closing the education- practice gap · toward nursing education, according to the survey....

New Nurse Readiness Survey

Closing the Education- Practice Gap Building Confidence + Competence

Closing the Gaps BuildConfidenceClosing the Gaps Build

Wolters Kluwer has conducted the New Nurse Readiness survey three times over the last decade, asking nurses in education settings as well as those in practice settings a range of questions about how prepared new nurse graduates are and if they are ready for practice. The data provides a retrospective snapshot of nurse graduate strengths and weaknesses that date back eight years, giving us insight into two different generations as they entered the nursing workforce.

The 2020 survey was conducted just as COVID-19 was beginning to spread globally, but the results point to a trend that had been underway for some time: new nurses are not fully prepared for practice. One of the primary gaps, according to the perceptions of faculty and practice nurses in the survey, is a lack of clinical judgment. When new nurses lack the ability to apply their knowledge, use evidence, or think critically, there is an absence of clinical judgment.

From an educational perspective, nursing graduates must be prepared for the new demands of changing care delivery models and an emphasis on population health. From a societal point of view, healthcare is rapidly evolving and nurses need to understand the importance of the social determinants of health and recognize patients who experience health/social inequity and insecurity. Operating in these models and using informed clinical judgment to make decisions require competencies that practice nurses believe are lacking in nurse graduates.

Along with these new demands is a new post-COVID-19 reality. We must prepare for a future of nursing education and practice without the advantage of clarity about what comes next. Are nursing students scared off because of perceived dangers and the “fear factor” caused by COVID-19? Or will they be motivated to choose nursing as a profession to serve patients who need them more than ever? Will new nurses stay in the profession? Will there be a change in how education is delivered as education moves to virtual and hybrid models of course delivery?

It's clear that there is a continued opportunity to improve the preparation for new nurse graduates. As a call to action during 2020 International Year of the Nurse and Midwife, it’s time to rethink what practice-ready nursing looks like and create new education models in a yet-to-be-determined paradigm. These new models rely upon nursing faculty's continued understanding of the gaps and closer collaboration with their clinical counterparts.

Nurses in practice, meanwhile, need to understand the limits of academic preparation, cultivate a culture of learning within the healthcare organization, and commit to orienting and building competency in the new nurse, ensuring reduction to patient errors and harm.

—Julie StegmanVice President,

Nursing Segment,

Health Learning, Research & Practice

Wolters Kluwer

—Anne Dabrow Woods DNP, RN, CRNP, ANP-BC,

AGACNP-BC, FAANChief Nurse,

Health Learning, Research & Practice

Wolters Kluwer

NCSBN Research Findings

E vidence suggests that only 23% of new graduates have entry-level competencies, and many of the errors related to patient safety are caused by ineffective clinical

judgments.1 These gaps in nursing practice of new graduates are attributed to ineffective communication, the complexity of the clinical environment, lack of knowledge about patient care, and lack of experience in working in teams.

Wolters Kluwer data from over the last several years has tracked a continuing decline of the perception of the clinical preparedness of new nurses—from the perspectives of nursing faculty, hiring managers in practice, and new nurse graduates themselves.

In addition to identifying areas where nurses are less or more prepared, the data shows where there are gaps between the perceptions of faculty and those in practice and how to bring them in closer alignment in preparing new nurses for practice.

Introduction

Entry-level nurses are involved in practice errors.

Entry-level nurse errors were related to poor clinical decision making.

Employers are satisfied with decision-making abilities of entry-level nurses.

Two of the most important top five required skills needed upon entry into the field are critical thinking + problem solving.

50% 65% 20%

The data also shows ways in which healthcare organizations can help entry-level nurses stay committed to an organization while feeling empowered and confident.

So, why have these gaps continued to widen since 2012? At the center of the debate is whether nursing students have enough learning opportunities in which classroom theory and skills are put to the test in real-world clinical settings and whether new nurses can apply clinical judgment in their decision making.

The goal is to prepare new nurses so, once they are practicing, they can manage patients with higher acuity and more comorbidities in complex situations—accurately assessing, using evidence, and making sound clinical decisions.

The National Council of State Boards of Nursing (NCSBN) provided a comprehensive overview of the subject of clinical judgment in nursing education, and the report indicated several key findings.

2 closing the gap

Since 2012 when the first New Nurse Readiness survey was conducted, the methods of preparing new nurses have shifted considerably as a result of:

• A growing shortage of clinical sites, combined with faculty shortages at nursing schools across the country, is limiting student capacity, which has impacted the ability to prepare nurses for the kinds of critical decisions they have to make in a variety of healthcare settings.

