Update on Phase II of
NCSBN’s
Transition to Practice Study
NCSBN Long-Term Care Conference
August 24, 2011
Josephine Silvestre, MSN, RN
Nancy Spector, PhD, RN
Associate, Regulatory Innovations
2009 New Nurse:
“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.”
- NC Transition Study
Background…
NCSBN 2002 & 2004 Employer Studies:
“Yes definitely” to survey question regarding
novice graduates being prepared to provide
safe and effective care:
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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:
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Follow up
Initiative
Quality improvement
Time management
Tracking multiple responsibilities
Conflict resolution
Delegation
Background…
 NCSBN hosted the Transition Forum
February 22, 2007
 Speakers from other disciplines and countries all
came together.
 Various research findings showed need for
transition programs.
 Stakeholders agreed to a standardized
regulatory model (AACN, AONE, ANA,
NAPNES, NLN)
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
Lack of Transition Programs Affect
Safety and Quality
 Patient safety
 Competency
 Retention
Visual Model
It’s a Collaborative Model
Modules
Illinois, North Carolina and
Ohio are the Study States: 113
sites
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 study or control group
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 –
Versant
5. Louis Fogg, PhD – Rush College of Nursing
Research Objectives
Primary:
 To determine whether newly licensed nurses’
participation in NCSBN’s TTP model improves
safety and quality outcomes
Secondary:
 To determine how well the preceptor module
prepares preceptors for their role
 To identify the challenges, and potential solutions,
of implementing the NCSBN transition model
 To determine cost/benefit analysis
Survey Measurement Tools
New Nurse Surveys
Demographics
Competency – NEC & QSEN
Satisfaction – Modified Brayfield & Rothe
Practice issues – NCSBN
Preceptorship experience – National
Institute of Health (NIH) and North
Carolina Foundation for Nursing
Excellence
Survey Measurement Tools
Preceptor Surveys
Demographics
Competency – NEC & QSEN
Preceptorship experience – NIH and
North Carolina Foundation for Nursing
Excellence
Phase I Patient Outcomes
 Patient falls with and without injury
 Postoperative thromboemboli
 Hospital acquired pressure ulcers
 Patient satisfaction with nursing care
Phase I Patient Outcomes
 Catheter associated UTI
 Central line associated blood stream
infections
 Failure to rescue
 Medication administration errors
 LOS
Data Collection
 Web-based data
collection system
 Surveys/evaluations
 Knowledge
assessments
 Hospital outcomes
data
Confidentiality
 Participants will receive individual
password-protected access to the website
 Information collected from new nurses,
preceptors, nurse managers
 Outcomes data entered by site coordinators
will be kept confidential; data will be
reported in aggregate
Phase I - Randomization to Model
or Control
Stratified by:
 Rural, suburban, urban
 Numbers of new nurses
 Number of sites
Phase I – June 2011
 Educate institutions regarding TTP study
 Obtain informed consent and enroll
preceptors & their nurse managers
 Preceptors (intervention group) completed
training module
 Complete surveys
Phase I – July 2011
 Obtain informed consent & enroll new
graduate nurses
 Complete measurement tools
 Demographic & Initial surveys
 Knowledge Assessment
 Initiate interactive online modules
 To be completed within 3 months of start date
 Each module will take approximately 6-10 hours
Phase II
 Applications are being accepted for Phase II in
Ohio, Illinois and North Carolina
 External validity
 RNs and LPNs in settings other than hospitals
 Long-term care, community-based facilities,
ambulatory care, etc.
Long-Term Care Facilities
 Assisted living
 Nursing homes
 Rehab centers
 Skilled nursing care centers
Community-Based Facilities
 Home health
 Public health
 Visiting nurses
Ambulatory-Care Facilities
 Free-standing urgent care
 Free-standing surgical centers
 Health care provider offices
Transition to Practice Website
Located at:
www.transitiontopractice.org
Timeline
The Future!!
Questions