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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
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!!
