Transition into Practice Study: Overview
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Transcript of Transition into Practice Study: Overview
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Transition into Practice Study: Overview
Nancy Spector, PhD, RN, Director of Regulatory Innovations
Phase II Site Coordinator MeetingChicago, February 1-2, 2012
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Welcome to Chicago!
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Illinois, North Carolina and Ohio: Selected as the Study States
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Ohio
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North Carolina
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Illinois
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Long-Term Care
Home Health
Ambulatory Care
Public Health Total
Illinois 30 3 2 - 35
North Carolina 2 - 4 6
Ohio 7 - - - 7
Total 39 3 2 4 48
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It Has Been a Collaborative Effort
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Research Advisory Panel Participants
1. Jane Barnsteiner, PhD, RN, FAAN – University of Pennsylvania
2. Mary Blegen, PhD, RN, FAAN – UCSF3. Mary Lynn, PhD, RN – University of North
Carolina, Chapel Hill4. Elizabeth Ulrich, EdD, RN, FACHE, FAAN – Vice
President, Hospital Services, CAE Healthcare5. Louis Fogg, PhD – Rush College of Nursing
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Your State Coordinators
Illinois – Debra Bacharz, PhD, RN
North Carolina – Ashley Trantham, MS
Ohio – Joyce Zurmehly, PhD, DNP, RN
Lea Yoakem, MSN, RN
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Special Gratitude
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Board of DirectorsMyra Broadway, Maine – PresidentShirley Brekken, Minnesota – Vice PresidentJulie George, North Carolina – TreasurerDebra Scott, Nevada – DirectorBetsy Houchen, Ohio – DirectorLanette Anderson, West Virginia – DirectorKatherine Thomas, Texas – Director Ann O’Sullivan, Pennsylvania – DirectorPam Autry, Alabama – DirectorJulio Santiago, Illinois – DirectorEmmaline Woodson, Maryland - Director
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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
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Background of the Problem
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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
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Background…
Advisory Board Company (2008) Surveyed
5,700 frontline nurse leaders
400 nursing deans/directors/chairs
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Background…
90% academic leaders believe their new students are prepared.
10% of health system nurse leaders believe new nurses are prepared.
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Advisory Board Study
Biggest Improvement Needed:
Follow up Initiative Quality improvement Time management Tracking multiple responsibilities Conflict resolution Delegation
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Background…
Research varies
Kovner (2009) – 26% in two years
Before economic downturn, as high as 35 -60%
What’s next? (Auerbach, Buerhaus & Staiger, 2011)
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The Perfect Storm Brewing…
Expertise gap (Orsolini-Hain & Malone)
10% staff are newgraduates
50% turnover from2011-2020 (Dracup & Morrris, 2007)
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Practice Expectations: Hit the Ground Running!
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Transition to Practice: A Missing Piece in Nursing
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Transition to Practice in Other Disciplines
Medicine, Pharmacy and Pastoral Services: CMS funding.
Physical Therapy: regulatory community is discussing it.
Teachers: “mentor induction programs.”
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International Work with Transition to Practice
AustraliaCanada IrelandPortugalScotland
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National Bodies/Studies Recommending a Transition Program
UHC/AACN
Joint Commission (2003)
Carnegie Study of Nursing Education (2010)
IOM Future of Nursing report (2010)
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Lack of Transition Programs Affect Safety and Quality
Patient safety
Competency
Retention
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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
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Description of Model
Pass NCLEX
Separate Orientation
Flexible and robust
6 month preceptorship
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Description of Model
Integration: feedback & reflection; safety & clinical reasoning
License renewal
Preceptors are trained
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Institutional Support for One Year Support starts at the top
Organizational communication about the program
Cooperation with personnel, resources, etc.
Celebration!
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Visual Model
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Transition to Practice Study
Longitudinal, randomized, multi-site study comparing patient outcomes in organizations that use our transition model versus those that use their traditional method.
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Unique Study of Transition
1. Actual patient outcomes
2. Randomization to intervention or control group
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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.
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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.
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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.
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Phase I
Internal Validity
RNs only
Hospitals: rural, suburban, urban, consortia
1500 new graduates were enrolled
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Phase II
External validity
RNs and LPNs
Long-term care, home health, public health, and ambulatory care
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Survey Measurement Tools
New Nurse and Preceptor Surveys
Demographics
Competency – NEC & QSEN
Study: Evaluation of Modules
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New Nurse Surveys
Knowledge assessment (pre- and post-)
Satisfaction – Modified Brayfield & Rothe
Practice issues - NCSBN
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Preceptor Survey
360 degree – National Institute of Health and North Carolina Foundation for Nursing Excellence
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Site Coordinator Surveys
Demographics
Patient satisfaction
Staffing/turnover
Number of patients
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Site Coordinator: Perception of Outcomes Inventory
To be completed at all sites
Adapted from existing tool developed by Alexander & Kroposki
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Site Coordinator
Long-Term Care Patient Outcomes Survey
Unit and organizational level Medicare Nursing Home Compare database
Pressure ulcersImmunizationsUTI’sMobilityPain management
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Site CoordinatorHome Health Patient Outcomes Survey
Complete outcomes at organizational level Medicare Home Health Compare
Pain managementWound healthMedication administrationImmunizationsDiabetes management
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Site Coordinator
Ambulatory Care Patient Outcomes Survey
Department and organizational level Based on AHRQ standardized outcomes:
Falls Immunizations Medication reconciliation Emergency room visits
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Site Coordinator
Public Health Patient Outcomes Survey
Program and organizational levelChildhood immunizationsChlamydiaPrenatal care
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Reliability and Validity
Three sites in Chicago area
Reliability: Internal consistency
Validity: Two phases
Cognitive interviews
Factor analysis
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Timeline
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Transition to Practice…
“The quality of our expectations determines the quality of our actions.”
-A. Godin
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The Future!!