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
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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:
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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…
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!!