Nurse Surveys

Knowledge assessment (pre- and post-)

Satisfaction – Modified Brayfield & Rothe

Practice issues - NCSBN

Preceptor Survey

360 degree – National Institute of Health and North Carolina Foundation for Nursing Excellence

Site Coordinator Surveys

Demographics

Patient satisfaction

Staffing/turnover

Number of patients

Site Coordinator: Perception of Outcomes Inventory

To be completed at all sites

Adapted from existing tool developed by Alexander & Kroposki

Site Coordinator

Long-Term Care Patient Outcomes Survey

Unit and organizational level Medicare Nursing Home Compare database

Pressure ulcersImmunizationsUTI’sMobilityPain management

Site CoordinatorHome Health Patient Outcomes Survey

Complete outcomes at organizational level Medicare Home Health Compare

Pain managementWound healthMedication administrationImmunizationsDiabetes management

Site Coordinator

Ambulatory Care Patient Outcomes Survey

Department and organizational level Based on AHRQ standardized outcomes:

Falls Immunizations Medication reconciliation Emergency room visits

Site Coordinator

Public Health Patient Outcomes Survey

Program and organizational levelChildhood immunizationsChlamydiaPrenatal care

Reliability and Validity

Three sites in Chicago area

Reliability: Internal consistency

Validity: Two phases

Cognitive interviews

Factor analysis

Timeline

Transition to Practice…

“The quality of our expectations determines the quality of our actions.”

-A. Godin

The Future!!