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:

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…

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, multi-

site 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 ObjectivesPrimary:

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