While clinical sites have seen a decline, there has been an increase in simulation, including virtual simulation, which has been driven in great part by faculty, which delivers realistic patient encounters where students are responsible for making a variety of clinical reasoning decisions.

• Digital native nursing students are relying more heavily on digital tools and technology, while faculty are responding by finding the right resources to respond to today’s demands and changing generational characteristics.

• Faculty are providing access to electronic health records (EHR) and evidence-based point-of-care tools

and reference content that practicing nurses use, which adds even more fidelity to the learning experience.

• On the horizon, testing is expected to change, which will have a profound impact on licensing new nurses. No earlier than 2023, NCSBN will introduce a new test design with the goal of better assessing students’ clinical judgment skills.3 The next-generation NCLEX project (NGN), which incorporates case studies like those seen in real-world situations, will reflect the kinds of critical decisions nurses have to make in a variety of healthcare settings and add fidelity to assessment. Will the preparation of new nurses shift even more in the next few years now that nursing schools have to prepare students to sit for the NCLEX?

US nursing schools turned away 75,029 qualified applicants from baccalaureate and graduate nursing programs in 2018 due to an insufficient number of faculty, clinical sites, classroom space, clinical preceptors, and budget constraints.2

Source: Wolters Kluwer Closing the Nursing Education-Practice Readiness Gap

The Widening Perception Gap Between Education and Practice

Incoming nurse graduates are completely unprepared/ minimally prepared as they start practice.

Education 15% Practice 38%

Today’s nurse graduates are less prepared than nurse graduates 5-10 years ago to enter practice.

Practice 66%Education 46%

https://www.ncsbn.org/next-generation-nclex.htm

https://www.ncsbn.org/next-generation-nclex.htm

nurse readiness survey 3

Educators believe that their education is preparing nurse graduates to practice in today’s healthcare environment (72%), while practicing nurses are not as convinced (39%).

In a separate Wolters Kluwer Nursing Student Market Survey conducted at the start of 2020, nurse respondents echoed the perceptions of practicing nurses: 67% believe they are prepared to enter practice—down from 78% in 2018. Further, only 20% of the new nurse respondents reported they are very strong in their general knowledge of nursing.

Survey Results

Sentiment Towards Nursing Education*

Source: Wolters Kluwer Closing the Nursing Education-Practice Readiness Gap* Respondents who strongly or somewhat agree.

Today’s nurse graduates need different skills than nurse graduates did 5-10 years ago.

Incorporating technology into the classroom makes nursing education more effective.

The nursing curriculum should be standardized nationwide to give all graduating nurses the same

foundation from which to begin practice.

Their education prepares today’s nurse graduates well to practice in today’s healthcare environment.

49% 83%

84%73%

81%68%

72%39%

n Education n Practice

The Changing Education Landscape

B oth education and practice respondents generally agreed that today’s nurse graduates need different skills than they needed 5-10

years ago (84% vs. 73%, respectively). But there are vast differences when it comes to other sentiments toward nursing education, according to the survey.

Practicing nurses are very likely to agree that the nursing curriculum should be standardized nation-wide to give all nurses the same foundation (83%). Educators, meanwhile, prioritize incorporating technology into the classroom (81%).

4 closing the gap

Nursing students also recognize the role technology plays in preparing them for practice. According to the separate 2020 Wolters Kluwer Nursing Student Market Survey, 76% of respondents agreed that incorporating technology into the classroom helps better prepare them for their future careers.

Clinical Judgment: Thinking Like a Nurse

The data shows that when nurses are more prepared, they have better skills around the critical thinking necessary for better clinical

judgment. Conversely, the lack of clinical judgment is also a factor for nurses being less prepared to enter practice. The importance of clinical judgment skills in new nurses is supported by multiple studies and efforts to properly prepare students. These efforts include NCSBN, which has analyzed the NCLEX to determine what changes in the test are necessary for measuring that nurses are ready to face all the challenges they will meet in real-world situations.4

86%81%

66%55%


Simulation

Video


87%

76%

students agree that they are comfortable in using technology in their nursing program.

students agree that the use of technology in their program enhances their learning.

+

+

Technology a Factor in Preparedness

Among all respondents who believe nurse graduates today are more prepared to enter practice than nurse graduates 5-10 years ago,

nearly 78% cited better technology in the 2020 survey– about the same as in 2012 (81%). The prioritization of technology in helping nurses enter practice speaks to the shift in the use of technology over the last decade.

For example, faculty and nursing students are increasingly turning to technology to provide solutions to the reduction in available clinical sites, to help increase NCLEX pass rates, to gain exposure to tools used in practice, such as EHRs, and to increase the use of course content that enhances clinical reasoning.

