Transition to Practice Regulatory Model: Implementing Change

1. Transition to Practice Regulatory Model: Implementing Change Nancy Spector, Director of Regulatory Innovations NM Statewide Nursing Faculty Conference June 4, 2009, 1:00-2:30 p.m.

3. Mission of NCSBN The National Council of State Boards of Nursing (NCSBN), is composed of Member Boards, provides leadership to advance regulatory excellence for public protection.

4. Resources for Educators • www.ncsbn.org/ Go to: programs & services • For Transition: https://www.ncsbn.org/363.htm • Leader to Leader • nspector@ncsbn.org

5. Background of the Problem

6. Background of the Problem • Benner’s work over 20 years • Kramer’s “Reality Shock,” from 1974

7. Background… NCSBN delegates voted in 2002 to: “Identify and promote effective models to facilitate a successful transition of new nurses from education to practice.” and “Participate in strategies for retention of the new graduate.”

8. 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

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

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

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

13. Transition to Practice: A Missing Piece in Nursing

14. Background… • Turnover rates (2006 Nurse Executive Center: “Transitioning New Graduates to Hospital Practice”) • One Year- 36% • Two Years- 75% • Three Years- 50%

15. 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)

16. Background… • Computerized NCLEX, allowing for almost immediate licensure • Context of practice: “frenzy” • Health care becoming more complex • Nursing shortage • IOM and other studies on patient safety

17. Transition to Practice Work • Goals: To promote public safety by supporting newly licensed nurses during their critical entry period and progression into practice. • Premises • Definitions

18. Transition to Practice Model

19. Description of Model • Pass NCLEX • Separate Orientation • Flexible and robust • 6 month preceptorship

20. Description of Model • 1 year institutional support • Feedback and reflection • License renewal

21. Description of Model • Website plans for modules • Preceptorship training • QSEN for RNs

22. Transition to Practice Fact Sheet • The problem • The impact • The solution

23. Transition to Practice Evidence Grid • International Work • National Work • Individual Work

24. FAQs… • Why should this be implemented through regulation? • How was the model designed? • Are you seeing this as a failure of education and/or practice?

25. FAQs… • Are the modules just re-teaching? • What about cost? • How can this be implemented in rural areas?

26. FAQs… • Will NCSBN mandate transition to practice in all boards? • What about the current climate of job shortages?

27. It’s a Collaborative Model

28. Collaborative Input… Formally with 14 organizations as well as our membership: • Pilot before mandating through regulation • Consider costs

29. Collaborative Input… • Outcomes from pilots will be important • Successful national programs are being implemented • Be sure LPN needs are met • Tightening of job market

30. Collaborative Input… • Preceptor training • Several states are interested in piloting • Timeframe needed • Embraced the model for being inclusive • Willingness for collaboration

31. Transition Dashboard • Pilots (June 2011) • Modules • Marketing • Business Plan

32. Transition Dashboard • Preceptor Development • Research • Funding

33. Transition Tool Kit • Available at: https:www.ncsbn.org/363.htm

34. Transition Tool Kit • Evidence grid • Fact sheet • FAQs • Most recent article • Dashboard

35. Transition Tool Kit • Goals/definitions/premises • Model description • Example of model rules for Boards • Example of Transition to Practice Verification form (TPV form)

36. Timeline 2009-10 • Business plan • Content outline for nurse (LPN and RN) modules • Convene research advisory panel • Develop specifics of pilots • Identify funding sources • stakeholder collaboration

37. Timeline 2010-11 • Develop nurse (LPN and RN) modules • Develop preceptor modules and online connections • Establish pilot sites • Identify funding sources • stakeholder collaboration

38. Timeline 2011-12 • Implement pilots • Collect data • Identify funding sources • stakeholder collaboration

39. Transition to Practice… “…the one goal that unifies us all – improvement both in individual patient care and in the health care delivery system – might be achieved.” -Marlene Kramer, 1974

40. The Future!!