NCSBN Update Nancy Spector, Director of Education

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NCSBN UpdateNancy Spector, Director of Education

• NLNs Education Summit, September 19, 2008

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Mission
The National Council of State Boards of Nursing
(NCSBN), composed of Member Boards, provides
leadership to advance regulatory excellence for
public protection.
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• Contact Information
• nspector_at_ncsbn.org
• 312.525.3657
• www.ncsbn.org

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NCSBN Initiatives

• Education
• Regulation
• Research

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Education

• 2007-08 Faculty Qualifications
• 2007-09 Transition to Practice
• 2008-09 Innovations in Education Regulation

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2007-2008 Charges

• Advise staff on content of Faculty Shortage
  Conference
• Held March 26, 2008, in Chicago
• Review and present recommendations for future
  nursing faculty qualifications and roles

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Background of Charge

• 2005-2006 PRE studied evidence-based nursing
  education
• NCSBN conducted National Study of Elements in
  Nursing Education
• NCSBN conducted systematic review of nursing
  education outcomes
• Hosted Invitational meeting for stakeholders,
  across disciplines

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Background of Charge

• The following question pervaded all of this work
• There is the need for qualified faculty to
  supervise and guide students, but how qualified
  is qualified?

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Background of Charge

• Due to the faculty shortage, programs are
  struggling to attract qualified faculty
• Lawmakers in some states are calling for lower
  faculty standards

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Background of Charge

• But is lowering qualifications the answer?
• At the same time, the 1999 IOM and other reports
  have called attention to practice errors.
• The 2003 IOM report called for an overhaul of
  health care education, stating that health
  professionals are not prepared for the complexity
  of health care now.
• The 2008 national Carnegie Study of Nursing
  Education found that nursing education suffers
  from inadequate teaching as it is.

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2007-2008 Committee Activities

• Met in person for 3 meetings held 1 conference
  call meeting
• Held collaborative conference call meeting with
• AACN
• CCNE
• NAPNES
• NLN
• NLNAC

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2007-2008 Committee Activities

• Reviewed work from 2006-2007 PRE Committee
• Faculty Shortage Survey to NCSBN members
• National Comparison of Faculty Qualifications
  report
• Reviewed 35 evidence-based articles and/or
  consensus statements by experts in nursing
  education

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2007-2008 Committee Activities

• Reviewed minutes from relevant Education
  Consultant Network calls
• Reviewed relevant surveys to Education Consultant
  Network
• Gained input from discussion at March 26th
  Faculty Shortage Implications for Regulation
  conference

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2007-2008 Committee Activities

• Developed 8 premises as a foundation for
  recommendations
• Determined three roles of faculty based on the
  literature collaborator, director of learning,
  role model
• Developed recommendations for the Board of
  Directors
• Recommended changes to the Education Model
  Administrative Rules

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Review of the Literature

• Orsolini-Hain Malone (2007) describe the
  impending gap in nursing expertise
• At the same time, patient acuity is increasing,
  health care systems are more complex and
  technologic advances are growing
• Medical errors and patient safety are a major
  concern

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Review of the Literature

• Riner Billings (1999) studied perceived needs
  of faculty in Indiana
• 352 nurse educators in sample
• Included those teaching from LPN through PhD
• Found significantly more needs when faculty had
  BSNs or masters degrees in other areas

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Review of the Literature

• NCSBNs EBNER report
• Based on National Study of Elements of Nursing
  Education and NCSBNs systematic review of
  nursing education
• Found positive outcomes with high-level
  interactions with students
• Faculty would need graduate coursework to
  implement research-based teaching strategies
  identified

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Review of the Literature

• Graduate preparation in education
• Halstead (2007) reviews the evidence
• Tanner (2007) must develop pedagogies in the
  science of learning
• NLN and AACN positions
• Carnegie study of nursing education

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Review of the Literature

• Some national recommendations for faculty to have
  doctorates
• Carnegie Study of Nursing Education
• AACNs position statement for baccalaureate
  programs recommend nursing faculty have
  doctorates

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Recommendations

• To Model Education Rules(www.ncsbn.org and go to
  Boards of Nursing)
• MSN required for PN and RN educators
• Have graduate preparation in the science of
  nursing, including clinical practice, and
  graduate preparation in teaching and learning,
  including curriculum development and
  implementation.

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Other Supportive Recommendations(with no model
rule changes)

• Other supportive faculty with graduate degrees in
  related fields may participate on a RN nursing
  faculty team to enrich and augment nursing
  education.
• Other faculty, BSN prepared, may participate on a
  PN nursing faculty team to enrich and augment
  nursing education.
• Boards of Nursing are encouraged to collaborate
  with educators to foster innovation in nursing
  education.

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Supportive Recommendations(with no model rule
changes)

• When Boards of Nursing evaluate the preparation
  of faculty members, it is essential to consider
  the three roles of faculty that the Committee
  members developed from a synthesis of literature
  collaborator, director of learning, role
  modeling

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Supportive Recommendations(with no model rule
changes)

• When Boards of Nursing evaluate the preparation
  of faculty members, it is essential to assess the
  processes of orientation to be sure that all
  faculty (including part-time, adjunct, novice,
  preceptors) are effectively oriented.

