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1
The Impact of Transition Experience on Practice
of Newly Licensed Registered Nurses Suling Li,
PhD, RN Associate Director of Research NCSBN
2
Background

• New RNs struggling with transition into practice
• Shortened gap between taking NCLEX and being
  licensed
• High job stress and high turnover rates in new
  RNs
• Complexity of health care environment
• Increased workload due to acute nursing shortage

3
Goals

• To describe the transition experience of newly
  licensed RNs
• To identify factors that influence transitions
  into practice
• To examine the impact of the transition
  experience on clinical competence and safe
  practice issues of newly licensed RNs

4
Conceptual Framework on Transition

• Structure of transition
• Content of transition
• Characteristics of preceptors
• Characteristics of the new nurse
• Partnerships between the new nurse and the
  preceptor
• Institutional support for both the new nurse and
  the preceptor

5
Outcomes

• Primary Outcomes
• Clinical competency
• Practice errors and risks for practice breakdown
• Secondary Outcomes
• Stress level
• Job turnover

6
Assessing Outcomes

• Two perspectives
• Perspective of the new RN
• Perspective of his/her preceptor/mentor

7
Outcome Measures

• Clinical competence (35 items)
• Clinical reasoning and judgment
• Pt care delivery and management skills
• Communication and interpersonal relationships
• Recognizing limits and seeking help
• Practice errors and risks for practice breakdown

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Design

• Survey of nurse-preceptor dyad

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Sample Profile Demographics

• New RNs Preceptors
• N RN 560 231
• BSNs 32.8 31.5
• ADNs 60.7 49.7
• Age (yrs) 32.4 42.2
• Female 94.4 92.2
• White 81.2 88

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Characteristics of the New RNs

• Hospital 86.4
• Full time 91.2
• English first language 92.6
• Graduates of USA programs 99.0
• With LPN experiences 19.9
• Employed in urban area 47.3
• Months of working experience 11.4

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Characteristics of Preceptors
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Workload of Preceptors

• Client care assignment
• Yes, regular load 45.8
• Yes, reduced load 31.7
• No 22.5

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Pre-Graduation Synthesis Experience
ADNs BSNs (n335) (n181) Synthesis
course required 33.8 68.2 Length of the
course (wks) 7.0 9.9
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Transition Experience
15
Internship Experience
16
Duration of Transition
17
Preceptor Involvement
18
Content of Transition Programs
19
Days Before First Patient Care Assignment
20
Patient Care Assignment
21
Patient Care Assignment
22
Clinical Competence Overall
23
Clinical Competence Subconcepts
24
Most Competent Areas
25
Least Competent areas
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Clinical Competence During 1st YearOverall
New RNs
Preceptors
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Clinical Competence During 1st YearSubconcepts
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Clinical Competence and Work Setting
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Transition and Clinical Competence

• During first 3 months of practice, those who had
  a primary preceptor performed at a higher
  competent levels (B0.45), especially in the
  areas of communication and interpersonal
  relationships (B.51), as well as recognizing
  limits and seeking help (B.49).

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Practice Errors
31
Practice Errors Index
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Transition and Practice Errors
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Clinical Competence and Practice Errors

• New nurses who were more competent (r -.35),
  especially in the areas of clinical reasoning
  ability (ß-.38) and communication and
  interpersonal relationships (ß-.33), made less
  practice errors.

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New RN Turnover
Either changed position or plan to leave, 40.0
35
Transition and Turnover
36
Perceived Stress
37
Perceived Stress During 1st Year
38
Clinical Competence and Stress
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Transition and Stress

• The longer the work experience the less the fear
  experienced by graduates about harming the
  patients (B-.11)
• Graduates who had an internship (B-.11) were
  less likely to feel expectations were unrealistic
• Graduates who had a transition programs that
  addressed specialty knowledge (B-.10) were less
  likely to feel expectations were unrealistic

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Stress and Practice Errors
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Summary of Findings

• Transition experiences of new RNs vary across
  practice settings
• New RNs are more competent in the areas of pt
  care delivery and management, compared to the
  areas of clinical reasoning and judgment skills,
  as well as recognizing limits and seeking help
• During the first 3 months of practice, new RNs
  who had a primary preceptor practiced at higher
  competent levels
• Without the assistance of preceptors, new RNs
  practiced at less competent levels during their
  initial phase of independent practice

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Summary of Findings

• New RNs with preparation for specialty practice
  in transition programs made less errors
• Less competent and/or stressed new RNs made more
  practice errors
• New RNs who had an internship experience were
  less likely to leave their current position
  within the next 6 months

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Acknowledgements

• Advisory Group 2006 2007 NCSBN PRE Committee
• Nancy Spector, NCSBN Director of Education
• Gino Chisari (Chair, 2006)
• Brenda S. Jackson (Chair, 2007)
• Mary Blubough (Board Liaison)
• Connie Brown
• Barbara Knopp
• Barbara Newman
• Cynthia Van Wingerden
• Debra Werner
• Lepaine McHenry
• Marcy Echternacht
• Therese Shipps
• Mary Calkins
• Mary Doherty, NCSBN Practice, Regulation,
  Education Associate
• Research Support
• Data Collection Lindsey Gross
• Statistical Support Richard Smiley

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Contact Information

• Suling Li, PhD, RN
• Tel [phone]
• sli_at_ncsbn.org