Update on Phase II of NCSBN’s

Transition to Practice Study

NCSBN Long-Term Care ConferenceAugust 24, 2011

Josephine Silvestre, MSN, RNNancy 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, 2007Speakers 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 newgraduates

50% turnover from2011-2020 (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 – UCSF3. Mary Lynn, PhD, RN – University of North

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

Versant5. 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 SurveysDemographics

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