transition to practice regulatory model: implementing change

Transition to Practice Regulatory Model: Implementing Change

Nancy Spector, Director of Regulatory Innovations

NM Statewide Nursing Faculty Conference

June 4, 2009, 1:00-2:30 p.m.

Mission of NCSBN

The National Council of State Boards of

Nursing (NCSBN), is composed of Member

Boards, provides leadership to advance

regulatory excellence for public protection.

Resources for Educators

www.ncsbn.org/ Go to: programs & services

For Transition: https://www.ncsbn.org/363.htm

Leader to Leader

nspector@ncsbn.org

Background of the Problem

Background of the Problem

Benner’s work over 20 years

Kramer’s “Reality Shock,” from 1974

Background…

NCSBN delegates voted in 2002 to:

“Identify and promote effective models to facilitate a successful transition of new nurses from education to practice.” and “Participate in strategies for retention of the new graduate.”

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

Transition to Practice: A Missing Piece in Nursing

Background…

Turnover rates (2006 Nurse Executive Center: “Transitioning New Graduates to Hospital Practice”)

One Year- 36% Two Years- 75%

Three Years- 50%

Background…

NCSBN hosted the Transition Forum February 22, 2007Speakers 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)

Background…

Computerized NCLEX, allowing for almost immediate licensure

Context of practice: “frenzy” Health care becoming more complex Nursing shortage IOM and other studies on patient safety

Transition to Practice Work

Goals: To promote public safety by supporting newly licensed nurses during their critical entry period and progression into practice.

Premises

Definitions

Transition to Practice Model

Description of Model

Pass NCLEX

Separate Orientation

Flexible and robust

6 month preceptorship

Description of Model

1 year institutional support

Feedback and reflection

License renewal

Description of Model

Website plans for modules

Preceptorship training

QSEN for RNs

Transition to Practice Fact Sheet

• The problem

• The impact

• The solution

Transition to Practice Evidence Grid

International Work

National Work

Individual Work

FAQs…

Why should this be implemented through regulation?

How was the model designed?

Are you seeing this as a failure of education and/or practice?

FAQs…

Are the modules just re-teaching?

What about cost?

How can this be implemented in rural areas?

FAQs…

Will NCSBN mandate transition to practice in all boards?

What about the current climate of job shortages?

It’s a Collaborative Model

Collaborative Input…

Formally with 14 organizations as well as our membership:

Pilot before mandating through regulation

Consider costs

Collaborative Input…

Outcomes from pilots will be important

Successful national programs are being implemented

Be sure LPN needs are met

Tightening of job market

Collaborative Input…

Preceptor training Several states are interested in piloting Timeframe needed Embraced the model for being

inclusive Willingness for collaboration

Transition Dashboard

Pilots (June 2011)

Modules

Marketing

Business Plan

Transition Dashboard

Preceptor Development

Research

Funding

Transition Tool Kit

Available at:

https:www.ncsbn.org/363.htm

Transition Tool Kit

Evidence grid Fact sheet FAQs Most recent article Dashboard

Transition Tool Kit

Goals/definitions/premises Model description Example of model rules for Boards Example of Transition to Practice

Verification form (TPV form)

Timeline

2009-10 Business plan Content outline for nurse (LPN and RN)

modules Convene research advisory panel Develop specifics of pilots Identify funding sources stakeholder collaboration

Timeline

2010-11 Develop nurse (LPN and RN) modules Develop preceptor modules and online

connections Establish pilot sites Identify funding sources stakeholder collaboration

Timeline

2011-12 Implement pilots Collect data Identify funding sources stakeholder collaboration

Transition to Practice…

“…the one goal that unifies us all – improvement both in individual patient care and in the health care delivery system – might be achieved.”

-Marlene Kramer, 1974

The Future!!