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Explore solutions for the practice gap in nursing transitions, featuring debates on simulation, turnover rates, and residency programs. Enhance evaluation methods to improve learning outcomes and patient safety.
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Transition to Practice Karin Sherrill Laura Crouch Carol Cheney
Arizona Simulation Network http://azsimnet.com
Practice Gap • First article in 1930 (Townsend, 1931) discussed Practice Gap • Benner novice to expert • Kramer’s “Reality Shock” from 1974
Problem: NCSBN Employer Study (2002 & 2004) Are novice graduates being prepared to provide safe and effective care? http://www.ncsbn.org
Problem: Advisory Board Company Survey (2008) • 5,700 frontline nurse leaders • 400 nursing deans/directors/chairs http://www.advisoryboardcompany.com
Problem: Advisory Board Company Survey (2008) • Concerns: • Initiative • Quality improvement • Time management • Tracking multiple responsibilities • Conflict resolution • Delegation http://www.advisoryboardcompany.com
Turnover Rate • Research varies • Kovner (2009) found 26% in two years • Others as high as 35 – 60%
Transition/Residency Programs United States (more?) International Australia Canada Ireland Portugal Scotland • California’s New Grad RN Transition Program • North Carolina Transition to Practice Initiative • Vermont’s Nurse Internship Project
Pass NCLEX Separate Orientation Hospital Policies Includes all levels of Nursing Entry 5 Online Modules 6 Month Preceptorship (w/preceptor training)
Simulation Study http://www.ncsbn.org
Standardized Patients vs. High-fidelity Patients • Finding standardized patients • Scenario Reality • Script development time vs. ad lib • Objectives and Outcomes • Cost Sleeping vs Sleeping
Simulation Hours • How many simulation hours in a nursing program? • How much time for simulation in each course? • Placement of simulation within the semester • How do we measure/ evaluate simulation effectiveness r/t time?
Healthcare Reform Changes • As funding reduces so will amount of education
56% of all Medication Errors do to improper IV Administration Patient Safety and Quality Healthcare 06/05
Central Venous Catheter Insertion • CVC statistics- In US over 5mil/year placed • ≥15% patient complications • 5-19% mechanical • 5-26% infectious • 2-26% thrombotic • Need to reduce errors
With Proven Outcomes • 92% decrease in pneumothorax • 83% decrease in infections
Revision of Traditional Training • Weighted Checklists • Train to errors • High fidelity simulation
With Proof of Learning and Generalization Increases learning by 300%
Focus on Quality and Safety • Reduce Errors • Increase Quality • Increase safety • Improve efficiencies • Reduce Costs • Reduce Costs • Reduce Costs
Nursing On-boarding • Highest rate of attrition is in 1st yr • New nurses are overwhelmed when placed into patient care
It costs a Banner facility $1,000,000 just in wasted OR time to train 14 surgeons in robotic surgery.
Formative Evaluation • Aimed at course/simulation improvement • Asks learners for feedback to improve • All along the way you look at ways to improve, make changes
Summative Evaluation • Provides info whether someone or something did what it is designed or supposed to do • Associated with number scores or letter grades
Formative and Summative • The same information can be used for either
“Audit”ive Assessment • Audits provide “reasonable assurance” that something is error free or that quality standards are being met • Measurement rather than to express an opinion about the fairness of statements or quality of performance (leave this assessment to peer reviews and boards)
Evaluations Assessments and Audits… Oh My! • Simulation is a practical application • Look at knowledge, skills, critical thinking, interpersonal relations • All of which bridge the gap from transition to practice • Help to guide us to meet both the learner needs and needs of the healthcare system • Gives us data…
