Transition into Practice Study: Overview Nancy Spector, PhD, RN, Director of Regulatory Innovations Phase II Site Coordinator Meeting Chicago, February 1-2, 2012 Welcome to Chicago! Illinois, North Carolina and Ohio: Selected as the Study States Ohio North Carolina Illinois Long-Term Care Home Health Ambulatory Care Public Health Total Illinois 30 3 2 - 35 North Carolina 2 - 4 6 Ohio Total 7 - - - 7 39 3 2 4 48 It Has Been a Collaborative Effort Research Advisory Panel Participants 1. Jane Barnsteiner, PhD, RN, FAAN – University of Pennsylvania 2. Mary Blegen, PhD, RN, FAAN – UCSF 3. Mary Lynn, PhD, RN – University of North Carolina, Chapel Hill 4. Elizabeth Ulrich, EdD, RN, FACHE, FAAN – Vice President, Hospital Services, CAE Healthcare 5. Louis Fogg, PhD – Rush College of Nursing Your State Coordinators Illinois – Debra Bacharz, PhD, RN North Carolina – Ashley Trantham, MS Ohio – Joyce Zurmehly, PhD, DNP, RN Lea Yoakem, MSN, RN Special Gratitude Board of Directors Myra Broadway, Maine – President Shirley Brekken, Minnesota – Vice President Julie George, North Carolina – Treasurer Debra Scott, Nevada – Director Betsy Houchen, Ohio – Director Lanette Anderson, West Virginia – Director Katherine Thomas, Texas – Director Ann O’Sullivan, Pennsylvania – Director Pam Autry, Alabama – Director Julio Santiago, Illinois – Director Emmaline Woodson, Maryland - Director NCSBN Staff Kathy Apple, CEO Maryann Alexander, Chief Officer Nursing Regulation Interactive Services Department Finance Department Human Resources Department Information Technology Department Marketing and Communications Department Research Department Regulatory Innovations Department Background of the Problem 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… Research varies Kovner (2009) – 26% in two years Before economic downturn, as high as 35 -60% What’s next? (Auerbach, Buerhaus & Staiger, 2011) The Perfect Storm Brewing… Expertise gap (Orsolini-Hain & Malone) 10% staff are new graduates 50% turnover from 2011-2020 (Dracup & Morrris, 2007) Practice Expectations: Hit the Ground Running! Transition to Practice: A Missing Piece in Nursing Transition to Practice in Other Disciplines Medicine, Pharmacy and Pastoral Services: CMS funding. Physical Therapy: regulatory community is discussing it. Teachers: “mentor induction programs.” International Work with Transition to Practice Australia Canada Ireland Portugal Scotland National Bodies/Studies Recommending a Transition Program UHC/AACN Joint Commission (2003) Carnegie Study of Nursing Education (2010) IOM Future of Nursing report (2010) Lack of Transition Programs Affect Safety and Quality Patient safety Competency Retention The Real Evidence… “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.” New graduate - NC Transition Study Description of Model Pass NCLEX Separate Orientation Flexible and robust 6 month preceptorship Description of Model Integration: feedback & reflection; safety & clinical reasoning License renewal Preceptors are trained Institutional Support for One Year Support starts at the top Organizational communication about the program Cooperation with personnel, resources, etc. Celebration! Visual Model Transition to Practice Study Longitudinal, randomized, multisite 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 intervention or control group Research Objectives Primary: To determine whether it is feasible to implement a standardized model for transitioning new RNs and LPNs/VNs to practice in long-term care, ambulatory care, home health care, and public health settings. Research Objectives To determine whether newly licensed RNs’ and LPNs’/VNs’ participation in NCSBN’s TTP model improves patient safety, leads to improved quality outcomes, and improves nurse retention. To determine whether NCSBN’s preceptor module adequately prepares nurses for the preceptor role. Research Objectives To identify the challenges of and potential solutions for planning and implementing the transition model. To determine the cost-benefit analysis to implement the TTP model. Phase I Internal Validity RNs only Hospitals: rural, suburban, urban, consortia 1500 new graduates were enrolled Phase II External validity RNs and LPNs Long-term care, home health, public health, and ambulatory care Survey Measurement Tools New Nurse and Preceptor Surveys Demographics Competency – NEC & QSEN Study: Evaluation of Modules New Nurse Surveys Knowledge assessment (pre- and post-) Satisfaction – Modified Brayfield & Rothe Practice issues - NCSBN Preceptor Survey 360 degree – National Institute of Health and North Carolina Foundation for Nursing Excellence Site Coordinator Surveys Demographics Patient satisfaction Staffing/turnover Number of patients Site Coordinator: Perception of Outcomes Inventory To be completed at all sites Adapted from existing tool developed by Alexander & Kroposki Site Coordinator Long-Term Care Patient Outcomes Survey Unit and organizational level Medicare Nursing Home Compare database Pressure ulcers Immunizations UTI’s Mobility Pain management Site Coordinator Home Health Patient Outcomes Survey Complete outcomes at organizational level Medicare Home Health Compare Pain management Wound health Medication administration Immunizations Diabetes management Site Coordinator Ambulatory Care Patient Outcomes Survey Department and organizational level Based on AHRQ standardized outcomes: Falls Immunizations Medication reconciliation Emergency room visits Site Coordinator Public Health Patient Outcomes Survey Program and organizational level Childhood immunizations Chlamydia Prenatal care Reliability and Validity Three sites in Chicago area Reliability: Internal consistency Validity: Two phases Cognitive interviews Factor analysis Timeline Transition to Practice… “The quality of our expectations determines the quality of our actions.” -A. Godin The Future!!