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Next Steps

• Related to fostering innovation in nursing
  education, the Board of Directors appointed
  members to a new Innovations in Education
  Regulation Committee with the following charges
• Identify real and perceived regulatory barriers.
• Develop a regulatory model for innovative
  education proposals

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Innovations in Education Regulation Committee

• Plan to meet with representatives from NLN and
  AACN for input
• Develop recommendations for Boards of Nursing to
  foster innovations in nursing education
• Disseminate myths about regulatory barriers

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Transition to Practice Initiative

• Charge
• Recommend an evidence-based regulatory model
• for transition to practice

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Goal of Model

• To promote public safety by supporting newly
  licensed nurses in their critical entry and
  progression into practice.
• Developed 6 premises and relevant definitions
• (Reports are available at www.ncsbn.orggo to
  Programs and Services, the Education, and then
  Transition)

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The Evidence

• How much evidence is enough?
• Systematically reviewed published and unpublished
  data
• Considered level of research
• No Level I articles

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National Bodies/Studies Recommending a Transition
Program

• Versant
• UHC/AACN
• Joint Commissions 2003 White Paper
• Carnegie Study of Nursing Education
• Hofler (2008) Nursing Education and Transition
  to the Work Environment A Synthesis of National
  Reports
• Orsolini-Hain Malone (2007)

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Transition Programs Protect the Public

• Patient safety
• Competency
• Retention

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Safety and New Nurses

• 11 total reports
• 4 Discipline data/incident reports
• New nurses engage in concrete thinking
• Del Bueno 50 would miss life-threatening
  conditions

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Safety and New Nurses

• Orsolini-Hains Malone report new nurses fail to
  recognize changes when CPR is needed only 27 of
  adults and 18 of kids survive
• Ebright colleagues studied near misses
• NCSBN national study when new nurses had
  transition programs which addressed specialty
  care, they made fewer errors.
• Johnstone and Colleagues out of Australia
  experiential learning to manage risks in
  practice NOT a re-education.

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Competence and New Nurses

• 9 total reports
• NCSBN UHC/AACN reported increased stress with
  new graduates increased stressed was associated
  with significantly increased errors.
• NCSBNs post-entry study (qualitative)
  preliminary data show that new nurses need to
  reflect on alternate decision-making.
• NCSBN UHC/AACN study found 3-6 months vulnerable

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Competence and New Nurses

• Longitudinal study out of Norway (Bjork and
  Kirkevold) followed new nurses for 8-14 months
• Received little feedback.
• Had little opportunity for reflection.
• While became more efficient, they made the same
  practice errors that they made as novice nurses.
• Implications New nurses need support and
  feedback and opportunities for reflection.

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Competence and New Nurses

• Dartmouth-Hitchcock transition program
• Incorporated simulation for high-risk, low
  frequency events.
• Found increases in competence, confidence, and
  readiness for practice.

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Retention

• 8 Total Reports
• All showed significant decreases in turnover
• Current studies showing that a significant number
  are leaving nursing (4.5 in 1980s compared to
  16.8 in 2004).

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Retention

• Ebright found that novice errors are related to
  unfamiliarity with the unit and workflow
  patterns.
• MA BON found new LPNs errors were often linked to
  familiarity with the practice setting and lack of
  transition programs
• Behrens report in Chicago Tribune looked at
  discipline in the IL BON and found increased
  complaints with temporary nurses.

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Modules

• Specialty content (including prioritizing and
  organizing)
• Communication
• Safety
• Clinical Reasoning
• Utilization of research findings
• Role Socialization (including delegating and
  supervising)

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Preceptor

• Evidence supported a one-one preceptor
  relationship
• Preceptor training is supported
• When preceptors not available, perhaps
  communicate via Web site as in Scotland?

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Other Recommendations

• Incorporate feedback and reflection
• Length of program 6 months 1 year of support
• Re-license after first year when successfully
  complete transition program

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The NCSBN Transition Model
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Next Steps

• Cost
• All studies showed positive ROI
• CMS pays for medicine and pharmacy
  residencieswhy not nursing?
• Implications for Boards of Nursing
• Cost for Boards
• Resources
• Model Rules

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Next Steps

• Collaboration
• AONE consultant on committee
• Educators
• AHA
• CMS
• Joint Commission

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Regulation APRN Consensus Paper

• Delegate Assembly approved APRN model language in
  August
• Board of Directors endorsed the Consensus Paper
  in September Board meeting
• Found here www.ncsbn.org go to Programs and
  Services then to APRN

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Next Steps

• LACE being developed
• Licensure, accreditation, certification,
  education
• Assist with implementation
• Improve communication about issues

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Regulation

• Journal of Nursing Regulation Summer of 2009
• Center for Regulatory Excellence Grants
  available with BON collaboration
• Up to 300,000
• www.ncsbn.org go to Research then NCSBN Center
  for Regulatory Excellence

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Research

• Simulation Study
• Boards would like direction on how educators use
  simulation
• Working with Rush College of Nursing
• Would like to replicate with more sites
• Raw data indicate combo group could be the most
  effective, though results inconclusive

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Research Discipline Study

• Discipline Data on 52,297 Nurses from 44 Boards
  of Nursing Reporting to NURSYS from 1996 through
  2006
• - JONAs Healthcare Law, Ethics, and
  Regulation, July September, 2008

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Race/Ethnicity
88
4
1.5
3
81
10
2
1
5
1
2
.4
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Type of License
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Gender
6
6
17
17
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Age at Time of Disciplinary Action
Average age at the time of disciplinary action
was 43
Ages limited from between 17 and 80
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Years of Experience at Time of Disciplinary Action
Average 12 years.
1 yr or less 7 2-5 20 6-10 26 11-24 3
7 25 or more 8
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Next Steps in Research

• Post-Entry Study to be published
• Practice outcomes of APRNs
• Medication Assistants are they safe?
• Workforce Supply Data Reports available to the
  public
• Practice Professional Issues yearly on new
  nurses
• Organizations opportunity for asking questions

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Questions?