An Evaluation of a RN Transition Program

1. An Evaluation of a RN Transition Program Maria-Idalia O. Lens, RN, PHN, MSN, FNP-BC, DNP(c) DNP Oral Defense December 2011 http://mariaidalialens.wikispaces.com/

2. Background Growth of RNs Nursing shortage Nursing schools (high enrollment) New graduate RNs, not finding jobs CINHC (2010) Survey Transition to practice IOM report

3. Review of Literature CHOCUHS and AACN Residency programs (yearlong) Residency programs (decrease turnover, $40,000 nurse) Halfer-Graf (sense of belonging) Casey-Fink (increase in confidence, more support) Stress level, organization, communication, and leadership Acute care areas Cost (ROI) $

4. Framework Dreyfus Model of skill acquisition Novice, advanced beginner, competent, proficient, expert Benner’s stages of nursing Novice, advanced beginner, competent, proficient, expert

5. Implementation CINHC Betty-Moore Foundation Kaiser Community Fund SFBA nursing school (5 counties, 4 school)

6. Aim of Program Increase skills, confidence, and experience Retain new nurses in the profession Increase employability of new nurse graduates

7. Participants Applicant Criteria Program Criteria Facility requirements Program Coordinator

8. Methods Casey-Fink Graduate Nurse Experience Survey® (CFGNES®) (2006), online via SurveyGizmo™ (r=.71 to .90, alpha=.89) Brief QSEN (not determined, in process) Long QSEN (not determined) PreceptorshipExperience Survey (2006) (alpha=.97)

9. Casey-Fink Demographics: Age, education, ethnicity, etc… Skills: Most uncomfortable performing Stressors: Causes Role transition: Confidence in performing nursing roles i.e. delegating, autonomy, organization, errors, pt safety, and orientation.

10. Brief QSEN Patient centered care: Recognize the pt as a source and partner in compassionate and coordinated care in respect to preferences, values, and needs. Safety: Minimize risk of harm to pt’s in system effectiveness and individual performances. Evidence based practice: Integrate best evidence with clinical expertise and pt/family preferences.

11. Teamwork and collaboration: Function within nursing and inter-professional teams, communication, respect, and shared decision-making. Quality: Use data to monitor outcomes and improve methods to design and test changes to improve quality care. Informatics: Use technology to communicate, mitigate, and support decision making.

12. Preceptorship Experience Survey Questions 1-12 address experience (# perceptors, relationship with staff/preceptor) Questions 13-55 self evaluation of competency (skills) Question 56-65 demographics similar to Casey-Fink

13. Data Collection CFGNES® (pre and post program), online Brief QSEN (2 weeks into program and post program), paper Long QSEN (self evaluation), paper Preceptorship Experience Survey (post program), paper

14. Data Analysis Pre and post data: comparing answers for similarities and differences (CFGNES® and Brief QSEN) Kim Experience survey measure confidence Cohen’s d: effectiveness of program effect sizes as "small, d = .2," "medium, d = .5," and "large, d = .8"

15. Project Outcomes: Demographic: Cohort 1

16. Demographics: Cohort 2

17. Casey-Fink Skills: Cohort 1

18. Casey-Fink Skills: Cohort 2

19. Stressors Pre Data Finances (C1: 84.6%; C2: 90.9%) Living Situation (C1: 15.4%) Personal Relationships and job performances (C2 36.4%) Post Data Finances (C1:85.7%) Personal Relationships (C1: 42.9%)

20. Role Transition

21. Role Transition

22. Casey-Fink Analysis

23. Casey-Fink Analysis

24. Brief QSEN competency

25. Brief QSEN: Safety

26. Brief QSEN: EBP

27. Brief QSEN: Team and Collaboration

28. Brief QSEN: Professionalism

29. Brief QSEN: Quality

30. Brief QSEN: Informatics

31. Preceptor Experience

32. Evaluations 90% of participants obtained jobs in nursing. Jobs obtained were in acute care, school nursing, and community clinics. Program in non-acute area; aims meet, increase confidence, maintained skills, and increased employability. Different from other studies: more ethnically diverse, compared to Caucasian (geographic). Other studies stated licensure results, moving, and expectations were their highest stressors, due to pain vs. unpaid program and time of studies. Analysis currently being done in regards to realibility and validity for the brief QSEN. Financial total costs of program at all sites $973,981, cost per participant $2,246-$3,300

33. Comments “Casey-Fink survey did not relate to clinic setting” “I am so much more confident in as nurse in the ambulatory setting” Preceptor comment: “It was an honor to have someone so eager to learn”

34. Continuous Quality Improvement PDSA/SDSA Plan: Meet with stakeholders Do: Discuss benefits of program Study: Current residency programs Act: Review current literature and apply Standardize: Establish protocol Do: Develop criteria Study: Evaluate after implementation Act: Review and change as needed

35. Continuous Quality Improvement

36. Implications for Nursing Transition programs can be used to introduce new RNs to the workforce. Programs can be in non-acute areas. Funding secured to continue the program. New residency programs in different specialty areas (NPs, CNMs) Santa Rosa Medical Center received money for NP residency program for 4 NPs for a yearlong program, first NP program in CA. Affordable Care Act 2010, allocates money to FQHC’s.

37. Lessons Learned Larger study sample High attrition rate IRB for all study sites Each site did their own program Acute vs. Non-acute Placement agency

38. Conclusion and Dissemination Plan Residents felt more confident after program 36/40 maintained nursing jobs Remained in nursing profession Employed in school, community, acute, non-acute settings Expanded to Southern CA Future in home health or hospice care (pending funding) Santa Rosa Community health center (expanded to NPs) Manuscript in progress, submission to future poster presentation 2012

39. Acknowledgements All faculties at the University of San Francisco for the support throughout the program: Judith F. Karshmer, PhD, APRN, BC, KT Waxman, DNP, MBA, RN, CNL, Kia James, Ed.D, MPH, BSN, RN, CNL, Susan Prion, Ed.D, MSN, MA, BSN, RN, and Jessie Bell, RN, PHN, MSN. Would like to thank the California Institute of Nursing and Health Care: Deloras Jones, RN, MSN, Nikki West, MPH. Statistician: Sulekha Anand and to my family for their support.

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