transition to practice regulatory model: implementing change nancy spector, phd, rn june, 2008
TRANSCRIPT
Transition to Practice Regulatory Transition to Practice Regulatory Model: Implementing ChangeModel: Implementing Change
Nancy Spector, PhD, RNNancy Spector, PhD, RN
June, 2008June, 2008
Mission of NCSBNMission of NCSBN
The National Council of State Boards of The National Council of State Boards of
Nursing (NCSBN), composed of Member Nursing (NCSBN), composed of Member
Boards, provides leadership to advance Boards, provides leadership to advance
regulatory excellence for public protection.regulatory excellence for public protection.
Background of the ProblemBackground of the Problem
Background of the ProblemBackground of the Problem
• Benner’s work over 20 yearsBenner’s work over 20 years
• Kramer’s “Reality Shock,” from 1974Kramer’s “Reality Shock,” from 1974
Background of the ProblemBackground of the Problem
NCSBN 2001 Employer’s study NCSBN 2001 Employer’s study
““Yes definitely” to new graduates providing Yes definitely” to new graduates providing safe and effective care:safe and effective care:
• 45% - diploma graduates45% - diploma graduates• 40% - BSN graduates40% - BSN graduates• 35% - ADN graduates35% - ADN graduates• 30% - PN graduates30% - PN graduates
Background of the Problem:Background of the Problem:
Not About BlameNot About Blame
Background of the ProblemBackground of the Problem
• Computerized NCLEX, allowing for almost immediate licensure
• Context of practice: “frenzy”
• Health care becoming more complex
• Nursing shortage
Background of the ProblemBackground of the Problem
Turnover rates (2006 Nurse Executive Center: “Transitioning New Graduates to Hospital Practice”)
• One Year – 36%
• Two Years – 75%
• Three Years – 50%
Background of the ProblemBackground of the Problem
Underinvestment of Novice Nurses(2006 Nurse Executive Center):
CMS Funds•American Council for Graduate Medical
Education
• American Society of Health-System Pharmacists
• Association for Clinical Pastoral Education
Background of the ProblemBackground of the Problem
NCSBN Hosted Transition Forum:• February 22, 2007
• Speakers from other disciplines and countries all came together
• Various research findings showed need for transition programs
Background of the ProblemBackground of the Problem
NCSBN Hosted Transition Forum:• February 22, 2007
• Stakeholders agreed to a standardized regulatory model (AACN, AONE, ANA, NAPNES,
NLN)
• Buy-in is so important
Charge from Board of DirectorsCharge from Board of Directors
Recommend an evidence-based regulatory model for transition to practice.
BarriersBarriers
•Time Constraint – October 2007 – April 2008
•Committee make up
•States are autonomous
EvidenceEvidence
5 International Projects5 International Projects• Canadian Nurses AssociationCanadian Nurses Association• ScotlandScotland• IrelandIreland• PortugalPortugal• AustraliaAustralia
EvidenceEvidence
16 National Projects/Studies:16 National Projects/Studies:
• 2002 American Health Care Association2002 American Health Care Association• Behrens (investigative reporter) (2000)Behrens (investigative reporter) (2000)• Carnegie study of nursing education Carnegie study of nursing education
(preliminary)(preliminary)• EBNER (2006)EBNER (2006)• Joint Commission 2002 White PaperJoint Commission 2002 White Paper
EvidenceEvidence
National:National:• Hofler: synthesis of national reports (2008)Hofler: synthesis of national reports (2008)• HRSA (2007)HRSA (2007)• NCSBN analysis of discipline data (2007)NCSBN analysis of discipline data (2007)• NCSBN employer studies (2004)NCSBN employer studies (2004)• NCSBN post-entry study (preliminary)NCSBN post-entry study (preliminary)
EvidenceEvidence
