Upload
joseph-mchugh
View
218
Download
0
Tags:
Embed Size (px)
Citation preview
Transition of Nurses from Education & Practice
Nancy Spector, Director of Education
• Strategic initiative that seeks excellence in regulation
• Board needs: Unintended consequence of CAT
• PERC’s recommendations
Background
• January – March 2002
• Stratified random 1000 RNs (focus on RNs)
• 3 stage mailing
• 633 usable surveys
2002 Practice & Professional Issues Survey (Spring)
Surveys – Drs. Smith & Crawford
• Self reports
• Questions
– Work environment– Education and transition– Involvement in errors and difficulty with
assignments– Demographics
Outcome 1: Involvement in errors – 49%– Definition: incidents or
“occurrences that resulted in harm to clients or had the potential to place a client at risk for harm. You may have been involved as the one making the error, the supervisor of others making errors, or as the one discovering errors made by others.”
Outcomes
Types of Errors/Occurrences
1.3
11
0.3
37
40
75
2
13
1.7
36
47
71
0 10 20 30 40 50 60 70 80
Care povided by impaired Professional
Client elopement
Avoidable death
Delays in care/treatment
Falls
Medication
Percent
RN LPN/VN
Work Place Causes of Errors
0 10 20 30 40 50 60 70 80
RN
LPN/VN
Inadequate staffing
Lack of adequatecommunicationLong work hours
Lack of support from otherdepartmentsPoorly understood policiesand proceduresInadequate orientation
Lack of supplies orequipmentOther
Inappropriate use of UAP
Lack of adequate referencematerialLack of CE classes
• Problems understanding English & non English speaking clients & staff
• Problems reading or understanding MD orders
• Prior work as NA – more likely• Prior work as PN – less likely• OT – more likely• Age – younger more likely
Other Factors Related to Errors
• 20% too difficult
• Average days to first assignment: 8 days
• 13% said first assignment too challenging
Outcome 2:Difficulty of Current Assignment
• Self report of perceptions
• Definition of error
Study Limitations
Secondary Analysis of Data for Transition Models Multiple chi squares and t-tests on variables
%Before graduation 35.1Before licensure 52.8Part of post hire orientation 63.8Paid for work performed 76.7Paid tuition to be in program 12.5Voluntary 19.5Mandatory 55.3Assigned same nurse as preceptor/mentor 49.7Assigned preceptor/mentor worked the same scheduled I worked 48.3Designed to increase general knowledge and skills 62.0Designed to increase specialty knowledge and skills 62.4
Internship/Externship, Preceptorship, Mentorship Descriptors - RN
• Knowledge type: General versus Specific
– General includes core information
– Specific includes specialty knowledge
– Mixed results
Evidenced-Based Models for Successful Transition
• Specific knowledge – Fewer errors (p=.000)
– Better prepared for current assignment (p=.047)
• Core knowledge
– More prepared to function as a team (p=.036)
– More prepared to provide teaching (p=.024)
Evidenced-Based Models for Successful Transition (Con’d)
Evidenced-Based Models for Successful Transition (Con’d)
• Provide a transition program with core knowledge and also specialty knowledge.
* Best Practice Recommendations
Evidenced-Based Models for Successful Transition (Con’d)
• Placement of transition programs
– Before or after graduation
– Pre hire versus post hire
– Pre licensure versus post licensure
Evidenced-Based Models for Successful Transition (Con’d)
• Placement of transition programs
– Fewer errors with post graduate programs (p=.004)
– Better prepared for current assignment with post graduate programs (p=.015)
Evidenced-Based Models for Successful Transition (Con’d)
* Best Practice Recommendation:
•Post hire/pre licensure transition programs
–Kentucky Model
Evidenced-Based Models for Successful Transition (Con’d)
• Mandatory versus Voluntary Programs
– Mixed results
– Mandatory – more errors (p=.044)
– Voluntary – less prepared to administer meds (p=.027)
No recommendation– bears watching
Evidenced-Based Models for Successful Transition (Con’d)
• Same mentor with same schedule– More confidence (sum score) (p=.000)
– Evidence supports increase confidence
* Best Practice Recommendation:
• Same mentor with same schedule
Evidenced-Based Models for Successful Transition (Con’d)
* Best Practice Recommendation:• For regulators the following are key aspects of
education:
– Making decisions– Providing direct care to 2 clients– Knowing when and how to call the physician– Supervising care– Working effectively within a health team
• 2003 Employers Survey(Drs. Crawford & Smith)
– 1189 employer responses
– 41.9% said new RN (BSN & ADN) provide safe, effective care
Other Research
• 2003 Employers Survey (Drs. Crawford & Smith)
– 69.1% said their transition programs last 6.7 weeks– Longterm care offered the least– Employers rated these skills as most important:
1. Critical thinking or clinical decision-making
2. Therapeutic relationships
3. Medication administration
4. Management leadership
5. Psychomotor skills
Other Research (Con’d)
• Experienced and new nurses July 2002 – June 2003• N=592
Design• 56% standardized transition• 36% customized transition
Type• 62% preceptorship• 21% orientation
Survey Spring 2003 (Drs. Smith & Crawford)
1. Critical thinking and clinical decision-making
2. Medication administration
3. Psychomotor
4. Therapeutic relationship
5. Management/leadership
Most Important Skills (Students)
• Collaborate with VNIP
• Investigate HRSA work with residencies
• Study on outcomes– Vermont
– Kentucky
– National
• Develop model based on outcomes
NCSBN Future
The art of progress is to preserve order amid change and to preserve
change amid order.
Alfred North Whitehead