In terms of how students today learn, it is not surprising that education and practice respondents were most likely to say that today’s nursing students prefer to learn through digital tools. Source: Wolters Kluwer Nursing Student Market Survey

Source: Wolters Kluwer Nursing Student Market Survey

Learning Preferences

Technology Role in Practice Readiness


What’s at Stake

In addition to the obvious risks of causing errors and patient harm stemming from a lack of clinical judgment, there is the equally important risk of

graduating nurses who do not practice with confidence. The survey data shows today’s nurse graduates are no more confident to practice than they were eight years ago.

Lack of confidence, together with a lack of options to cover and practice skills and clinical competencies to practice, creates a situation in which new nurses are less able or willing to handle stress and react to new and evolving clinical situations. This, combined with the intrinsic characteristics of the new generation of nursing students, often leads to workplace dissatisfaction.

79% 77%

77% 56%

54%26%

Bettertechnology

Better nursingcurriculum/

teaching

Better critical thinking/clinical

judgment



Worse critical thinking skills/

clinical judgment

Over-reliance on technology

View nursing as just another job

55% 60%

53% 53%

44% 52%

Clinical judgment is based on the kinds of decisions that need to be made—how nurses focus on interactions with the client and the client’s needs and

expected outcomes. Students must be able to apply their knowledge, critically think, and use evidence to make good clinical decisions.

Clinical Judgment: Thinking Like a Nurse, continued

Factors for Nurse Graduates Being LESS Prepared for Practice Compared to 5-10 Years Ago

Factors for Nurse Graduates Being MORE Prepared for Practice Compared to 5-10 Years Ago+ -

2020 2012


How Confident are New Nurses?

Today's nurses are not any more confident than they were eight years ago, according to respondents.

34%33%

6 closing the gap

Align with the needs of the clinical setting and collaborate with clinical partners.Review the curriculum to ensure inclusion of essential competencies, and, at the course level, use the full teaching-learning cycle and evidence-based teaching practices to prepare students for the realities of the clinical setting.

Nurse faculty should meet with healthcare institution professional development practitioners to fully understand the pain points and challenges that are being experienced by practicing nurses so they can weave these experiences into the teaching-learning cycle.

Help new nurses be more deliberate in making clinical judgments.Identify ways to formalize a transition program or residency that allows new graduates time to adjust to the demands of clinical practice.

Nursing Faculty Nurse Educators in Practice

Nurse educators and practicing nurses must continue to strive for close collaborations in order to close gaps and better prepare nurses

for clinical practice. There are many opportunities for academia and clinical settings to start or continue

productive dialogues about the types of programs that will help close gaps. Co-developing those programs or enhancing existing ones will help ease new nurses into practice in the most efficient ways.

The Call for Partnership

$82,000 the cost of new nurses in economic and professional terms.5

28%turnover rates among first-year nurses.5

+

+

It’s no surprise, then, that turnover rates are skyrocketing among new nurses. In fact, turnover is roughly 27.6% in the first year of practice and as much as 53.9% in the second year. New nurse attrition is costly in economic and professional terms—and can negatively impact patient-care quality.2

Understanding new nurse values and attitudes helps nurse educators launch graduating nurses off to a good start, while those institutions hiring nurses can focus on strategies that help retain them, build their skills, and commit them to lifelong learning.

Impact of Nurse Attrition

Improve Communication and Cooperation Across Faculty and Practice Nurses

What's at Stake, continued


Integrate a consistent clinical judgment model throughout the teaching-learning process and in simulation.This helps students establish clear and high-level learning outcomes using active learning strategies, provides opportunities for students to practice and assess their attainment of the learning outcomes, and offers high-level evaluation strategies that measure students’ ability to make nursing judgments.

Incorporate or build on a strong, case-based approach into the curriculum.Give students a multitude of opportunities to recognize and analyze cues and generate solutions by considering interventions. This creates a great foundation for using evidence to make good clinical decisions.

Bring fidelity to the learning experience.Provide students with an environment to practice clinical judgment skills through virtual and other simulated learning that helps them to identify and interpret important patient cues, identify actions based on priority problems, implement solutions/take action, and evaluate outcomes. Working with virtual patients, students can enhance their clinical reasoning by contextualizing realistic patient care scenarios.

Simulation also exposes students to the types of clinical scenarios on the Next Generation NCLEX, and also to the type of thinking they’ll have to practice as a new nurse.

Develop support models that ease the transition to practice.Formalize partnerships with academia that establish expectations for shared goals and offer access to clinical units that welcome the opportunity to host students and faculty and are willing to collaborate to improve practice.

Consider dedicated education units (DEUs) or residency programs that focus on supporting the transition to practice.

