Update on Phase II of NCSBN’s Transition to Practice Study

1. Update on Phase II of NCSBN’sTransition to Practice Study NCSBN Long-Term Care Conference August 24, 2011 Josephine Silvestre, MSN, RN Nancy Spector, PhD, RN Associate, Regulatory Innovations

3. 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

4. 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

5. Background… Advisory Board Company (2008) Surveyed • 5,700 frontline nurse leaders • 400 nursing deans/directors/chairs

6. Background… • 90% academic leaders believe their new students are prepared. • 10% of health system nurse leaders believe new nurses are prepared.

7. Advisory Board Study Biggest Improvement Needed: • Follow up • Initiative • Quality improvement • Time management • Tracking multiple responsibilities • Conflict resolution • Delegation

8. 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)

9. The Perfect Storm Brewing… • Expertise gap (Orsolini-Hain & Malone) • 10% staff are new graduates • 50% turnover from 2011-2020 (Dracup & Morrris, 2007)

10. Practice Expectations: Hit the Ground Running!

12. Transition to Practice: A Missing Piece in Nursing

13. Lack of Transition Programs Affect Safety and Quality • Patient safety • Competency • Retention

14. Visual Model

15. It’s a Collaborative Model

16. Modules

17. Illinois, North Carolina and Ohio are the Study States: 113 sites

18. 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.

19. Unique Study of Transition • Actual patient outcomes 2. Randomization to study or control group

20. Research Advisory Panel Participants • Jane Barnsteiner, PhD, RN, FAAN – University of Pennsylvania • Mary Blegen, PhD, RN, FAAN – UCSF • Mary Lynn, PhD, RN – University of North Carolina, Chapel Hill • Elizabeth Ulrich, EdD, RN, FACHE, FAAN – Versant • Louis Fogg, PhD – Rush College of Nursing

21. Research Objectives Primary: • 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

23. 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

24. Survey Measurement Tools Preceptor Surveys • Demographics • Competency – NEC & QSEN • Preceptorship experience – NIH and North Carolina Foundation for Nursing Excellence

25. Phase I Patient Outcomes • Patient falls with and without injury • Postoperative thromboemboli • Hospital acquired pressure ulcers • Patient satisfaction with nursing care

26. Phase I Patient Outcomes • Catheter associated UTI • Central line associated blood stream infections • Failure to rescue • Medication administration errors • LOS

27. Data Collection • Web-based data collection system • Surveys/evaluations • Knowledge assessments • Hospital outcomes data

28. 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

29. Phase I - Randomization to Model or Control Stratified by: • Rural, suburban, urban • Numbers of new nurses • Number of sites

30. 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

31. 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

32. 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.

33. Long-Term Care Facilities • Assisted living • Nursing homes • Rehab centers • Skilled nursing care centers

34. Community-Based Facilities • Home health • Public health • Visiting nurses

35. Ambulatory-Care Facilities • Free-standing urgent care • Free-standing surgical centers • Health care provider offices

36. Transition to Practice Website Located at: www.transitiontopractice.org

37. Timeline

38. The Future!!

39. Questions