National:National:• NCSBN’s Transition Study (2006)NCSBN’s Transition Study (2006)• NCSBN’s Transition Study (unpublished)NCSBN’s Transition Study (unpublished)
• RNRN• PNPN
• National Survey of Nursing Home Workforce National Survey of Nursing Home Workforce Satisfaction (2006)Satisfaction (2006)
EvidenceEvidence
National:National:• University HealthSystem University HealthSystem
Consortium/American Association of Colleges Consortium/American Association of Colleges of Nursing (2007)of Nursing (2007)
• Versant (2001)Versant (2001)
EvidenceEvidence
7 Statewide Projects/Studies:7 Statewide Projects/Studies:• California – In process; White paperCalifornia – In process; White paper• Kentucky – LegislationKentucky – Legislation• Massachusetts – Preliminary dataMassachusetts – Preliminary data• Mississippi – Office of Workforce Nurse Mississippi – Office of Workforce Nurse
Residency ProgramResidency Program
EvidenceEvidence
Statewide:Statewide:• North CarolinaNorth Carolina
• Vermont Nurse Internship ProgramVermont Nurse Internship Program
• Wisconsin Residency ProgramWisconsin Residency Program
EvidenceEvidence
12 Individual Studies/Projects:12 Individual Studies/Projects:
• BjBjøørk & Kirkevold (1999) – Empirical evidencerk & Kirkevold (1999) – Empirical evidence
• Children’s Memorial, Chicago (2007) – Children’s Memorial, Chicago (2007) – Cost/RetentionCost/Retention
• Dartmouth-Hitchcock (2007) - SimulationDartmouth-Hitchcock (2007) - Simulation
• Del Bueno (2005) – Novice nurses judgmentDel Bueno (2005) – Novice nurses judgment
EvidenceEvidence
Individual:Individual:• Ebright, Urden, Patterson & Chalko (2004) – Ebright, Urden, Patterson & Chalko (2004) –
Near misses and adverse events in novice nursesNear misses and adverse events in novice nurses• Johnstone & Kanitsaki (2006) – Clinical risk Johnstone & Kanitsaki (2006) – Clinical risk
management in new graduatesmanagement in new graduates• Johnstone & Kanitsaki (2008) – Novice nurses Johnstone & Kanitsaki (2008) – Novice nurses
integration of patient safetyintegration of patient safety
EvidenceEvidence
Individual:Individual:
• Johnstone, Kanitsaki & Currie (2008) – SupportJohnstone, Kanitsaki & Currie (2008) – Support
• Keller, Meekins & Summers (2006) – Keller, Meekins & Summers (2006) – Cost/RetentionCost/Retention
• Pine & Tart (2007) - ROIPine & Tart (2007) - ROI
EvidenceEvidence
Individual:Individual:
• Orsolini-Hain & Malone (2007) – Excellent Orsolini-Hain & Malone (2007) – Excellent review citing impending gap in clinical review citing impending gap in clinical expertiseexpertise
• Sir Charles Gairdner Hospital Centre for Sir Charles Gairdner Hospital Centre for Nursing Education – Australia Nursing Education – Australia
Once Evidence was CollectedOnce Evidence was Collected
• Developed DefinitionsDeveloped Definitions
• Core Elements of ModelCore Elements of Model• PreceptorshipPreceptorship• Feedback and ReflectionFeedback and Reflection• Across Settings and EducationAcross Settings and Education
Summary of the EvidenceSummary of the Evidence
• How much evidence is enough?
• Our perspective is on public protection• Safety• Competence• Retention
The ModelThe Model
ConsiderationsConsiderations
• Cost• ROI 67.3% (Versant); 884.7%
(Methodist Hospital in Houston)• Money saved on decreased turnover and
fewer replacement nurses• What about cost to Boards?
ConsiderationsConsiderations
• Collaborations
• Legislators• AHA• Nursing practice• Nursing education• Joint Commission• CMS
ConsiderationsConsiderations
• Link to licenseLink to license
• Enforcement?Enforcement?
• CompromiseCompromise
Next StepsNext Steps
• National Web siteNational Web site
• Identify strategies for implementation, Identify strategies for implementation, e.g., pilots? RNs/acute first?e.g., pilots? RNs/acute first?
The Future in NursingThe Future in Nursing