Establish journal clubs where new nurse graduates can learn how to critically appraise evidence and implement it into their own practice.

Develop onboarding programs that decrease time-to- productivity of new nursing hires.Onboarding/orientation programs for new nurses must use an instructional scaffolding approach that delivers practice-ready, competent nurses. Once graduate nurses are practice ready, institutions can implement rapid onboarding and cross-training programs to quickly train nurses to shift from one unit to another similar unit to assist with caring for the patients on that unit.

Improve nurse orientation with preceptorship programs. Beyond facility orientation, new nurses also have to orient to their units. In one model, unit orientation is based on an incremental productivity model; the new nurse is paired with a nurse preceptor, gradually increasing the number of patients assigned to the new nurse and preceptor each shift. Eventually the new nurse and preceptor take a full assignment.

In an alternate model, from day one, new nurses take on a full patient assignment with their preceptors. During this time, the new nurse gradually assumes increased role responsibilities based on his or her demonstrated competence in a variety of skills. Once simple skills such as taking vital signs are mastered, the new nurse is introduced to a new skill of greater complexity. This process is repeated as the new nurse learns and demonstrates expertise with an increasingly sophisticated skill set.


8 closing the gap

Conclusion

Identify opportunities to incorporate blended learning into orientation in order to make new nurses most productive, faster.It’s imperative that new nurses have both the need-to-know orientation training to make them productive and ongoing professional education to deliver improved patient care and outcomes.

A blended learning environment helps to achieve both of these objectives by combining learning techniques with other tools to improve knowledge retention. New nurses get the evidence-based orientation training they need to ensure they carry out their roles competently and thoroughly. But it doesn’t stop there. Ongoing professional development programs that are adapted to the needs of the organization and learning style of the individual provide opportunities for growth, also helping to reduce high turnover rates.


Explore ways to tailor education programs to students through adaptive learning techniques and instruction.Artificial intelligence in education has presented a whole new opportunity to tailor learning programs to the individual. With adaptive learning environments, students access learning programs personalized to them based on their performance and how they answer certain questions.

Students can gain test-taking confidence and exposure to NCLEX-style questions, while improving critical thinking skills that are essential for practice-ready nurses.

Understanding the profession’s perceptions of the level of preparedness and knowledge aptitude of nurse graduates entering practice—and comparing it to the perspective

of hiring managers and nurse educators in practice and academic settings—are important in providing better patient care and outcomes, reduction of errors, job satisfaction and retention of new nurses.

Providing students access to clinical experiences that build clinical judgment and acuity in complex care situations is an essential part of preparation, and can be delivered in both live and simulated care environments. The concept of “practice makes ready” fosters clinical judgment that equips new nurses to adjust quickly to practice settings. Emerging technology such as AI and new learning techniques open up new opportunities.

Preparing practice-ready nurses who enter the workforce with confidence is also an important strategy for combating attrition rates. This requires digging deeper into areas the current survey identified as having the widest perception gaps to identify why nurse educators in academia and practicing nurses differ in their opinions, how those differences might impact nurses transitioning from school to practice, and how areas of weakness can be best addressed.

While the perspectives on how new nurses can be more clinically effective vary, stakeholders and students agree that clinical judgment is the key to success, which will provide alignment across faculty and practicing nurses as nursing education continues to evolve in the 2020s.

¹ 2017 National League for Nursing, https://nursing.ceconnection.com/ovidfiles/00024776-201703000-00003.pdf. ² AACN’s report on 2018-2019 Enrollment and Graduations in Baccalaureate and Graduate Programs in Nursing. ³ Alyson Brenton, NCSBN Next Generation NCLEX (NGN) Project, https://www.ncsbn.org/2018_ Webinar_NGN.pdf. 4 https://www.ncsbn.org/11447.htm. 5 2020 NSI National Healthcare Retention & RN Staffing Report.

nursing readiness 9

Closing the Gaps BuildConfidenceClosing the Gap Build

MethodologyWolters Kluwer conducted an online survey in January-February 2020. The survey targeted faculty, program directors and deans on the education side; on the practice side, nurse managers, nurse educators, and directors of nursing were surveyed. This survey is part of a multi-year tracking study, following surveys conducted in 2012 and 2016, and was designed to measure how perceptions among the respondents may have changed over time. In total, 572 valid responses were collected with 316 respondents (55%) in education settings and 256 respondents (45%) in practice settings.

New Nurse Readiness Survey

Contact information: Wolters Kluwer Two Commerce Square2001 Market Street Philadelphia, PA 19103

Please visit https://yearofthenurse.nursingcenter.com/for more information.

closing the education- practice gap · toward nursing education, according to the survey....

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