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? 60.0% 50.0% 40.0% 2002 30.0% 2004 20.0% 10.0% 0.0% Diploma BSN ADN PN 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 • California’s New Grad RN Transition Program • North Carolina Transition to Practice Initiative • Vermont’s Nurse Internship Project • • • • • Australia Canada Ireland Portugal Scotland • 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 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 Virtual and Hands-on Simulations 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 Correlation with Experts 0.9 0.8 0.7 0.6 0.5 Increases learning by 300% 0.4 0.3 0.2 0.1 0 NOVICES BEFORE TRAINING CONVENTIONAL ACLS LOW END TRAINING SIMULATION WITH ERRORS TRAINING HIGH END SIMULATION WITH ERRORS TRAINING 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… Let’s Debrief…..